state is threatening to go after license over precharting

grannye_b · Nov 10, 2004

LESLIE,

I WOULD LOVE TO TALK TO YOU ABOUT THIS STUFF. PLEASE CONTACT ME. I AM ON PROBATION NOW AND I AM DOING MY LAST TERM PAPER ON HOW THE DISIPLANY PROCESS RELATES TO THE NURSING SHORTAGE.

THANKS SO MUCH.

BETTY

mattsmom81 · Nov 11, 2004

Those nurses who like to judge others, I say this: you don't work my area, it isn't YOUR practice, its mine. I think its so so sad how quick nurses are to place judgment on another nurse and are so self righteous. It is a huge problem in our profession IMO.

Those here like me who may have check'd a 'TEDS intact' box 2 hrs ahead to save time...watch out because the documentation police are watching. :uhoh3:

CHATSDALE · Nov 11, 2004

Chris you are right you never really regret doing things the right way..i have seen things that would curl your hair..we had one nurse who would chart everything before 12mn and then go to sleep till 4a....one time one of his patients who was awake and taking meds at 6a was found dead at early am rounds..usually between 4:30 and 5a...talk about egg on the face

at another facility state walked in at 5a and there was insulin charted for 6:30...there was also meds in cups with names on them...also charted..they got a BIG write-up

KRVRN, BSN, RN · Nov 11, 2004

Bill,

Do realize that not all RN's prechart because they feel pressured to do so by administration to get large workloads done or to avoid OT. Some RN's truly are just lazy.

SmilingBluEyes · Nov 11, 2004

Those nurses who like to judge others, I say this: you don't work my area, it isn't YOUR practice, its mine. I think its so so sad how quick nurses are to place judgment on another nurse and are so self righteous. It is a huge problem in our profession IMO.
Those here like me who may have check'd a 'TEDS intact' box 2 hrs ahead to save time...watch out because the documentation police are watching.

Amen!!!! Some very high and mighty replies here, some from people who have very little experience in a variety of settings.

Yes, I always do what I chart I did---I don't lie......but believe me, it becomes more cumbersome as time goes by. I have only been at it 7 years and I can see already a HUGE difference in the amounts of paperwork we have to do---more gets heaped on each and every year, and NONE is ever taken away or reduced! It translates into making less and less time for us to do ACTUAL bedside care. It's getting ridiculous, charting for the lawyers the way we have to. And we are pressured more and more to be DONE at 7:30----paperwork included, our every late punch, questioned. Also, JCAHO always comes up with new things, as well, that translate into more work being done away from the bedside.

Sometimes, I wonder if anyone has piecharted the amount of work RNs' spend, doing other tasks, like blood draws, room cleanups/trash removal, cardiopulmonary teaching, etc, as well as charting--along with the regular tasks we are expected to do. Some of us must be a heckuva an amazing lot to do it all and stay on the charting as well---and manage to please management by clocking out on time! Good for you! I find it more challenging and frustrating every day. :angryfire

SmilingBluEyes · Nov 11, 2004

there are nurses who prechart at the start of their shift then basically do as little as possible.
the precharting described in this thread is secondary to time limits and being overworked.
mgmt. does not give a damn about nsg workloads; they just want it done, period.
and that is why that nsg is in crisis mode today.
the only thing i am proposing is rather than prechart, do your job by the book and if you don't finish treatments and/or meds, then you report that to the nm and to the oncoming shift.
if all the nurses who prechart did this, there would be more evidence in the burdensome workloads that nurses are forced to encumber.
but with precharting, not only is it technically fraudulent, more important (to me) is that nurses are demonstrating that they can indeed, get their work done. and if that is the case, why should or would there be any changes?
i've seen nurses come in on their days off, just to finish work (w/o being paid). i am flabbergasted when i see this, and it merely adds to the image of nurses being martyrs.
leslie

This is the real picture here. Thank you Leslie. The majority are not doing this to be lazy or to lie-----it's just too much is asked to do with too little time and staffing. That is the bottom line here. Precharting is not a solution-----but when incident reporting is ignored and nurses blown off when they bring legitimate complaints to light, little else remains to be done in some areas.

allnurses Guide · Nov 11, 2004

I'll have to weigh in here on Chris's side.

If I can't get my charting done during the 12 hours I'm at work and I've really been working and not being lazy as some nurses have recounted here, then management better damn well NOT get on my back about overtime.

You can't be taken advantage of unless you allow it. I don't need a union to respresent me.

My goal is to have all my assessments done and written by 5 a.m. Then I force myself to get back to the chart periodically during the day - if I don't, I have a mess at the end of my shift and that is my fault.

Our computer system for charting meds is a new to us but an old DOS program that is unwieldy and frustrating. We have a paper record that we use as we pass meds and then get back to the computer when we have time. This is a major source of delay for us. One computer which the other nurse needs to use plus the ward clerk. Also, when pharmacy is online putting meds in the computer we don't have access to that patient. I may get all my 8 a.m. meds passed but can't chart until 10 a.m.

We also had a problem with nurses pre-pouring . . when they had less than 6 patients! Now there is a big sign over the med drawers about how prepouring is unprofessional and wrong.

You aren't going to be able to be 100% perfect but we ought to strive for perfection and tell management to devise a better system if the one we have isn't working.

steph

Bill Levinson · Nov 11, 2004

I have only been at it 7 years and I can see already a HUGE difference in the amounts of paperwork we have to do---more gets heaped on each and every year, and NONE is ever taken away or reduced! It translates into making less and less time for us to do ACTUAL bedside care.

This is known as non-value adding WASTE in industry. Anything that does not provide care to the patient is WASTE and management should be looking for ways to eliminate or minimize it. E.g. barcode readers at patient bedsides to log data at point-of-use, thus eliminating the nurse's need to walk to a station to do the job.

It is management's failure to eliminate non-value-adding waste that is helping to drive up the cost of health care while keeping nurses' pay lower than it should be. No wonder managment resents overtime; it can't pay people to fill out paperwork! But it is management's job to figure out how to minimize that paperwork.

allnurses Guide · Nov 11, 2004

This is known as non-value adding WASTE in industry. Anything that does not provide care to the patient is WASTE and management should be looking for ways to eliminate or minimize it. E.g. barcode readers at patient bedsides to log data at point-of-use, thus eliminating the nurse's need to walk to a station to do the job.
It is management's failure to eliminate non-value-adding waste that is helping to drive up the cost of health care while keeping nurses' pay lower than it should be. No wonder managment resents overtime; it can't pay people to fill out paperwork! But it is management's job to figure out how to minimize that paperwork.

I agree. And it is the nurse's job to not put up with it.

steph

SmilingBluEyes · Nov 11, 2004

This is known as non-value adding WASTE in industry. Anything that does not provide care to the patient is WASTE and management should be looking for ways to eliminate or minimize it. E.g. barcode readers at patient bedsides to log data at point-of-use, thus eliminating the nurse's need to walk to a station to do the job.
It is management's failure to eliminate non-value-adding waste that is helping to drive up the cost of health care while keeping nurses' pay lower than it should be. No wonder managment resents overtime; it can't pay people to fill out paperwork! But it is management's job to figure out how to minimize that paperwork.

I agree,but what do you suggest we do when it's rampant everywhere? "voting with our feet" only can go "so far".

leslie :-D · Nov 12, 2004

I agree,but what do you suggest we do when it's rampant everywhere? "voting with our feet" only can go "so far".

and the only reason there is so much duplication/triplication of efforts when it comes to paperwork revolves around the 'cya' mentality and/or for reimburse-ment purposes.

mgmt. does not care about nsg woes; they just want to see the bottom line and that's why unity in nsg is so very important.

SmilingBluEyes · Nov 12, 2004

exactly leslie. So i just love it when people tell us "not to take it anymore" but offer NOTHING in the way of truly viable solutions. I have yet to figure out how to make management and JCAHO stop this madness. Anyone?