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?
It sounds like your co-workers haven't bought it to this written education stuff, and based on what you listed as education topics (location of appendix, name of pain med, etc) I am not sure I have either. You really have written info on what SCDs do? And you have scientific evidence that providing written info on them results in better outcomes? Seriously?
May the fault isn't entirely in your lazy, poorly organized, ignorant, out of compliance co-workers. I am guessing they don't buy into the educational material itself.
A little something that may shed some light on the thumbing of the nose at your attempt to become more complaint by us in here and your co-workers:
I like my current manager a lot, but as I said, she is not without her flaws. This post describes one of them. I was a travel nurse and got to witness a lot of different nurse manager styles and techniques. One manager I always respected a lot was at a job in WA. It was on a GI M/S unit. Very busy, they believed in keeping pain management as a high priority which lead to there being a lot of post of PCAs (with six patient load, often, four of them had a PCA) and she had things set up on the unit so that the pt. flow as quick enough to satisfy the suits but pt. care was not sacrificed.
What did this GI unit director do/understand that so many other managers (or people in your position trying to help create policies/procedures)?
She understood the balance between workload and quality care. For every task you add to the nurses duties, quality goes down. Think about it. If you say nurses must now fill out form A once per shift and they have six patients, that is six form A's they must do for an either hour shift, might have to do 12 if they are working a twelve hour shift. Even if form A takes only three minutes, that times six is twenty minutes. Thats time away from the bedside. That is a dressing change not getting done, someone waiting twenty minutes longer for a pain med. or everyone's meds being pushed back, yet again, another twenty minutes.
The undeniable, inevitable rule is, when you add a task to the nurses duties...........quality of care goes down. Period. No amt. of telling people to work faster (lol) or preaching "But I can do it" will change that fact.
The problem is, administrators and mangers seem to think care is lacking, hence they are looking for something to add to the care to make it right. Everyday, they have meetings, try to decide what is lacking and what form needs to be mandated or what new task needs to be added to the duties to make the quality of care good. Unfortunately, they miss the point of the pt. workload/care of quality relationship with this approach. When you add more to do, quality goes down. So, they are like the donkey with the carrot on a stick in front of its face as they seek the "mystery form to mandate" that will finally make the care of their facility high quality.
Add a task, quality goes down. No shortcut around this.
The manager of the GI unit understood this relationship. What did she do about it? Nursing concerns that affected care were truly listened to and acted on. For instance, there were a lot of high fall risks on the unit (as I said, lots of PCAs, elderly people got groggy from pain meds and would forget to put on the call light to get out of bed, fall risk). There were only so many low beds on the unit and IT TOOK FOREVER to get central supply to deliver one when you needed it.
Her solution? Change all the beds on the unit to the new beds that can be either standard beds or low beds. Now, when you get a pt. you are not scrambling to figure out if they are a fall risk or not so you can order a low bed. If you have someone who's condition changed and they were not a fall risk before but are now............no problem, press the button, lower the bed. I can not even begin to explain to you how much time this saved us.
What did she expect in return for ordering the beds and now making life easier for us? If she had a new form she wanted filled out on everyone, it was expected to be filled out. No debating if you think it is practical or not.
You have to have an understanding of the workload/care quality relationship if you want your coworkers to "be on board" with you. Grandstanding, telling them how great you are and how you got it done and confronting them is going to get you notta, as you have already seen.
When they see you have their and their pt's best interest in mind, they will get on board with you.
To the OP - you would show real leadership if you tried to figure out why people are not doing required education documentation. Really listen to them, and not dismiss their opinions. Then you could show real initiative by fixing what's wrong with the system. Because that's what's broken, not the nurses. Nurses tend to be nurturers and people pleasers. If they're digging their heels in about something there's a good reason.
I suggest you make the required documentation so easy a caveman could do it. For example, one of my hospitals uses the compass/cerner computer charting. If you're not familiar with that, it's basically clicking a bunch of boxes. Assessments are arranged by columns, so you start at the top and click your way down to the bottom. I've suggested that they implement the required documentation into the assesment charting. That way, it's really hard to miss and you don't have to open a separate screen to do that and the nurse knows it's a Joint Commision required form. And why does your facility require that you print off materials? As an above poster said, many paitents do not find those helpful.
I am going to voice my opinion from a different angle....
Do you recall a common term "frequent flier?" These patients, the elderly, and chronic diseases are what you most commonly see on a med-surg floor...do you not think they have heard ALL the teaching they care to hear?????!!!! Then some 26 yo whippersnapper with 2 yrs experience comes in arrogantly to "teach" something that they KNOW ALREADY and heard a gazillion times.....you *seriously* think they want YOU to "teach" them YET AGAIN?!?!?
I will be honest here..... I read the first post, I immediately scrolled up to see how old the poster was and the years experience. Then I rolled my eyes. As I reached the end of the posts, I had this vision of a very arrogant, self-righteous young person who delights in her (his) sense of superiority.
I know that In one hospital the nurses had to chart on both a paper chart AND a computer chart....not to mention the clipboard outside the door for vitals and assundry information....and this with a 6 patient load on a renal/telemetry floor! Then of course, we see all the threads on....if you DON'T clock out on time...you will be written up! Well, how much more paperwork can we give nurses with high patient:nurse ratios and still expect them not to exceed their alloted 12 hr shift? It gets to the point of being unreasonable.
Just because *someone* (usually an academic type) believes that DAILY patient education is a good idea doesn't mean that it IS. This is where HUMINT (human intelligence) comes in. If I have a diabetic in ESRD and he/she is a FF, I BET that they have probably had all the "teaching" they can stomach!
"I will be honest here..... I read the first post, I immediately scrolled up to see how old the poster was and the years experience. Then I rolled my eyes. As I reached the end of the posts, I had this vision of a very arrogant, self-righteous young person who delights in her (his) sense of superiority. "
THIS is what I was trying to say.....
I was also going to suggest what Fungez (i think) suggested....If it NEEDS to get done (it is a JC requirement) add it to the chart and have the nurse check mark a box. Honestly, THATS ALL WE HAVE TIME FOR. Unless you are going to take away another task.
As others have said, pt education happens all the time and in many different ways. Yes, pt education should be documented somewhere. Make it EASY for us.
Then, open your eyes. Look for ways to make the nurses job EASIER in other ways. This is what we want.
Specializes in multispecialty ICU, SICU including CV.
Well, I think the daily education is a Joint Commish requirement.
Otherwise, spot on. These youngguns today...they jest don't lissen.....
It is. I stated this earlier, and was going to reiterate as well. I tried digging around on TJC website to see what exactly the regs were and I had no luck (anyone else want to slog through that stuff?)
Daily education is mandatory. However, I don't know that passing out daily WRITTEN education is mandatory. My facility meets this reg by documenting education in our progress note. We do have a template where all you have to do is "check a box" -- re: plan of care, orientation to the unit, tests, restrictions, whatever (there are about 20 checkboxes.) We can also freehand write it in if we prefer. Giving written materials is optional except on discharge, admission (have an admission packet) and specific high-risk discharge meds (coumadin, lovenox). For us, it's really easy. You go to write your note at the end of your shift and figure out what you educated your patient on (dietary restrictions when you passed out patient's tray? Sternal precautions when you got patient OOB?) and click a box. Done. Voila. If patient attends classes (e.g. diabetes ed, cardiac rehab) that is a checkbox as well.
Situation OP is describing sounds a little over the top and I think she is going to have a hard time getting nurses on board with it, for sure. 4/28 (or whatever it was) actually sounds pretty good to me for patients having had formal, written instruction.
I was thinking about this. So, if you have a patient staying for two weeks on your floor, he or she will accumulate 14 different sheets of "patient teaching"? Sorry, I know it's your job to get it done, but it's ridiculous. As a patient, I would think it ridiculous. I don't learn by reading, I learn by being shown or spoken to. Many people are like that.
You asked for opinions, you're getting them. Maybe YOU need to go back to management and explain why it's not getting done rather than trying to get the nurses to bend when they can't bend anymore without breaking.
I was thinking about this. So, if you have a patient staying for two weeks on your floor, he or she will accumulate 14 different sheets of "patient teaching"? Sorry, I know it's your job to get it done, but it's ridiculous. As a patient, I would think it ridiculous. I don't learn by reading, I learn by being shown or spoken to. Many people are like that.
You asked for opinions, you're getting them. Maybe YOU need to go back to management and explain why it's not getting done rather than trying to get the nurses to bend when they can't bend anymore without breaking.
I have talked to management, several times a week. As I mentioned earlier, we are eliminating some paperwork to try to promote compliance on this issue. I may be young and inexperienced but I truly want what is best for all of the patients. If I thought adding a box for nurses to check saying "I provided education to my patient today" would be checked if and only if it was actually done, I'd be all for it. You all sound like excellent nurses who try to educate your patients and incorporate this into your daily care. This is NOT done on my unit. I had an alert and oriented pt, walkie-talkie very nice educated lady pod 2. When I was asking her about her surgery she kept telling me she had hernia surgery. She didn't, she had a fundoplication. To me this is important that she knows the surgery she had done. I throughout the night educated her on her procedure and why it was done, she seemed shocked to know she did not have her hernia reduced (and no it was not reduced during the fundoplication, I asked the surgeon). We have something similar to checking boxes on another of our "care plan functions" The boxes are always checked but the work is not done.
I have talked to management, several times a week. As I mentioned earlier, we are eliminating some paperwork to try to promote compliance on this issue. I may be young and inexperienced but I truly want what is best for all of the patients. If I thought adding a box for nurses to check saying "I provided education to my patient today" would be checked if and only if it was actually done, I'd be all for it. You all sound like excellent nurses who try to educate your patients and incorporate this into your daily care. This is NOT done on my unit. I had an alert and oriented pt, walkie-talkie very nice educated lady pod 2. When I was asking her about her surgery she kept telling me she had hernia surgery. She didn't, she had a fundoplication. To me this is important that she knows the surgery she had done. I throughout the night educated her on her procedure and why it was done, she seemed shocked to know she did not have her hernia reduced (and no it was not reduced during the fundoplication, I asked the surgeon). We have something similar to checking boxes on another of our "care plan functions" The boxes are always checked but the work is not done.
Okay, if you're going to accuse your coworkers of falsification you better be prepared to back that up. That's a serious charge which can lead to loss of license.
And regarding your patient who thought she was getting X when she actually got Y. Do you really think that her surgeon met with her in her pre-op consultation and misled her? Then misled her again when she signed the consent? And the surgeon colluded with the nurse who witnessed her consent signature? Do you think this really happened?
Imagine this scenerio, which is going to happen to you someday.
You:....and so after this fifteen minutes of verbal education and this five page printout about the sequential compression devices, you understand the need and purpose for them?
Specializes in multispecialty ICU, SICU including CV.
And FYI, OP, I know you know this, but a Nissen fundoplication is surgery for severe GERD -- it's a stomach wrap. It's quite possible that this patient had a huge hiatal hernia and this is why she had such horrible GERD, hence the Nissen. To a layperson, this might be "hernia surgery" -- it's not that far off track.
People don't always get everything right no matter what you tell them. In my stepdown days, I recall that I had JUST finished up doing 10-15 minutes of this patient's initial coumadin education for his brand new aortic valve, including patient's target INR, etc. I was finished and the staff surgeon walked into the room and started quizzing the patient, "What's your INR supposed to be?" (Good surgeon -- worried about the follow up care of his patient, IMA.) The guy couldn't remember what I had told him for a value not 5 minutes before.
It's real -- you might shake your head, but it is. Patients don't absorb it all, and even if they did, they might not follow directions. I think the point that you might be missing in all this is that we can only do so much. You can throw papers at these people until the cows come home, but in the end, all you might be doing is killing trees. Unless people really like reading (and I don't think it's the majority of the population that learns and retains information this way, but I'm not an education expert), you're not going to get through, which is the whole point, isn't it?
nursej22, MSN, RN
4,854 Posts
It sounds like your co-workers haven't bought it to this written education stuff, and based on what you listed as education topics (location of appendix, name of pain med, etc) I am not sure I have either. You really have written info on what SCDs do? And you have scientific evidence that providing written info on them results in better outcomes? Seriously?
May the fault isn't entirely in your lazy, poorly organized, ignorant, out of compliance co-workers. I am guessing they don't buy into the educational material itself.