May 7, 2009

The paperwork side of nursing

Over the last couple months, it seems to me that the Hospital has doubled the amount of documentation and paperwork they require us to get from patients. We already document like crazy, especially in OB because there is such a high risk of litigation if something goes wrong. All of this in the name of good practice, informed consent and patient safety. That's all fine and dandy, but it's gotten a little out of hand. Right now, when a patient comes to us in labor, we have to have the patient sign 2 hospital consents (1 for mom, 1 for baby) 2 HIPPA forms (mom and baby), epidural consent if they desire one, a consent that states we offered the mother the option to donate cord blood although we haven't had collection kits to do so since 2004, consent for the baby's hep B vaccine, and the internet picture consent. As of Monday, we now have a new universal protocol that has been implemented for patient safety for invasive procedures, which includes 3 verifications of a procedure and a 3 page informed consent form. The idea is that the doctor explains the procedure, the risks, benefits, etc. to the patient in the office and then the doctor signs the form, attesting that they have obtained informed consent. That consent form is then supposed to be sent over to the hospital before the patient arrives for the procedure. We, the nurses, are then supposed to have the patient fill out the rest of the form on admission, where they write in what procedure they are having, whether or not they will allow the procedure to be photographed, have observers or sales reps present and that they will allow the hospital to dispose of bodily fluids and tissues. It's a HUGE pain in the ass. I understand the reasoning behind it, but it just hasn't been working. At all. We have to have patients sign these for c-sections, epidurals, pp tubals and inductions. Here's where it gets ugly - we have midnight inductions about every night except Friday and Saturday. We cannot start pitocin unless we have an informed consent signed by the doctor AHEAD OF TIME. Guess how many we've actually gotten ahead of time? None. So the docs are pissed because they aren't about to come in at midnight to do the consent, the patient's pissed because they are there at midnight and we can't do anything, and the nurse is pissed because we get the ass chewing from both the doc and patient. They decided that an induction is an invasive procedure because we are using a dangerous medication (if not used properly). But, we use pitocin after the placenta is delivered to help the uterus clamp down, and to augment labor if the labor has stalled and we don't have to get informed consent in those situations, even though we are using the same medication. None of this is going smoothly and it's a HUGE HUGE pain in the ass and very frustrating. There really has got to be a better way to ensure that the patient understands the procedure and that informed consent has been obtained.
In addition to this, we now have to start doing formal instrument/lap counts for vaginal deliveries. The techs have always done a count before and afterwards, but now we have to do one like we do for c-sections. And for c-sections, we have these nifty blue bags with 10 pockets that we can put the laps in to help with counting. They have now decided to do away with these, as the center divider can break and there is the potential that one lap could slide across 2 pockets and look like 2 laps, leading to an incorrect count. Seems logical, but now we have to figure out a way to lay out all those bloody laps some other way. We also have to turn in our count sheets. Really, I'm all for patient safety, and they've added these things to help with that. The only problem is there are already policies and procedures in place for that. People just have to follow them, and with the extra stuff they've added, there are just more places for things to break down and for errors to occur.
Oh, we also now have quarterly mandatory meetings for nurses hospital-wide, a new recorded reporting system called Optivox (which so far has been a pain in the butt), an 8 hour training session for the hospitals computer charting because of a huge upgrade (we only use that charting system for medications - we have a different one because of fetal monitoring but we still have to sit through the whole damn thing), training for the new OB hemorrhage rapid response team, which will add yearly competencies. All this in addition to monthly staff meetings, CPR and NRP renewal every 2 years, annual unit competencies, ACLS, and a number of committees that are busy trying to lay out workflow in the new unit. I am really starting to feel like most of my time is spent in meetings or documenting, instead of being at the bedside, taking care of patients. All of this extra stuff I know is suppose to be fore patient safety but it's taking time away from hands-on patient care. Sometimes I wonder what my grandmother would think about nursing today. She was trained as a nurse in the 1930's. She'd probably be appalled. Sigh. It's for the greater good. That's what I'll keep telling myself.

10 comments:

Anonymous said...

Very informative reading. I am a career changer who is finishing my pre-req's this fall, applying for the nursing program in January, and hoping to be finished in a couple of years (seems like forever!). My interest is in labor and delivery and therefore reading your blog is giving me great insight. It looks like I made a good choice in waiting to do this after I raised my own children because it is going to take some real career dedication, which I am up for. :)

Joy said...

And this is exactly why my nurses didn't give me the time of day when I was in the hospital giving birth. I had no support from them before or after delivery because they were so focused on all the STUFF they had to get from me.

I felt like they were judging me and ignoring me on purpose. Now I understand they had a ton to do.

Nurse Lochia said...

Joy, even though there is a ton of paperwork, you still should have been given the care and support you needed. Frequently we'll care for the patient and end up staying later after the shift is over just to make sure we've completed all the documentation. I'm sorry for the poor hospital experience.

Jen said...

It is ridiculously insane all the paperwork and documentation that has to be done on each and every patient.....to the point that they are telling us word for word what to document. How is that even legal?

It truly does leave very limited time to handle patient care. And it seems like every time something new is added....it's the nurse that is responsible for it all. It's getting to be way too much legal stuff and not enough time to actually take care of the patient's needs. I forgot to add up one braden score & I get written up for it.....nevermind the 9320840934098230943092 things I documented correctly or the lives I saved inbetween charting.

Then the hospital will whine about patient satisfaction scores being too low. Sigh.....

Fertilized said...

WOW - what a PITA. I will be extra nice to my nurses!

Yehudit said...

we don't have to get informed consent in those situations

++++++++++

You don't have to get informed consent before giving pitocin for augmentation or third stage?

THAT GIRL said...

My hand is cramping to just reading this! I love charting at my PRN job... all computerized with "normal value" buttons! My weekend option (full time) employer... lets just say I document vaccines in 6 different locations!

Anonymous said...

love your new avatar!! i don't remember signing anything to auth. filming, but i am sure it was filmed as i heard/saw the nurse stand facing no one in particular and read my name and some numbers and note the time?? maybe you could enlighten us who were all warm, fuzzy and agreeable at the time, and don't remember. thanks, i enjoy reading your blog.

tammy said...

Sounds a lot like the L&D where I work, we also have a visiting policy and newspaper announcement consent form that we have to get signed. And this is just a start, if a patient comes in for anything other than labor, there is more paper work. If there is shoulder dystocia or other complications, then more paper work! I told my boss that 1 more paper to fill out and we need 2 nurses for 1 patient. One nurse to do the patient care and one nurse to fill out the paper work. At my job, it takes me longer to do the paper work to rule out labor and send a patient back home than the patient is actually in the hospital. It's a sad world when more of your time is spent doing paper work than taking care of the patients. L&D used to be a lot more fun place to work, I love taking care of the patients but, I don't enjoy all of the paper work.

pinky said...

I feel your pain. We need to hire more staff. One to take care of the patient and one to do the paperwork.

When I first started in OB there were 5 sheets of paper we had to fill out. At that time they told me, "we are working on decreasing our paperwork." I now see that was an outright lie. Now I don't know how many papers we fill out. We do it on a computer and the computer spits out reams and reams of paper. And we are not suppose to circle or highlight anything in the paper chart. So it takes us longer to give report to maternity. I keep telling myself it is going to get better some day. I know that might be a lie I tell myself but it is working for me.