The next time you decide to yell at a nurse because he/she hasn't waited on you in the five minutes you pushed your call button (leading to bad satisfaction scores that are publicly reported), remember, it's because he/she has been doing this and documenting pain scales.
This is what we are waisting our time on. $50+ an hour in wages and benefits and we are turning our nurses into the signature police and documentation pimps and whores. The next time you complain that your pain is out of control, you're gonna have to wait while your nurse documents how bad the pain is. And then go back and time the order that she forgot two days prior. Oh yeah, and he/she has to play documentation police to the docs too, in addition to the clinical nurse specialists already running covert operation Maximize Reimbursement.
What the Hell is health care delivery coming to? A bunch of paper pushing scared little snitches running the hamster wheel with their tails cowering between their legs. Do you think the patient gives a crap whether you filled out your pain flow record to the likings of the Marijuana Mafia. Or that your time of day was present. It's all legal crap. Rules made by lawyers, for lawyers. We're stuck in the middle of this bloated pig trying to do the best we can while lawyers charge hundreds of dollars on hour on the front end, back end and middle end collecting their fees anyway they can. More rules to screw up. More lawsuits to follow. More settlements. More fees. More expense. Who loses? We all do. A highly complex, engrained culture of fear is here to serve you. But first please sign this release...
By the way, I'm not sure what this means. Maybe they smoked too many joints.--->
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July 16, 2008 Oakbrook Terrace, Ill. On July 15 Congress voted to override President Bush’s veto of the Medicare Improvements for Patients and Providers Act of 2008 that includes a provision relating to hospital accreditation deemed status. The Medicare reform bill is now law. While Congress clearly expects an uninterrupted continuation of the deemed status significance of Joint Commission hospital accreditation, the provision removes the unique deeming authority that the Medicare statute has specifically given The Joint Commission’s hospital accreditation program since 1965. In principle, The Joint Commission generally supports the provision’s intention. The provision requires all accrediting bodies, including The Joint Commission, to apply to CMS for hospital deeming authority. This is a process that The Joint Commission and all other accrediting bodies already go through when seeking deeming authority for the quality oversight of other types of providers, such as home care, laboratory and ambulatory surgery accreditation programs. It is important to note that accredited hospitals will not lose their deemed status. The provision contains a transition period so as not to disrupt the deemed status of accredited hospitals in addition to a 24-month period for The Joint Commission to apply for deeming authority and be recognized by CMS. The Joint Commission will apply for and is confident that it will receive deeming authority. |
Any takers?
Oh, Amen.
ReplyDeleteIt's insulting how micromanaged my job is. Since I'm a agency nurse I miss out on the wonderful world of Joint Commission, but I still get the fallout when I forgot to write "WRV" after my verbal orders. I don't recall what exactly these initials mean but they indicate that I have repeated the orders back to the physician. As though I wouldn't know to do that unless I had those magical three letters to remind me! Between things like that and keeping my med scan rate above 98% I'm ready to quit nursing, but it's like stripping. They pay just enough so that it's really hard to quit.
For those who don't know what a scan rate is: passing meds used to be very simple. You had a paper MAR and you would initial as you gave meds. Now I have to scan each med and then the patient. Sound good in theory, but in practice it takes me about four times longer to pass meds, due to the inefficiency of the scanner. It cuts into my patient care and med errors still occur. I'd love to see a study comparing med error rates with scan vs. paper, as well as overall patient outcomes.
Every staff restroom in out hospital has multiple signs of stuff nurses have to do. They're supposed to assess to asses every IV, every pain, every change in status. They're supposed to educate patients and families. They're supposed to be nice to doctors. Oh, and they have to document all of this.
ReplyDeleteThe nurses at my hopsital range from good nurses to great nurses. But all of them spend 50 to 75% of every shift (6 to 8 hours every day) doing nothing but "charting." They aren't taking care of patients; they are staring at computer screens filling out preprinted forms (or typing in assessments) that no one execept JCAHO will ever read.
I think if we let nurses actually be nurses patients would get better faster.
Happy:
ReplyDelete"Deeming: To have as an opinion; judge"
"Authority: the power to determine, adjudicate, or otherwise settle issues or disputes; jurisdiction; the right to control, command, or determine"
Heh - seems the bureaucrats in Congress have upended the bureaucrats at JCAHO with a very timely act of ommision.
And you know what? The bureaucracy's so thick in healthcare these days that noone noticed.
That's what it means.
I am a patient. I am also angry that my nurses cannot respond to my call for help when my pain is so bad I am crying out loud. This was when I had a lumbar fusion and the surgeon nicked a nerve because of the difficulty of removing one of three disks and the pain in my left leg was unforgiving.
ReplyDeleteI place no blame on my nurses. They were kind and understanding and I say God Bless you all.
Annie Gourieux in Nashville, TN
I just quit healthcare administration after 21 years. Walking away from a good-paying job. I simply refuse to be part of the problem anymore. HIPAA, I think, was the straw that broke this camel's back.
ReplyDeleteexaaaaaactly,
ReplyDeletethis is why bedside nurses are leaving the bedside. The demands of paperwork, computer work, taking care of visitors and others who think the hopsital is a hotel for their amusement leaves no time for actual patient care. management is a huuuuge problem because they only want you to look good on paper. who cares that you are a great nurse in person, if you didn't complete the pain scale you are dirt.
Annie Gourieux said: "I am also angry that my nurses cannot respond to my call for help when my pain is so bad I am crying out loud." So are we, Annie. So are we!
ReplyDeleteIt's stuff like this that made me leave hospital nursing. Yes, we in SNFs have an enormous amount of regulations to adhere to, but at least my nurses don't have to fight with computers, bar code scanners, and other strangleholds. My administrator was recently in the hospital for 3 days, and I was horrified at just how little I actually saw a nurse. I saw them sitting at computers in the hallways, charting, but in the entire day I spent with her, I never saw a nurse lay a stethoscope on her, nor ask her about her pain, nor check her IV.
ReplyDeleteI was appalled. So, exactly what was she charting on that computer, since she never assessed my boss lady? It boggles the mind.
I feel for ya'll, I really do. And I know it's coming to SNFs eventually. There's no escape...