Paperwork, paperwork

Work has made a point of having several trainings lately that are useless, boring, and lead to only one thing: More paperwork for the nurses to do. Approximately a month ago, we had a mandatory nurses meeting on TB. Per state law, we give a mantoux to all new residents within 48 hours of admission. Protocol dictates that we follow with a second mantoux a week after the first one is read.

Several areas have been lacking by various nurses in this administration.

1. The lot number, exp. date, and manufacturer have not been recorded in the chart.
2. The results are not recorded in the nursing notes. For that matter, the administration of the mantoux is rarely recorded in the nursing notes.
3. The location of the mantoux is supposed to be recorded, at minimum, on the MAR.

Admittedly, I was unaware that there was a spot to record this information in their charts until nearly a year after I started. I found out because I asked. Seems to me that this is a matter of improper training on the part of administration.

Meanwhile, our clinical educator drags out a new poster from the CDC and a new form. This poster http://www.cdc.gov/tb/education/Mantoux/wallchart.htm is now plastered up in our medroom, covering up the actual useful poster from our main pharmacy, with expiration dates for medications. I cursed the CDC under my breath.

The new form that we are required to fill out upon admission includes such questions as
-Where were you born?
-Are you HIV or Hep B positive?
-Have you traveled outside the US in the last two years?

I'm wondering if I should ask these questions before or after I do the basic cognitive questionaire, which is another new form we are required to fill out upon admission, which is designed to determine (but not by the floor RN or LPN) if the new resident is A&O x3-4.

Either way, most of our residents are admitted with a family member at their side, who interfere with the cognitive questioning--and the floor nurse gets chastized if the resident if the form is not filled out upon admission. It's a real PITA to spend 30 min. or more of my time doing an admission in the room (this does not account for the time spent at the desk filling out the rest of the paperwork) attempting to get VS, do a head to to exam, a full skin assessment, starting a tissue tolerence test, getting a CNA to get a weight, orienting to the room, get a pitcher of water, bedpan, and basic toiletries in the room. These are the things that the family wants to see done ASAP.

My main concern when doing an admission is safety. Did I communicate enough information to the resident that they know how to use a call light and know where everything is? Have I spent enought time with them to know if they are cognitively aware enough to use a call light and/or ask for help aka Do they have "Impaired safety awareness." Just like in foster care, we strive to provide the least restrictive environment. Does their diagnosis require that they have assistance in transferring? Can they bear weight on both legs? Does the CNA know all of this?

My good CNAs will rush into the room with the weight chair loaded down with toiletries, ask about continence, and grab some incontinence pads. They will wait in the room under the guise of getting a weight and adjusting their toileteries to find out how A&O the new resident is, if they can bear weight, etc. I wish we had more of those.

But the rule in health care is "If it's not documented, it's not done." Therefore, despite MY priorities, I have to fill out a shit load of paperwork after I leave the room. Some of this info can't be determined in the first 30 min. Sometimes the resident/family doesn't know. The tissue tolerence test takes 4 hours--two hours sitting, two hours laying. I'll admit that I cheat. If I go back into the room two hours later (I'll tell the CNA to get me the first time they ask to go to the bathroom) I'll check their skin at that time and if it's all good, I back track the tolerence. If there is an issue, then I'll re-assess to find out where in the two hours it becomes an issue. More often than not, I just saved myself a big ass hassle.

Then there is my least favorite rule in nursing: If a nurse is at the nurse's station, it's because he/she is just waiting to leap up and do your bidding. The nurse is bored, has nothing to do, and is just waiting to run and help someone. We are never swamped with admissions paperwork, we are never swamped with regular charting or day to day paperwork. And we are never, ever, ever trying to take a break or tape report. If two nurses are at the nurse's station, the rule is that we are either playing on the computer or that we are chit-chatting. It's not possible that we are collaborating and trying to solve a problem that's happening with a resident. It's not possible that we are working together. Nope, those lazy nurses are doing nothing.

Needless to say, I'm not looking forward to our upcoming mandatory training. I know another form is going to be dragged out. None of these mandatory meetings are truly mandatory, but if I don't show, there's no system in place for me to get the information. Nope, no newsletter, no meeting summary or notes. I've suggested this very thing...and was thanked for my thoughts and input. Our clinical education director is stale, stagnant. She's been in this position too long. Most of her information is bad and outdated. It would be so nice if real education could happen.

I need to come up with something, but I'm not sure how or what. I've been thinking/brewing on a few things for a few months now, but haven't been able to effectively put anything together. Damn, I'm just as useless as she is. Maybe I can get her job when she retires?