What’s Taking the Nurse Away from the Patient Bedside?

April 11, 2014
iVantage Health

More than 100 nurses told us in a recent survey on nursing obstacles and inefficiencies. A ViewPoints post from iVantage’s Michelle Gray Bernhardt.

[dropcap]I[/dropcap]t’s widely known that nurses find the documentation process frustrating. A Google search on “improve nursing documentation” yields about 21,100,000 results. When we last asked members of our Nursing Knowledge Communities this same question (2010), we got the same answer. If anything, documentation demands have expanded since then as hospitals react to new auditing, regulatory, and sometimes licensing requirements.

Is there simply too much documentation expected of nurses? I remember a conversation with a nurse who told me that checklist style assessments were frequently checked off before the patient assessment was completed, in order to avoiding logging on again later. While checklists are thought of as time savers, this is clearly not the context in which time should be saved.

New and changing EHRs also take time to learn and to teach. Computers may drop connections, programs may be unstable. New features or modules are added to appease individual departments without taking into consideration how this will ripple through other areas. Hybrid part EHR/part paper records cause frustration as nurses struggle to remember what goes where and to have the appropriate materials (paper charts, computers) at hand when they need them.

To maximize nurses’ time, computers should also be readily available. Even mobile workstations can’t guarantee that an RN will have a computer accessible when they need it.

A related frustration is time spent reviewing the documentation ” by both nurses and physicians. One nurse noted that she sometimes says to physicians who are focused on computer screens that “the patient is over here.”

What do nurses think would improve the situation? Here are some of the things we heard:

  • Additional resources: Better (faster) computer systems. Someone to check daily documentation for completion.
  • An improved EHR: Simple sign-on for caregivers, easier charting systems, improved navigation, improved flow. One system for all units; one system to communicate with the entire organization. Voice recognition vs. data entry. More efficient charting where pumps, IAPBs, CRRTS, ETC flow through and don’t require the nurse to input hourly information.
  • Better Support: User-friendly IT support.
  • Change Practice Model: Replace Utilization Review by management to outcomes and standards.
  • Chart the Necessities: Eliminate unnecessary information. Chart by exception. Back to flow sheets then have them scanned into patient records. Completely remove nursing care plans.
  • Consolidate System or Practice Updates: Don’t inundate staff with e-mails about changes — have a link on the portal with updates for various areas (pharmacy, bsi, vap, falls, cauti data).
  • Eliminate Double Work: End duplicate charting. Information asked in pre-admission testing or during the admitting process would pre-populate and could be verified vs. re-entered.
  • More Computers: Have a computer in each patient room, or assign each staff member their own computer to save time looking for an available computer to use.
  • Physician Engagement: Physicians (vs. RNs) to place orders and be familiar with the EHR. Unite physician offices with ED computers to track and trend medication management. Make patient education easier to chart and more accessible to physicians. Report critical values directly to ordering provider or provider on call.
  • Streamline Communication/Education: Have one primary source for communication/updates to staff.  Limit e-mails.

Would you like to peer network to solve common healthcare challenges? Contact Michelle atTM mgray@ivantagehealth.com to join the INFORM Knowledge Web community.

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