Wednesday, June 6, 2012

Paperwork Calculation

Paperwork.  I’m good at it, but it keeps increasing.  In nursing, if you identify a problem, you then must implement an intervention, assess for efficacy, and keep trying until the problem is resolved.  And you have to document all of this.  Checklists for fall risk, pressure ulcer risk, involuntary movement scale, pain assessments, and so forth.  I spend more time documenting about the patient than I do with the actual patient.  This system supposedly ensures that there is a record of proper care.  But doesn’t the sheer volume of the record tell the reader that the nurse spent more time writing and typing than she did delivering care for the patient at the bedside?

We hold nursing education groups.  A list of attendees is no longer enough.  We have to document attendance, participation, and demonstrated learning on a flow sheet in the chart and in the nursing notes of each patient, in addition to completing a separate form for the entire group and sending this form to seven different administrative people.  Patients who refuse the group also need this documented in their charts (along with what the nurse did to try to encourage the patient) as well as on a separate refusal flow sheet, which needs to be sent to the physicians in addition to the seven administrative people.  The refusal lists triggers a flurry of phonecalls because where else would I be, if not at the desk next to the phone?  The 45 minute group is now cut back to 10 minutes to allow me to complete all of the documentation for the session.  The time had to come from somewhere, and the actual education time was the most apparent.  Administration seems more concerned about documenting that patients were educated than actually educating patients.

I have no doubt that if the nurse could spend more time with the patients and less time with paperwork, there would be less need for pain medication, sedatives, and fewer falls and injuries.

I consider myself a rather efficient and productive person.  This seems to be a set of skills that management does not possess.  They generate new mandatory forms every week, but do not take away any other required forms.  “We have to show that we are caring for the patients.”  All we can show is that we spent a lot of time writing.  The number of incidents and the overall dissatisfaction demonstrate that staff members do not spend a lot of time with the patients.

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