Nursing Quality — paperwork problems

nurseWhen Quasimodo answers your call light instead of the the nurse you know something is wrong.  It probably has to do with all that paperwork — one third of a nurse’s time is spent doing clerical work either on paper or on the computer.

Laura Landro of the Wall Street Journal reported 7/21/14:  “Nurses Shift, Aiming for More Time With Patients”.  Ms. Landro highlights one hospital where nurses are getting more help from LPNs and CNAs so they can spend more time at the bedside.

More low-level helpers — where does that lead?  Probably not to more Florence Nightingales at the bedside but rather fewer RNs who will mainly serve as supervisors.  Nurses are getting expensive so the trend will save money for hospitals.

Nurses are hit from many directions.  Shift-work is hard on family life and the educational requirements have increased.   Highly motivated nurses often escape the shift work by training to become outpatient nurse practitioners — why try to climb the corporate ladder?  Nurses aspire to be more like doctors at a time when doctors as hospitalists become more like nursing supervisors.  And, hospitals don’t see much value to experience —  they fire a 50 year old nurse so they can hire 2 twenty something nurses to save money.

Nurses are criticized for quality issues as well:

  • Poor shift to shift communication — who knows what the guy at the end of the hall has?
  • Collection of information that has no value 24 hours later — a huge waste of time.  Unfortunately, the nursing model is focused on filling out forms or online queries.   Always made worse by legal concerns.
  • Training that inhibits drawing a conclusion.  For example,  if a nurse finds a patient is on the floor bleeding from a cut on the head … the conclusion is “deficit of patient comfort”  rather than “scalp laceration and possible brain injury”.  That’s the doctor’s job — too bad the doctor is not always there.

It’s almost a perfect storm.  A general shortage of nurses, a background of quality problems, hospitals anxious to find lower cost employees, and nurses obtaining more training to command higher salaries.  Nursing is not going away but the RN job will be different in the future.

 

 

 

 

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