September 8, 2008
Charting tickets
All of you nurses out there know what I mean when I say I hate charting. It sucks. Really sucks when you're busy. Charting is one reason nurses never get off on time, because when you're actually taking care of the patient, you can't chart. I mean, it would just be wrong when you're baby is taking a dive, heart tones in the crapper, and you're racing back for a c-section, for you to stop and say "hey, I have to chart all of this, so you'll have to just wait a minute". So you end up having to go back, and fill in the gaps. Plus if you have other patients, that's more charting. Charting is important anywhere, but I think? obstetrics may see more lawsuits than any other department. And lately, the charting has been, shall we say, lacking on the unit for the last several months. So, after chart audit after chart audit, the system manager decided to start holding people accountable (really, you are accountable anyway) . She came up with this "ticket" system. She'll audit charts and if your charting is perfect, you get a blue ticket. If you forgot something that a coworker or she could change, you get a yellow notice, just letting you know you forgot something. If you forgot to chart something that you have to go back and fill in, you get a red ticket. Okay, I'll go along with that. But my problem is this: these tickets are being taped to our lockers, for everyone to see. I just have a real problem with that. First, everyone makes mistakes, so lets point out to everyone who comes into the locker room (RNs, techs, secs, housekeeping, nursing students) who's made a mistake. Second, I feel like I'm in grade school. We are trained, licensed professionals and we are getting issued "tickets" . With the blue tickets, after you've collected so many, you can turn them in for a prize. Come on. Are we children or nurses?! Yes, let everyone know when they've omitted something because lately the charting has sucked, but lets do something a little more private, and let's be treated like professionals. If tickets are the only option, lets be more discreet about it. Maybe folders in everyone's mailbox. I guess I'm touchy about it. I take great pride in my charting and care, and maybe it goes back to H.S. I was a good student, so anytime anyone would see me miss a question on a test, or they did better than I did, especially in math, they'd make a big deal out of it. Maybe I'm too sensitive, but man, it irritates me. Since I work weekends, if I get a bad ticket, that puppy could be up there for 4 days before I see it. Oh well, I guess it could be worse and I don't really have a great replacement for this damn ticket system.
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5 comments:
That seems like a really silly "award" system for a bunch of professionals.
Now I know why the nurse that was on during my baby's 4 minute decel said she would be going to write a long report about the incident. Ugh. Sounds dreadful.
My theory about the lawsuits in obstetrics is this: everyone expects life. They expect an improvement and addition to life. Medicine is there in case things don't go as expected, but families don't believe it's acceptable for life NOT to come and to come wholly. Every other field of medicine, they expect sickness and loss - medicine is there to keep the expected from happening. So if you're needed in ob, it's because the unexpected is happening. If you're needed in other fields, it's because the expected is happening. When our death-denying culture has to face death in birth, they sue out of disbelief and misunderstanding. And all this makes me sad, as a doula, childbirth educator and mother, because it's driven obstetrics to manage birth so defensively.
That sounds so absurd... but I'm not surprised. Nurse managers are coralled by administrators who often are not trained or educated in the medical field... that system sounds like the red/yellow/green light system they used in my child's kindergarten class... they pull a card for every infraction... and you get punished for the stoplight.
Really, it is laughable, and sad.
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I find, the older I get, the less I chart. Anything I say can and will be held against me in a court of law. And if I don't fuck up the care of the patient, they don't have a case. So I am done killing myself over the chart.
And yes, sometimes babies and Mothers die and there was not a thing we could have done to stop it. No amount of charting is going to revive the lady with the amniotic fluid embolism that then went into DIC. Nope....I am not saying we have to chart all that stuff. I just am not gonna worry about it the way I used to.
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