So, we are experiencing a number of changes going on at work. We have a new CNO, and she is wanting to implement new procedures and policies. Additionally, our manager is currently out, and someone else is covering her. We have been under a tremendous amount of pressure, with these new changes, to make it work. We have recently hired a spate of new grads into the ICU, as well as new agency nurses. Recently our interim director had a “come to Jesus” talk with us. I found it to be quite punitive in nature, and completely unrealistic.
Concern has been voiced over the slacking in documentation within the ICU. We utilize an antiquated computer documentation system that is neither user friendly nor time saving. It is bulky, unwieldy, and a challenge for even the most computer savvy people to use. We do primary care nursing in the ICU, which includes all personal care, medication, monitoring, etc. We often do not have a secretary and must enter all our own orders. We answer the phones, draw labs, turn and reposition, document, coordinate care with families, transfer patients, call doctors and implement the plan of care. We are responsible for several aspects of cleaning of equipment and rooms, and must do everything FAST. It is not uncommon to completely turn your patient assignment around several times during your “12” hour shift. I say 12 hours in quotations because nobody I know ever leaves on time.
Unlike the medical units, we do not have CNA’s. We do not have a free charge nurse. If you are charge nurse, you have a full patient load, and sometimes the sickest ones at that. During the day there are additional meetings, rounding and responsibilities as charge nurse. Most of us despise being charge nurse, because basically in the words of my dear coworker “you are everyone’s bitch”. The people I work with, however, are amazing. They are truly some of the best people I have ever had the honor to be in the trenches with. They maintain an awesome sense of humor despite being in a war zone everyday. 99.% of them truly care about their patients and their job. Yes, .5% are clueless, and .5% just totally annoying. but all in all, pretty darn good odds for a hospital full of strong personalities.
In addition to new constraints being placed on us to increase our speed of transfers, we are being asked to increase our documentation. we already document 2 shift assessments, hourly vital signs, hourly I&O’s, any interventions, meds, critical labs and need to contact the doctor. we transport our patients to all procedures and document on this. We are now being asked to document focus assessments every 2 hours on every system that is not within normal limits. That would be every system on our patient. Now, most nurses are constantly assessing their patients. we assess and intervene and evaluate continuously. The difference is to now go into the horribly time consuming computer system and document this, even if nothing has changed and we are doing no interventions. This is the complete opposite of the idea of “charting by exception”.
I recently read an article regarding some new legislation pending in 2 different states regarding mandating advance nursing degrees for all RN’s. This is the path leading to reimbursement, they say. I see a striking similarity to these pending legislations and the conversations being held in my job. It is all about justifying a reimbursement rate. Core Measures are mandated by regulatory committees, which failure to adhere to leads to financial consequences for the institution. Many diagnosis if acquired while in the hospital, will result in non payment for their treatment if the documentation is not there for its preexistence prior to hospitalization. The bottom line is, while higher standards of care for less money are being demanded, nurses are no longer taking care of the patients, but instead being asked to nurse the computer. We are wanted for our documentation in order to secure payment for the hospitals. We are asked to police the doctors, not to ensure safe care, but to make them document and order the required products and tests to ensure financial reimbursement. The very skills that make nurses invaluable- the eyes and ears present at the bedside, are being pushed further and further away.
I wish I knew what the answer was. I understand where this is coming from, and I do not fault them. Medicine in this country is still a business, and it needs to be financially stable in order to keep functioning. Health care costs are spiraling out of control, and the drain on our society is climbing. People want access to affordable, quality health care, and nurses want to give this. Administrators are responding to pressure from all sides to somehow make it work. I do however, think that everyone is running like chickens “the sky is falling the sky is falling”, and rather than calmly taking things back to basics, are standing with a finger in the dyke while the tsunami washes over the top. Nurses need to take back control of nursing. We need to be setting the standards, writing the requirements, and holding each other accountable to a higher level of care. We need to remember what we came into nursing for, and find a way to stop making things so freaking hard. Otherwise, who will be left to care for us?