Seriously...

[LouisVRN]

So as part of a continuing process to improve patient satisfaction and fiscally beneficial as well we are implement a revised discharge plan (basically trying to get everyone to prepare for the patients discharge from arrival, anticipate any needs/barriers and get the correct departments on board in an effort to reduce a last minute scramble).

That being the case, we are trying to reinforce the need to do daily teaching with the patient daily regarding something...anythhing. We have a very simple, easy to use application that allows us to print pretty much anything you could think of that you'd want to educate the patient on (diet, procedure, test, medication, equipment). The staff has been educated to print the daily teaching sign give one copy to pt one copy to chart.

Because this discharge redesign is relatively new in implementation we have a specific team who has spent time daily on the units to offer assistance, answer questions.

So today during my audit, I found that 4/28 pts received daily education. SERIOUSLY?!? What do I have to do to get people on board with any changes?

I am so frustrated right now I could scream!

[LouisVRN, RN]

First off, let my clarify by saying I AM a staff nurse, I am NOT management.

I do however feel strongly in promoting patient education and satisfaction, to me this is being a patient advocate. Now I am not saying there haven't been days when I haven't been run off my feet and my daily meal consisted of eating a pack of graham crackers while taking the first and only break to use the bathroom around 0400, but most days I am able to do round, medicate, teach, sit down and chart and get my chart checks done by midnight.

I am all for helping my colleagues. I am of the attitude of one does not sit unless everyone can sit. On a busy med-surg floor that is never. However, if you can not complete your job in 12 hours on a daily basis it is not a "busy floor" issue, it is a time management issue. If the nurses that are all leaving on time are able to teach their patients and you stay and yet you still have no time to teach your patients" this is YOUR issue.

It may require work to sit down and print out teaching material for the patients, they may respond better to spontaneous teaching opportunities, they may never read it and it may end up in the trash or as a placemat but we have been told it is an expectation of our jobs to comply with this. If this was the only compliance issue on my floor I could PERHAPS be more sympathetic, but seriously...

The list of compliance issues is huge: IV tubing not dated/labeled, IV bags not labeled, SCIP protocol not followed, no consent for blood/I&Ds, documenting a complete assessment on a post-op pt, completing correct documentation at the correct interval for a PCA, the list goes on and on.

I have asked staff why they are non-compliant or choose not to do the daily teaching and was told initially, "I don't know what to teach them on a daily basis" Done. I typed and distributed a list of about 50 daily teaching topics that would be applicable to most of our patients. I was then told "I just don't have time to find it and print it" Done. I filled a binder with pre-printed education of the most used topics that just has to be removed, affixed with a patient label and reviewed with the patient. I doubt it will make any difference.

I am starting to agree with a colleague who says the only solution is to "Performance manage them out the door".

[LouisVRN, RN]

In my experience with audits, I found that audits rarely capture information correctly. It could well be that more than 4 out of 28 are getting their daily education, it's the audit system that is flawed. If your new system requires that the pt education info is printed twice, with the second copy placed on the chart, and you are auditing by which charts have the print outs on them, your audit system probably won't work very well since many nurses won't print out that whole extra set for the chart since it is a pointless waste of paper, I know I wouldn't.

Our audit system allows us to see who launched the application and what was done within it, whether daily education was done, if it was printed or not. It automatically prints 2 copies, one for the patient one for the chart. While some of the nurses I have spoken to state that they do verbal education, it is the facilities expectation that this application will be used for each teaching as supplemental material.

[Baloney Amputation, BSN, LPN, RN]

However, if you can not complete your job in 12 hours on a daily basis it is not a "busy floor" issue, it is a time management issue.

Not always. Oftentimes it's a "my manager thinks I can do the work of 2-3 nurses" issue.

[LouisVRN, RN]

Not always. Oftentimes it's a "my manager thinks I can do the work of 2-3 nurses" issue.

If everyone else can do it and you cant thats not the case. Our patients don't change that much from day - night - day. If it no longer matters what group of patients you get that you always get the worst group...

[fungez]

I don't understand why you posted this.

1)Was it to ask our opinion why your coworkers are noncompliant? When we offered reasons why, you shot them them down. But it's the truth. We are too busy and we do have too much paperwork.

2)Was it to express how frustrated you are? Being a nurse is frustrating. Our patients are frustrating, our bosses are frustrating, our coworkers are frustrating. We're all frustrated. Join the club.

3)Was it to let everyone know how great a documenter you are? Okay, I believe you. Congratulations.

So which one was it? Number 1, number 2, or number 3?

[eriksoln, BSN, RN]

Not always. Oftentimes it's a "my manager thinks I can do the work of 2-3 nurses" issue.

I was going to say it's a "Murphy's Law" thing more often than not when I've had a bad day. I like to get my "tasks" out of the way ASAP, I don't mess around and socialize or take breaks until the vital "tasks" are completed (dressing changes, meds, assessments, turning and repositioning, pain management, documentation). Once that is done, I move on to more holistic things (teaching, spending time with the pt. to talk, teaching, hourly rounding sheets etc.....).

No matter how hard I try to set myself up well and have everything in place perfectly, there are just days where all of a sudden, BAM............EVERYTHING happens. And it is always during the last couple hours of the shift. Maybe cause its because I work nights and thats when everyone is waking up. IDK.

[zofran]

To the OP, you remind me of a young (and fairly new) nurse on my floor.

She walks around complaining that no body can get anything done "right." She is always finding mistakes her fellow co workers have made or nit picking about little things that didn't get done. For some reason, she is always able to sit at the desk, completely oblivious that everyone else is running around like crazy. She, like you, believes that nurses who cant get done on time have "time management issues."

Yes, her IV tubing is labeled and her meds are on time but I have to wonder if she is really seeing the whole picture and/or actually getting involved in the patient and their response to their illness. As you should know OP, the RN role is not task based. We use our assessment skills and prioritization to determine what needs to get done, and what can wait.

OP I would encourage you to explore what kind of nurse you really are......a critical thinker who can appropriately determine what REALLY needs to be done. Or are you just getting through your shift, going from one task to the next?

Wait, are you an RN or an LPN? Hmmmmm....

[LouisVRN, RN]

To the OP, you remind me of a young (and fairly new) nurse on my floor.

She walks around complaining that no body can get anything done "right." She is always finding mistakes her fellow co workers have made or nit picking about little things that didn't get done. For some reason, she is always able to sit at the desk, completely oblivious that everyone else is running around like crazy. She, like you, believes that nurses who cant get done on time have "time management issues."

Yes, her IV tubing is labeled and her meds are on time but I have to wonder if she is really seeing the whole picture and/or actually getting involved in the patient and their response to their illness. As you should know OP, the RN role is not task based. We use our assessment skills and prioritization to determine what needs to get done, and what can wait.

OP I would encourage you to explore what kind of nurse you really are......a critical thinker who can appropriately determine what REALLY needs to be done. Or are you just getting through your shift, going from one task to the next?

Wait, are you an RN or an LPN? Hmmmmm....

I am a RN, BSN, I have a concurrent degree in psych. I am not one to sit at the desk and berate my colleagues who are hard at work. I am the one that goes and asks what I can help them with. The staff on the floor come to me for advice, so I think that says something about my critical thinking skills. I definitely don't think i go from task to task, and do not think my co-workers and managers feel that way about me especially as I am one of the few nurses continually asked to precept. I do not believe going task to task without encouraging, reinforcing and providing alternatives in critical thinking would allow my colleagues be prepared to work on the floor.

I absolutely can prioritize, if something doesn't get done I don't mind occasionally passing off the "fluff" to the oncoming shift and they do not mind as the occurrences are few and far between. I have no problem with nurses who did not have time to educate their patients because they had a rapid response, multiple discharges/admissions, I only mind when I come on shift and ask how your day went and you proceed to tell me what an easy day it was, are browsing facebook, reading magazines or gossiping at the nursing desk, tell me nothing about work left unfinished and leave it for me to find during my 24 hour chart check.

Also, because we are trying to get everyone on board with this new idea, they have staff designated to aid the nurses in the duties of pt education and throughput (ie. typing education, helping with admissions/discharges, entering orders). I have problems when every hour I ask every nurse what I can do to help them and am told either "nothing, I'm doing well", "or could you get so & so off the commode/take them for a walk/ hang some meds" (and let me be clear I do not mind doing these things to help out) but at the end of the day the few things I have asked them to do in return are not done. I hate to be the harbinger of additional work but the fact is right now it is my job.

[LouisVRN, RN]

I don't understand why you posted this.

1)Was it to ask our opinion why your coworkers are noncompliant? When we offered reasons why, you shot them them down. But it's the truth. We are too busy and we do have too much paperwork.

2)Was it to express how frustrated you are? Being a nurse is frustrating. Our patients are frustrating, our bosses are frustrating, our coworkers are frustrating. We're all frustrated. Join the club.

3)Was it to let everyone know how great a documenter you are? Okay, I believe you. Congratulations.

So which one was it? Number 1, number 2, or number 3?

Mainly number 1. I didn't shoot them down, management did. My job is to enforce the new change, all of the staff has been told this is now a requirement of their job and has been but has not until this point been enforced. I did not shoot down everyone's ideas. Someone suggested I make a binder of pre-printed education that could be picked up rather than printed, that is logically going to help save some time and after agreement from the staff nurses this has been done. Unfortunately saying we are too busy and have too much paperwork doesn't make it go away. In addition we are looking to reduce some double documenting issues that have resulted from the change.

Partly number 2. I am frustrated. I have a good reputation at work, I am well liked. I don't want people to dislike me because I am making them do something they dont want to do. I also dont want to see anyone get in trouble because they are not complying with the new requirements of their job. It is frustrating to try to do a job to the best of your ability, meet resistance the entire way, have few offer constructive criticism and have no positive outcomes to show for a days work. Sometimes thinking "Well, I tried." isn't enough to help you sleep well at night. Yes, I lose sleep over my job yet I can see the benefits in making this change work, enough so that I want to keep trying.

And as far as number 3, why yes I am, thank you. :)

My goal in posting this was to get feedback, positive or negative. I can empathize with everyone's comments, I don't particularly want to fill out an additional form either. Half the time even though I print it I leave it somewhere, educate the patient, realize I don't have it to give them and spend the next 15 minutes tracking it down. But the fact is corporate compliance is good for everyone, in everything that we do, this change is evidence based. Additionally, I don't think anyone can or would argue that educating patients is one of the most important things we do, but one that is traditionally or necessarily considered a nicety. It shouldnt be this way. If you were placed in a jungle in the amazon, something totally foreign, possibly life changing, and possibly could kill you, you'd want to know as much about it as possible. For some of our patients, this is the equivalent to hospitalization. A lap appy? Yep, sure that's routine to us. I can guarantee you the majority of the patients we see could not identify their appendex if we asked them where it was, what its function was, what a laparoscopic procedure is, why they have so much gas after, what to do with their steri strips or what a cardiac diet entails. They do not know if Zofran or Zosyn is their antibiotic and can't tell you what the pain medication they are on is called or its potential side effects, they do not know if they can get out of bed or not, what their SCDs do and why our listening to their abdomens determines what they are having for breakfast. :spbox:

[fungez]

"We have a very simple, easy to use application that allows us to print pretty much anything you could think of that you'd want to educate the patient on (diet, procedure, test, medication, equipment)."

You asked for feedback so here's mine. If the facility requires written teaching along with or instead of verbal teaching, that's where there going to get the noncompliance. It's easy enough to say "okay, I'm listening to your bowel sounds now to see if your tummy is waking up after surgery blahblahblah." Requiring staff to open the app, find the correct education, print it off, walk to the printer, put paper in it because it's always out, print it off again, multiply that x6 patients each and every shift - well, that's the reason no one want to do it. And remember, what you consider simple and easy is sometimes complicated and difficult for other people.

"They do not know if Zofran or Zosyn is their antibiotic and can't tell you what the pain medication they are on is called or its potential side effects"

When you take your car in to be fixed do you know the name of every tool the mechanic used? Evey fluid he replaced? No, you just know your alternator is fixed and what the bill is. Patients don't care what their antinausea drug is called, they just want their nausea to be relieved. And just because they can't tell you what pain medication they've been given doesn't mean the nurse didn't tell the patient. Unfamiliar words are hard to recall - it doesn't mean no one has ever said those words to them. Poor patient recall does not mean education didn't take place. "I don't know" can mean I don't know, or it can mean I don't feel like talking right now, or why are you asking me these questions is this some kind of test.

[rnmi2004]

So, the only "correct" way to teach a patient, on your floor, is to give them printed information? And if your audit shows that the printed information wasn't given, the chart doesn't pass?

This is your problem.

I doubt that only 4 in 28 of your patients is educated on their plan of care. Not every patient (and/or family member) is literate. Elderly patients have poor eyesight. Someone with ADHD or another learning disability might be too stressed out from hospitalization for a printout to be of value to them. Some patients prefer a brief verbal explanation of their new med. If you are teaching a dressing change, a demonstration would be more effective than a printout. I could go on and on...

There are soooo many ways that I do patient teaching. Most of my patient teaching is informal. I can bet that your colleagues are educating their patients...they just know better than to insist that printed information is the only way to educate their patients.

You are basically asking your co-workers to waste their time, and I don't blame them for not going along with it.

[General E. Speaking, RN, RN]

Seems adding "just one more piece of paper" to fill out is neverending.