I had no idea, as a young impressionable eager nursing student, that I would eventually be SO inundated with paperwork once I became a nurse.
It is truly unbelievable how much crap we have to fill out and keep track of. I have no idea why this can’t be streamlined somehow, but then again, it may be impossible by this point. I just thought you might like to have an insight into the amount of utter banal paperwork I must keep track of. Keep in mind that any particular patient may have only some of these. But some of them actually have ALL of them.
First there’s the ABG flowsheet. It’s where we write down the patient’s ABG’s so we can keep an eye on trends at a glance. Never mind that every single day at 4pm the printer spits out up-to-date lab sheets on every lab test the patient has had. We need to have this one particular one for ABG’s.
Then there’s the blood glucose flowsheets. Even when the patient isn’t diabetic, if they are started on TPN, they have to have twice daily blood sugar checks. And you guessed it… there’s a separate sheet for that. If the patient is a diabetic and receiving insulin, it’s a good sheet to have to keep track of what the patient’s blood sugars are and if the amount of insulin is working.
Of course there is our “vitals” flowsheet where we write down vital signs (as often as every minute sometimes), keep track of titrating drugs, add up our Intake/Outputs, chart unscheduled meds. This one is most important and every single patient has one.
Next is the Blood Transfusion Consent form, along with Blood Transfusion Fact Sheet. Before, we just gave blood to whoever needed it, with a verbal consent. Now we have to get it in writing.
Let’s not forget the Advance Directive sheet. If someone comes in with no Advance Directive, we have to give them an information sheet describing what one is, and if they want to sign one right then and there, by golly there is yet ANOTHER sheet to give them to do that. Even if they don’t want an Advance Directive, we still, by law, must give them an information sheet.
The newest sheet is the Flu Vaccine consent. It comes bundled with 2 different flu vaccine info sheets, and another checklist to complete to determine if the patient is eligible to get the vaccine. Thank God that one’s only seasonal.
There’s the sheet we use to mount EKG strips to.
There’s also an admission sheet. We have to fill this out at the bedside, then go back to the computer and enter in all the information. As a side rant, after we’re done filling in the patient’s entire health history (never mind if someone’s already done it on a previous admission… this computer system is over 30 years old and apparently didn’t take that into account… we have to fill in EVERY blank for EVERY admission), we have to do a “teaching assessment” where we write what we think the patient’s knowledge of their current condition is, the steps we are going to take to educate him, and THEN we have to document somewhere that we’ve actually done the teaching. And don’t forget to include that you taught the family as well. THEN we have to come up with a “nursing care plan” whereas we come up with “problem statements”, desired outcome, deadline, and interventions that we will take to fix the “problem.” More on nursing care plans in another post. I hate nursing care plans.
Then there is the “basic care needs” that we must fill out, clicking this and that to add to the Master Care Plan that the patient has an NG tube, ET tube, ostomy, what lines they have, when those lines were put in, when the tubing changes were on what drips, right down to how much help they need bathing themselves, for God’s sake. Basic Care Needs are pointless as well. No one ever looks at them on the care plan, and they’re hardly ever updated. Go look at the patient! Don’t rely on a stupid care plan to tell you whether the patient has a foley catheter. I hate updating the tubing changes, because the tubing is always labeled with the date and time that it was hung. Charting it AGAIN is redundant.
If you make a med error, or even if your patient’s dentures are lost, or really for anything under the sun, you have to fill out a Quality Assurance form. Those are fun.
My least favorite is the restraint sheet. Many of our patients have restraints, usually to keep them from pulling out various tubes and wires whilst they are in their drug-induced haze. Restraints are a really huge issue with The Powers That Be. The restraint flowsheet is total bunk. You just initial boxes saying that you’ve checked the restraints to make sure they aren’t too tight, that you’ve offered food/drink every 2 hours, that you’ve asked the patient if they need the bathroom every 2 hours, that you’ve provided range of motion exercises and untied the restraints every 2 hours, and oh by the way, why exactly ARE you using restraints? And have you told the patient and family why? And have you made a f#@$#@$ing nursing diagnosis problem statement about it?? Thing is, our patients that are restrained are already receiving tube feedings, and have numerous tubes to take care of potty concerns, and basically have no clue about anything at all. I’m not saying those things aren’t important; they are. But they aren’t always applicable. And I feel that it’s pointless, because sometimes you just initial the box even when you haven’t had time to actually DO all of that.
Who could forget the wound care sheet? Whenever the patient develops or presents with any kind of wound, be it surgical, pressure ulcer, vascular, whatever, we have to take a Polaroid picture of it (using the little stick-on ruler papers for scale) and fill out a wound sheet, where we circle the area on the body that the wound is located, the measurements, what it looks like, smells like, what treatment we’re doing for it, and any other comment we care to contribute. One wound sheet for each wound. And the Polaroid (which may or may not turn out) gets taped to the Progress Notes for the docs to ignore.
Did I mention that there is a consent form for the patient to sign giving us permission to take a picture of their wound?
The lastest sheet that’s come out is going to be a doozy. Every charge nurse on every 8 hour shift is going to have to fill out this legal-paper-sized form saying what nurse has what patient, when the patient was transferred out if applicable, when a patient was admitted, when the nurse took her break, blah blah blah. I think these sheets are supposed to protect us due to the law that starts on January 1st, but come on. These stupid sheets need to be kept for 3 YEARS in case there’s ever a question that the new nurse:patient ratios weren’t followed to the letter. For my unit ALONE, that’s 1,095 pieces of paper PER YEAR that will have to be filed. Add in all the other units (at least 8 others) and you’ve killed a small forest with having to file away 8,760 pieces of paper. At the end of 3 years, we’ve accumulated 26,280 papers.
For the love of God and cotton candy, this has all gone WAY out of control. Everytime Joint Commission (you’ll notice I’ve not provided a definition for these jerk-offs… I wouldn’t know where to begin) gets their knickers in a knot over something, we seem to have to add yet another flowsheet to cover our asses. Basically, when I get a new admission, it is entirely possible that I will have to utilize every single one of these sheets on them. (Let’s not forget the OR checklist and consent forms) in addition to starting IV’s, mixing medications, inserting various tubes, monitoring urine output, vasoactive drips, etc, writing down vitals, tagging IV tubing, teaching the patient and family about everything under the sun, drawing labs, calling docs, IT HAS BECOME MADNESS.
I swear I spent JUST as much time filling out paperwork and computer crap as I did at my patient’s bedsides tonight. I’d be surprised that anyone actually read this entire thing. Filling out all this baloney is Tedious with a capital T. I just can’t wait to see what paper they throw at us next.