What are they teaching?

[egglady]

I have an honest question. I'm not being a old crabby nurse. Honest question here... What are nursing schools teaching? So many posts of new grads that didn't think nursing would be stressful or hard. Nursing is a very stressful job. Are these schools actually teaching our future nurses that nursing is Not a stressful job? If so, they are doing a disservice to our profession. I feel bad for these new nurses that seem to truly be shocked that it is a stressful profession.

[CKPM2RN, ASN, EMT-P]

On 8/21/2020 at 7:09 PM, 2BS Nurse said:

They're teaching EPIC!! How to write lengthy progress notes that no doctor will ever take time to read!

Gah! Don't get me started... EPIC wants documentation each shift on how the patient is meeting their NANDA-ish nursing progress metrics. Like I have time (or inclination) to go through and type in each section. So instead of a couple of paragraphs that could succinctly cover the progress of a patient, I'm supposed to write ten, or twelve, or twenty depending on the patient. All with a separate drop down or two of course.

[Jory, MSN, APRN, CNM]

My major beef right now with new graduates is this "trend" not to chart anything. They will say, "Oh, we are supposed to 'chart by exception' " but if you ASK them EXACTLY what that means? You get the deer in the headlines look. They have no idea.

Because I work as a midwife, sometimes when I do rounds there are significant social issues that need to be addressed. They will tell me a long, detailed story of this huge argument that happened in the room, mothers that are inappropriate, possible drug use in the room with the baby. I go to pull up the chart?

Nothing. Absolutely nothing documented.

I have complained about this until I'm blue in the face to management and unfortunately, one day something is going to happen and a nurse's license is going to be sanctioned. We have had social services referrals fall through the crack because of it, placing infants at risk when they go home. It's absolutely ridiculous.

[londonflo]

5 hours ago, Jory said:

They will tell me a long, detailed story of this huge argument that happened in the room, mothers that are inappropriate, possible drug use in the room with the baby. I go to pull up the chart?

Would nurses hesitate to document these things as they would be liable if CPS wasn't notified? I honestly don't know how these situations would be handled as a mandated report. When does behavior cross the line and become criminal and need to be reported to the authorities?

[Hoosier_RN, MSN]

13 minutes ago, londonflo said:

Would nurses hesitate to document these things as they would be liable if CPS wasn't notified? I honestly don't know how these situations would be handled as a mandated report. When does behavior cross the line and become criminal and need to be reported to the authorities?

At least if it's documented, it can be discussed, social services can get involved, and the proper channels be engaged. As Jory mentioned, if it's not documented, then it's basically ignored.

8 hours ago, CKPM2RN said:

Gah! Don't get me started... EPIC wants documentation each shift on how the patient is meeting their NANDA-ish nursing progress metrics. Like I have time (or inclination) to go through and type in each section. So instead of a couple of paragraphs that could succinctly cover the progress of a patient, I'm supposed to write ten, or twelve, or twenty depending on the patient. All with a separate drop down or two of course.

Software is employer driven, as EPIC is used by a hospital in my area, and doesn't have this feature. Meaning that the employer purchased the software to be set up this way for whatever reason

[londonflo]

1 minute ago, Hoosier_RN said:

At least if it's documented, it can be discussed, social services can get involved, and the proper channels be engaged. As Jory mentioned, if it's not documented, then it's basically ignored.

Good thought, but if harm comes to the newborn at home and follow up social service documentation isn't there, would the nurse documenting the safety threat to the baby be responsible for the lack of resolution? I guess the nurse would document SS aware? Totally out of my element here, can you tell?

[londonflo]

8 hours ago, CKPM2RN said:

Don't get me started... EPIC wants documentation each shift on how the patient is meeting their NANDA-ish nursing progress metrics. Like I have time (or inclination) to go through and type in each section.

I bet a look at your state's nurse practice act will mention the nurse uses the nursing process to plan, implement and evaluate nursing care. Identification and follow up of nursing problems is our job among a lot of other things. Every other profession documents a patient's journey toward meeting the identified problems -- PT, Social Work, Nutrition, Speech Therapy, etc.That is how they charge for their services. I know I may be in the minority here but I think identifying what nursing really does might get us out of the "room and board rate" and into being valued by administration.

[Hoosier_RN, MSN]

4 minutes ago, londonflo said:

Good thought, but if harm comes to the newborn at home and follow up social service documentation isn't there, would the nurse documenting the safety threat to the baby be responsible for the lack of resolution? I guess the nurse would document SS aware? Totally out of my element here, can you tell?

it's been years since I've worked in a hospital, other than teaching clinicals, just to note time frame of reference. The last that I worked in one, there was always a way through software to send a social services referral, and then, of course, note SS aware. It was the same in LTC, HH, and hospice. In dialysis, we send an email to social worker. In all settings, there are protocols that are streamlined with laws, for immediate need cases. This would be like suspect/known abuse. An employer P & P can direct that, and usually annual classes are held, as reporting for these cases are very time sensitive

[Newishnurse1995]

My clinical experience did not prepare me in the slightest. We only had 6 hour clinical days and we were just paired with a nurse. We couldn’t do any procedures or give out meds without our professor. There were about 10 people in our clinical group and only one professor. Obviously can’t be in 10 places at once. I wish we had the opportunity to actually stay for an entire shift and have more independence. I could have learned a lot more and gained more insight.

[bitter_betsy, BSN]

Tomorrow I will begin week 2 of my floor orientation. I didn't expect it to be easy and I didn't expect to have fun (I am also on my 2nd career so I knew better to begin with). What I also didn't expect was to sit in class during orientation and listen for 2 hours to a lawyer tell me what I needed to document in order to save my butt and how to document it before I even had a documentation class. After this person spoke, a nurse came who then proceeded to reiterate how it was her job to go through our documentation to find the information needed for the lawyer and every protocol that we needed to know in order to document to cover ourselves (ie there are protocols specifically for documentation in addition to protocols for saving lives). Roughly 4 hours was spent on how not to lose my license and withstand litigation due to documentation. The following week we had documentation class and we spent exactly 6 hours learning to document. At the end of the 6 hours, not only was I terrified, I also knew nothing. We have a test environment, but we can only get to it at work. We are not allowed to work off the clock and we are not allowed to be at work not on the clock. We also can't leave our shift to go work in the test environment because we have to stay with our preceptor.

I feel that I have a pretty good educational basis from which to build upon, but I am pretty terrified of making a documentation mistake almost to the point that I don't even want to do this anymore. The program that I use at work isn't similar in any way to either of the 2 programs that I used in nursing school. Not only am I learning how to implement the skills and knowledge that I learned in school, I'm having to figure out a documentation system to cover my butt with a whole 6 hours training on it and zero printed resources for it. I'm trying to find Youtube videos to help me but I feel like I spend every moment at home trying to prepare for my moments at work. At the end of week 1 - I am thoroughly overwhelmed mostly due to documentation. I am not making nursing mistakes - I am making documentation mistakes (ie not documenting according to the protocol that will save my butt). Is it more important to follow the protocol to save a persons life, or to follow a protocol to save my license because I didn't document the nursing intervention that I used in the nursing note that I had to stop to write while my patients BP was tanking? Lets not even add covid into the mix.

Yes it is stressful - but I didn't expect so much stress due to documentation.

[Newishnurse1995]

44 minutes ago, bitter_betsy said:

Tomorrow I will begin week 2 of my floor orientation. I didn't expect it to be easy and I didn't expect to have fun (I am also on my 2nd career so I knew better to begin with). What I also didn't expect was to sit in class during orientation and listen for 2 hours to a lawyer tell me what I needed to document in order to save my butt and how to document it before I even had a documentation class. After this person spoke, a nurse came who then proceeded to reiterate how it was her job to go through our documentation to find the information needed for the lawyer and every protocol that we needed to know in order to document to cover ourselves (ie there are protocols specifically for documentation in addition to protocols for saving lives). Roughly 4 hours was spent on how not to lose my license and withstand litigation due to documentation. The following week we had documentation class and we spent exactly 6 hours learning to document. At the end of the 6 hours, not only was I terrified, I also knew nothing. We have a test environment, but we can only get to it at work. We are not allowed to work off the clock and we are not allowed to be at work not on the clock. We also can't leave our shift to go work in the test environment because we have to stay with our preceptor.

I feel that I have a pretty good educational basis from which to build upon, but I am pretty terrified of making a documentation mistake almost to the point that I don't even want to do this anymore. The program that I use at work isn't similar in any way to either of the 2 programs that I used in nursing school. Not only am I learning how to implement the skills and knowledge that I learned in school, I'm having to figure out a documentation system to cover my butt with a whole 6 hours training on it and zero printed resources for it. I'm trying to find Youtube videos to help me but I feel like I spend every moment at home trying to prepare for my moments at work. At the end of week 1 - I am thoroughly overwhelmed mostly due to documentation. I am not making nursing mistakes - I am making documentation mistakes (ie not documenting according to the protocol that will save my butt). Is it more important to follow the protocol to save a persons life, or to follow a protocol to save my license because I didn't document the nursing intervention that I used in the nursing note that I had to stop to write while my patients BP was tanking? Lets not even add covid into the mix.

Yes it is stressful - but I didn't expect so much stress due to documentation.

You’ll be okay. You’ll know what you need to document. For instance if you have a patient who has Q4 neuro checks, NIH screenings, or had a blood transfusion, you’ll know where to document and what to document. Just comes with practice. I also always write a note when I spoke to a doctor, respiratory therapist, pharmacist, lab etc. Anything that really requires an intervention or new order. Don’t worry about that. Just do the best you can do. I have spent many days staying after a shift to finish up my documentation.

[Hoosier_RN, MSN]

2 hours ago, bitter_betsy said:

Yes it is stressful - but I didn't expect so much stress due to documentation.

Welcome to the wonderful world of nursing documentation. At least you got a class with a lawyer and a documentation specialist. Many don't even get that and have to learn to fly by the seat of their pants. Also document like you know the patient will drag you into court tomorrow

[bitter_betsy, BSN]

@Newishnurse1995

@Hoosier_RN

Thank ya'll so much! Luckily I do have a good residency program behind me and thankfully I was smart enough to delay going back to school for a year. The ER alone is hard and I knew that going in, but this added stress is terrible. I'm attached to this stupid chair again - just like I was in nursing school. I am thankful for where I am and the program that I have and the fact that my hospital is keeping me in the department I was hired for. So many of my friends have been stripped of their original position and placed into floors with minimal training and very little help.