Loading ...
Eight out of 10 nurses say they have left work distressed because they have been unable to treat patients with the dignity they deserve, a poll suggests.
Today, a different poll of nurses revealed another concern.
A poll of 1,752 nurses found that a fifth of the time of a standard nurse is spent doing non-essential paperwork.
Hmm, could these two issues be somehow…related? I stroke my imaginary beard.
One unfortunate product of today’s legalistic, sue everybody, health and safety-obsessed culture (wowzers, I’m starting to sound like Oldschoolbaby now. Are we merging into one?) is a situation where we’re supposed to document everything, and sometimes it can feel like documenting what you’ve done can be granted a higher priority than actually doing it in the first place. Sadly, we’re not the only profession that has this problem. Just ask a social worker, a teacher or a police officer.
Personally, I blame the lawyers. Create an environment when everyone’s terrified of getting sued for something, and they become fixated with dotting the i’s and crossing the t’s on the paperwork, and it can become a management-dictated obsession that starts eating into the actual getting-on-with-the-job.
I think I shall use this issue to point the reader to my old post on the use of care plans as a form of magical talisman. At the risk of blowing my own trumpet (arf!) I still regard this as being one of my favourite posts that I’ve made on this site.
I’m not saying all care plans are useless, but do nurses really need to spend half an hour writing a care plan detailing actions that any halfway competent nurse would do anyway?
(Popping over to Dr Crippen’s site, I notice that he’s made a post making roughly the same point, except with lots of hysterical gibbering added about “protocols”, consultant nurses, “psychobabel”…I got about halfway through and decided it was one to be filed under tl;dr.)
Most care plans I recall in UK were written as per ‘the magical talisman’ – for two reasons: litigation – and nurses too stupid/lazy to put any effort into it.
I partly resolved this (in a UK job) by making a standardised treatment plan for all patients that included all the simple bits that are commonplace (obs; meds; record; MHA rights; talk to the patient; etc) which was introduced on admission to run concurrent to anything else – thus leaving the nurse to think up something else that was actually meaningful to the individual for the empty care plan work.
There is some place for standardising care plans – just as there are ways to standardise medical diagnostics or how to do the shopping. The ’standard’ treatment actually requires competent staff to know what it is and how to do it – eg “Issue: Commencing Clozapine – Plan: Implement the Clozapine pathway” – you don’t need to detail the whole thing if it exists elsewhere and it is common practice (indeed a pre-requisite) that all patients undergo pre and peri clozapine protocols.
Aside note: I am greatly entertained here in Oz with the disparity between the medical treatment plan and the individual care plan (which is actually devised and reviewed by the complete MDT yet still fails to match the medical plan).
Care plans are supposed to inform the patient what care you are going to offer them. Of course, the vast majority of them aren’t written with this in mind, so you end up with nonsense like “schizophrenia” being presented as the “nursing problem”. Having just conducted a care planning exercise with a group of students who have been taught care planning techniques at every single opportunity, I am totally depressed at their continuing inability to write them.
Personally, I think care plans have had their day, and care pathways, as described by Mr Ian, should take their place. They too inform the patient what care to expect, but don’t rely on the literacy skills of the nurse to express that.
I partly resolved this (in a UK job) by making a standardised treatment plan for all patients that included all the simple bits that are commonplace (obs; meds; record; MHA rights; talk to the patient; etc) which was introduced on admission to run concurrent to anything else – thus leaving the nurse to think up something else that was actually meaningful to the individual for the empty care plan work.
At my local psych unit they introduced exactly this. Unfortunately it got stopped because some jumped-up manager went round the wards telling them to take the standardised care plans out and re-write them by hand. But then this was a manager who wound up making herself so unpopular with the clinical staff that she got bounced sideways to another job.
Possibly the breaking point might have been when she tried to persuade a roomful of consultant psychiatrists that they had to spend an extra 20 minutes per patient filling in risk assessment paperwork.
Picking up on beakie’s point: “nonsense like “schizophrenia” being presented as the “nursing problem” ” is spot on. And in fact, I would further that any paperwork now completed is not actually in the direct interest of the patient but is for the beneficence of the organisation (stats), legalities (MHA), litigators (risk) or, less frequently, clinicians (assessments).
I’m not sure in fact what paperwork is currently in use that actually does make provisions for direct patient care. Anyone?
I said it over at Crippen, and I’ll be happy to say it again, in agreement with z. Any half competent nurse knows the things that need to be done, but unfortunately the NHS is not full of even half competent nurses. Ruining it for the rest of us, so to quote a cliché. So now, the competent nurse has to try and provide patient care whilst jumping through the hoops and over obstacles made of paperwork. No wonder so many are burning out..