Thinking of leaving bedside nursing due increasing documentation, short staffing, etc

[JordanRose]

I have been a nurse for 17 years. I have worked both med/surg and ICU in a CAH (critical access hospital) my whole career. For the most part, I have really enjoyed my job. The past few months though, I find myself becoming more dissatisfied with my job. I still enjoy taking care of patients. It is the relentless, mind boggling, idiotic, double and triple charting that I am starting to despise. The charting is starting to really cut into my direct patient care time. I am a very organized, usually have all my ducks in a row. I can get my first assessment done, my meds passed, update the rounding doctor on the pt's condition, review the orders, and sit down to chart in a reasonable amount of time. (Our charting is computerized). I just can't seem to keep up anymore.

For example, now it isn't good enough that we chart "NKA" on a chart. We have to chart "NKDA", No Known Food Allergies, No known environmental allergies. We have to chart pain assessment every 2 hours, around the clock. If a catheter is in longer than 2 days, we have to document why the catheter is still in place. All kinds of new documentation requirements for vents and central lines. Flu/pneumovax vaccine sheet needs completed. Valuables sheet completed. Med Reconciliation form filled out on the computer. Pt receiving blood or blood products? That form needs completed. New admission? Then you get to start a whole new slew of paperwork/computer work. Oh, let's not forget the DVT prophylaxis order form. The list goes on, and on, and on, and on. It keeps getting longer too.

When will TPTB (on all levels...hospital administration, Joint Commission, state board of healths, insurance company, etc) realize that nurses are getting frustrated with all the forms and assessments we have to fill out with each pt? Even a 40 year old pt in with an uncomplicated case of pneumonia, the documentation is unreal anymore.

I don't see this easing up at all for bedside nurses. I am in my mid 40s with an ASN degree. I am seriously consider starting back to college to obtain my BSN, and possibly my MSN so I will have more job opportunities available to me other than bedside nursing. I am even considering leaving nursing all together. Not sure what area in would venture into though. Definitely have to think that one through.

I know good nurses are being driven away from the bedside because of various reasons. My sore point with nursing @ the moment is the excessive charting and documentation that is required of us.

Anyone feeling the same way as me?

[anotherone, BSN, RN]

Yes, but I guess they hospital wants all their bases covered, can you blame them? I want to leave nursing most of the time but i don't know where else to go.

[Anna Flaxis, BSN, RN]

Fortunately in the environment I'm in now, charting is not too burdensome. I spend more time at the bedside than ever.

I remember when I worked inpatient, however, it seemed as if every week they were coming up with some new form or piece of paper we had to fill out.

I did the math one day. Say I had four patients and my shift is eight hours. That would mean two hours per patient, but no. Subtract the hour's worth of charting for each one, and that leaves four hours, an hour per patient. But no, if I take my two fifteen minute breaks and my thirty, that's three hours between four patients. Oh, and subtract the thirty minutes it takes to take report at the start of the shift, and the thirty minutes it takes to skim labs and orders, and that leaves two hours for four patients. But wait, don't forget the chart checks! Now we're getting down to fifteen minutes per patient in an eight hour period. And we're supposed to do hourly rounds, "help" the CNAs with their duties, and put out fires that inevitably spring up.

So, when do I actually get to touch my patient, let alone look at them?

[DabearsDitka]

It's not only because of Joint Commision and hospital based policies but because there is a big change in the healhcare reform models that we are starting to see such as Value Based Purchasing and pay for performance and penatly for poor performance as hospitals will recieive higher reimbursements if they can show they do a better job than other hospitals in the area. I agree its a pain but some computer systems are better than others. I can't stand mckesson but love EPIC!

[goodneighbor]

What? You take breaks? What? You pee?

[Anna Flaxis, BSN, RN]

What? You take breaks? What? You pee?

LOL, I was wondering if anyone would catch that.

Yes, I do, as a matter of fact. Gotta take care of myself, else I'm no good to others!

[Orange Tree]

Our newest torture is filling out a skin assessment sheet for every patient on every shift. It's not enough that our whole assessment is already being charted in the computer, they want a separate sheet of paper to validate it. And the funny thing is, I get them handed to me all the time with "no breakdown" only to turn the patient over and find a stage two or three sacral ulcer.

Nurses are so busy filling out these stupid forms that they don't find the time to actually look at their patients.

[goodneighbor]

This is either the funniest or the saddest forum here! I am laughing because it is so true. Who is it that comes up with these forms?? It seems that facilities (hospitals, corporations, etc) look at us as "employees" when they should look at us as "professionals". Maybe we should join some kind of a group? Somewhere, somehow-someone is thinking-I'll just come up with a form "to help them out".

[footqueen]

That's the reason I left bedside nursing. Paper charting wasn't too bad, but everyone (TPTB) said it would get SOOO much easier with computerized charting. Well, just like the OP posted, they just dumped more and more "necessary" things to chart about!

It got really bad when we would get a "pop-up" on our computer screen if pts showed S/S of "possible" complications that we'd have to immediately address with the doc. ie: a 94 yo pt with elevated BNP (pop-up- possible CHF) call doc, who did NOT want to be woken up for this news (of course she has an elevated BNP, she's 94!) but we HAD to call. Same for S/S of sepsis (really? Elevated WBCs with a pna pt???? Call doc, get yelled at, and document, document, document).

If I could've used my judgment about calling the doc, had some standing orders, etc, it would have been tolerable. But I felt like a robot could've been programmed to do what I was doing. I got out...

[happy place]

There is so much that needs to be charted now that I am constantly in fear that I am forgetting to chart something. My solution was to find a job at a hospital that had higher nurse to patient ratios.. Instead of taking 6 pts, I have 4-5 now at the new facility.

[happy place]

Our newest torture is filling out a skin assessment sheet for every patient on every shift. It's not enough that our whole assessment is already being charted in the computer, they want a separate sheet of paper to validate it. And the funny thing is, I get them handed to me all the time with "no breakdown" only to turn the patient over and find a stage two or three sacral ulcer.

Nurses are so busy filling out these stupid forms that they don't find the time to actually look at their patients.

SAD, but so TRUE!!!!

[Roy Fokker, BSN, RN]

Just as governments can get almost any outrageous bill passed by braying "it's for the chiiiiiiiiillllddrrennn!", so too can all these idjits force more and more redundant, uesless paperwork by couching it in terms of "patient safety" or "patient outcome".

The trick to to catch these two-faced jokers when you ask for adequate staffing to cover all these new additional "protocols" [now there's a word I've come to loathe! "Protocol" ... that's the one answer to any and all sensible or inquisitive questions! "It's protocol!"] I've said it before and I'll say it again: I'll chart a thousand extra pages a shift if they'll give me adequate staff to do my job.

To quote a wonderful example:

Apparently being drunk is now a medical condition requiring all the care and expertise of a doctor and a team of medical professionals. People aren't allowed to be intoxicated anymore... nosireebob! If it weren't stupid enough to waste a stretcher for chronic drunks in already overcrowded EDs, enter the new *drum roll* .....

"Protocol"! (you knew that was coming, right?)

"All intoxicated pts. must now be put on 1:1 observation for patient safety". Surely no one would object to this? What's the harm?

Ever tried sobering up a chronic alcoholic? Yeah, the guy who drinks a fifth for breakfast every morning?

The harm is that now instead of watching legit complaints of "suicide attempt" and "drug overdose" and "altered mental status" - observers now also have to keep an eye on drunks as they are sobering up.

Bad enough that we have to waste putting trained pt. care personnel on these idiotic endeavours (seriously, you're paying an aide/PCTto watch a drunk sober up - the very same aide/PCT who would otherwise be assisting you in doing vitals, EKGs or transporting critical pts. to CT or Cath Lab etc.)

Naturally, there is no extra staff allocated to 'keep an eye' on all these "new" 1:1s - to the point where observers can be watching upto 4-6 pts. at a time; rendering the whole concept of "1:1 watch" into some kind of bizarre joke. What kind of "patient safety" does that really achieve - other than make sure another meaningless form is filled out to satisfy some dumb requirement invented by some narcissistic sadist (who, you know - no doubt crooned to the skies that 'see, I've improved pt. safety' and when it doesn't work out can point to his 'brilliant plan' on paper and say that it was poorly executed)?

What's that? You refuse to observe observe the pts. so that the aide/PCT can help out with other chores on the unit? You are not a team player!

Sooo... I refuse to jeopardize my license to comply with your nonsense but you won't staff for the inanity you thrust my way every shift ... and I'm the one who is not being a team player?

The usual excuse? "The job has been posted but no applicants yet" (this in a day and age of 16% unemployment and people losing homes??) Some amongst us have even relented and said "fine, just hire a sitter. Don't need much training other than ensure their own safety. If anything happens, page security and or nursing and we'll deal with it. It's what the aides/PCTs do now anyways!"

Nope: "we can't staff more - we've over budget!"

'Tis but one example.

There are myriad others.

Count me in as among those who has thought long and hard about whether to go forward and advance in this profession or to quit altogether and go do something else.

No job or career is worth your health or your sanity.

- Roy