Check the Box

Those of us on the front lines of hospital medicine face huge demands. We are given fewer resources and told to do more with less. Our managers cut our staffing, short-order our supplies, and then take home cost-saving bonuses for screwing us and our patients.

Nurses labor under the heavy yoke of charting. Assessments of all different types must be done. Every system must be thoroughly charted, every piece of liability-preventing paperwork must be filled out.

With the advent of computer charting, nurses are spending more time in front of a glowing screen entering data like clerks and less time at the bedside practicing nursing.

We have a system where what actually happens matters less than what gets charted.

At my facility, we had an incident where one nurse actually went to assess her patient and found a massive pressure ulcer. Such was the magnitude of this beast that it had been developing for at least several days; more likely it had been growing for weeks while the patient languished in bed.

When she went to chart it, she looked through the charting. Since admission, the ulcer was not documented. More to the point, it was actively charted that there was no wound. Dozens of nurses had charted that the skin was intact. Big, big problem: they didn’t just not chart a wound, they actively documented false data in the medical record.

In short, dozens of nurses checked the box, but not the patient.

When a nurse is given six or eight patients, with dozens if not hundreds of parameters to chart on each one in between hourly rounds, med administration, assessments, and dealing with the usual chaos of the hospital, it is an impossible task.

Eventually, they learn that nobody notices if they skip patient care, but they get “called on the carpet” if they skip documentation.

This creates a bizarre world where the nurse, rather than doing a good job, will simply half-ass it and then spend their shift checking boxes on the computer screen. To deal with the cognitive dissonance they act stressed and pretend to care. This is why so many of them are godawful bitches.

Respiratory care is going in a similar direction. It takes five minutes to administer a breath-actuated nebulizer treatment; it takes me at least that long to chart. Where I used to pay attention to my patients, I now spend my time hunched over a COW, pecking away at the keyboard, checking my boxes.

Patient care no longer matters. What matters is charting, covering our asses, and squeezing the most productivity out of our already ragged staff. Nietzsche said that “God is Dead;” I’m here to tell you that, in modern medicine, caring for or about your patients is dead. It’s irrelevant.

Charting defines reality, reimbursement, and liability. It is the ultimate driver behind everything in our world.

It doesn’t matter if we’re doing a really shitty job as long as we chart really well.

What a fucked-up system.

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2 Responses to Check the Box

  1. Cherie Olson says:

    Amen. So horribly true. I feel the exact same way. I don’t get to take care of my patient because I’m too busy making sure all the charting is completed so I don’t get myself or my employer in any trouble. It’s not why I went in to a medical profession.

  2. Wanderer says:

    So sad. So true. I clocked it one shift and found I spent at least 20minutes/hour on the computer. Extrapolated out, that’s a full third of my shift. That’s in addition to going all over to get supplies, pull meds, run to other units to steal food, paging a doc 4 times, chasing the LOL back to bed 7 times, waiting on hold for report, restraining the combative psych patient, etc., etc….

    I was happy (lucky?) to spend 10 minutes solid with a patient at the start of the shift all so I could go and check the boxes. Click, click, click.

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