more vent: how/why did we let this happen?

[HannahLeah]

Hi fellow HH nurses. I just have to ask- whose idea was all this paperwork crap that we do??? How did we let bureaucrats into our profession so far that we do more for them than we do for the real patients? (yeah, yeah, I know the stock answers- but really- nursing is a proud profession, we work hard and are one the most trustworthy of professions- why dont we get any credit for that anywhere? we hold peoples lives in our hands yet we cannot be trusted that we did what we are supposed to if we dont write down every detail?)

I just spent TWICE the amount of time filling out forms and flowsheets and checking little boxes than I did doing actual patient care. With a pen and a few lines I could have completed sufficient documentation of what I did in about 5 minutes for the first client (every other day dressing changes) and an hour maybe for the Hospice admission. Instead I was 2 hours in the field and 4 hours at my desk.

Has anybody ever even suggested that it would be sufficient to gather OASIS data on , say, 1 patient out of 10 or something, instead of every single time they sneeze? How about not making me chart on every single aspect of a person when he is seen 3 or4 times a week and has been stable for months except for the wounds that are not healing? Really, I last saw this man over a month ago and nothing about him has changed. If something had I could have charted THAT.

Computers were supposed to make things easier, instead they include every possible conceivable detail and you have to read, find the N/A boxes to check off or decide you dont really like the choices they allow, so now find the comments box and write it in, (and keep scrolling down- theres more!) then keep flipping thru page after endless page, and you're still not done, now you must "chart directly to the care plan" by clicking more boxes to prove you assessed for all the things you just said you assessed, oh and now go make a summary note too, because no one else wants to page through an entire assessment to see whats really going on with this person.

sorry. Ive been a nurse since the days when night shift charted in red pen and an entire shifts worth of caretaking was documented in about 4 lines. We spent our hours taking real care of real people, they got backrubs and hot water bottles and they loved us because we were there at the bedside, not glued to our papers at the desk. What have we let happen to nursing?

[joprasklpn]

not everyone documents as completely as others, so we all get the punishment, but you shouldn't have to worry about letting anything out with all the flow sheets we have now. But to me a piece of paper doesn't actually mean the care was done. There will always be slackers. More attention should be given to the actual patient.

[caliotter3]

Sometimes it is very obvious when someone is charting care they did not, in fact, provide. That is their answer to the paperwork problem, along with leaving out as much as possible, required or not. I resent the extra work involved with CYA charting that comes about because of the passive aggressive behavior of clients who refuse to deal honestly with the doctor, but demand deviations from the plan of care. Add to that a condescending manner of behavior, and you have just another instance of making the workplace a little less inviting to the nurse that is aware of what is necessary to be well "covered".

[jjjoy, LPN]

In general in many fields there is also a trend to attempt to record and save every last bit of data. A big part of it CYA. Save tons of info that will never be looked at again because some little detail at some point may be contested legally. Another part is hoping to review all that data to find ways to better measure productivity and quality of service... usually with the intention of increasing efficiency and decreasing costs. But again, you end up wth so much data there that much of it never gets reviewed at all. And of course, there's the notion that computers allow for automatic, faster documentation. Which is true in some cases but most definitely not across the board. Many computer programs do not 'talk' to each other and/or do not have the capabilities to capture clinical data in a way that can later be easily accessed and utilized, so there often ends up being lots of duplication of effort that electronic documentation is *supposed to* minimize.

[caliotter3]

In general in many fields there is also a trend to attempt to record and save every last bit of data. A big part of it CYA. Save tons of info that will never be looked at again because some little detail at some point may be contested legally. Another part is hoping to review all that data to find ways to better measure productivity and quality of service... usually with the intention of increasing efficiency and decreasing costs. But again, you end up wth so much data there that much of it never gets reviewed at all. And of course, there's the notion that computers allow for automatic, faster documentation. Which is true in some cases but most definitely not across the board. Many computer programs do not 'talk' to each other and/or do not have the capabilities to capture clinical data in a way that can later be easily accessed and utilized, so there often ends up being lots of duplication of effort that electronic documentation is *supposed to* minimize.

Particularly true in healthcare where you are less apt to have people who have equal backgrounds in IT and healthcare/medical fields.

[heron, ASN, RN]

There's also the incredible amount of fraud that has historically bedeviled any government-paid service. Once something is covered by medicare/medicaid, then the for-profit vultures swoop in and loot the system for as long as they can. Then CMS starts requiring more and more documentation to prove that pts needed the care that was billed and that they actually got that care. This is what happened in hospice and I would be astounded if it did not happen in home care as well.

[MauraRN]

We, as a profession, have allowed ourselves to become billing and insurance clerks. Sure, we dress it all up in NANDA approved language, but clerks we have become. What a waste of education and experience.

[HannahLeah]

Thanks for the replies, I was not happy with myself for spilling my feelings on this subject, but I tend to think of this forum as the only place to do it- glad I didn't get the usual blank stares like I do at work. I have stopped saying such things in the 'real' world- no one else seems to think there is anything wrong, they just keep accepting more and more of it and shrugging.

Do any of you think there is any hope of reversing this trend? Or should I just shut up altogether and slog through like everyone else?

[HmarieD]

There's also the incredible amount of fraud that has historically bedeviled any government-paid service. Once something is covered by medicare/medicaid, then the for-profit vultures swoop in and loot the system for as long as they can. Then CMS starts requiring more and more documentation to prove that pts needed the care that was billed and that they actually got that care. This is what happened in hospice and I would be astounded if it did not happen in home care as well.

It's already happening. Look for new documentation and assessment standards to be initiated April 2011 for all therapists. There have been too many agencies "gaming" the system. Now we all pay the price.

[Isabelle49]

It's already happening. Look for new documentation and assessment standards to be initiated April 2011 for all therapists. There have been too many agencies "gaming" the system. Now we all pay the price.

You hit the nail on the head when you said, 'gaming' the system! I can't wait to retire.