In response to this post about the mountain of paperwork that we as nurses have to deal with, Mary Anne wrote this:

I thought hospital nurses had it easier with paperwork, boy was I wrong!
I’m a geriatric nurse in long term care. Have been for my 12 years in nursing, and the amount of paperwork has increased 10 fold especially in these last 7 years.

I tried to figure out, once, how many times I write my name or initials, or any type of entry, on various forms, but lost count quickly.

First, there’s the sign-in sheet, then the narc book, med and treatments sheets (there are currently 41 residents on my unit and 1-7 pages for each). Then you have the POC book, in which I as an 11-7 nurse must generate hand-written I&O sheets (both daily and weekly), glucometer check sheet, toileting sheets, assignment sheet, elimination and food/nutritional sheets (all three done monthly), the charts, the log book, and God forbid someone falls! Then you have the incident report, statement sheet, chart entry, care plan update, injury to extremity and/or head injury flow sheets, update of the fall risk assessment, call to the MD/NP and family or all the transfer paperwork if you have to send them out to the hospital.

There are weekly skin check sheets and incident report if you find a skin issue, and department copies for that. In with the med sheets (or MARS), are the prn pain monitoring sheets, behavior sheets, and O2 sats and lung sounds monitoring sheets (for use with any inhaler and nebulizer treatment).

Needless to say, the majority of my night is spent writing SOMETHING. I have been feeling like I’m pulled further and further away from the bedside and I’m getting very sad about it. Guilt when I take even more time away from my residents? I have it. Especially on Book Night. It’s the last day of the month going into the new month. And it’s hell!

We must turn over all the old month’s sheets into the new month’s sheets. Actually, leading up to it is worse. That’s where the pharmacy we use sends us all the Residents MARS AND TARS (med and treatment sheets) and we have to edit them. It’s not easy especially when they screw them up from one month to the next or a resident has a lot of new orders, or the pull doesn’t get done on time. We have to check the accuracy of every med and treatment the person has ordered along with allergies, doctor, birthdate, diagnosis, room etc.

Then there’s the Nursing Summaries. Oh joy!

These are monthly consolidated reports about what the resident has gone through in the last month, and it shows their acuity level, but it isn’t accurate if the CNA’s flowsheets are wrong which is often. This is how we get paid. If they are wrong, we lose points and money. It’s a lot of pressure when you’re not able to spend a lot of time on them.

And as an 11-7 nurse, I’m responsible for the weekly drug order for all the residents on my unit. It takes about 2-3 hours if done right. We also change the CD foley bags every 2 weeks, the O2 tubing and other equipment every week, G-tube supplies every night, do treatments, pass meds and soothe emotional or out of control residents.

Cleaning and restocking the Treatment and Med carts andordering supplies are all put aside until there’s time. No one on the other shifts ever does it. So I’m left with no supplies when I come on duty.

I’m sure I’ve missed something, there’s so much. Eight hours is definitely not enough time to get it all done. If I didn’t have to get home to get my husband off to work and child off to school, I’d leave about 9-930am everyday. As it is, I sometimes have to get my family taken care of and go back to work to finish. Sometimes I get paid and sometimes I don’t. The head honchos think we should get out on time, and they won’t pay overtime anymore. So we get in trouble if the work isn’t done, but we volunteer our time to get finished. And it cuts into my precious sleep time.

Why do I stay where I am? It’s all I know. Hospital nursing scares the hell out of me at this point. I feel dumbed down. The place is 5 minutes from my house and son’s school. I like my nighttime co-workers. And still another reason to stay is that it looks good on a mortgage application to have stayed a long time at one place, something we’re going to be facing soon.

I always wanted to be a ‘Scrub’. I loved the OR in school. LOVED IT! I know they have more surgical techs now and nurses have different roles in the surgical ward, but that’s all I ever wanted to be. Right by the doctor’s side passing instruments, watching the surgery. Cool.

When my mother lay dying from end stage chronic hepatitis, she was screaming at me “get out while you can!” She was referring to nursing. She was a nurse until the day she died, she kept up her CEU’s even though she’d stopped practicing a long time before. I wonder, should I get out or stay?

I don’t know what else to be.

It’s never too late to learn something new. Get your mortgage, then get a new job! I know, easier said than done.