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Nurse on the Run

The Path of Least Resistance

Published March 27, 2014 9:38 AM by Lorettajo Kapinos

I believe everyone wants to do a good job. Maybe I'm a fool, but I can't imagine ever saying, "Today, I am going to do something terribly wrong, on purpose."  Usually there's a reason people diverge off the path. Maybe they need something they aren't getting. Maybe they are seeking to hide something. Maybe they are desperate or frustrated or overwhelmed.

But most often, I think people stray from doing the right thing, because it's easier and no one is going to call them out on it.

Say for example, you are an ED nurse. You know you should document vital signs every two hours, but to document the results is cumbersome and time consuming. If something goes wrong with the patient, the vitals are stored in the monitor--everyone knows the ED monitors all their patients all the time, right?-- you can enter them later if necessary.

You don't actually NEED to enter vitals. No one audits charts. No one really cares, unless there's a problem. And problems are what ED nurses handle best.

Some people call this behavior lazy or careless.There's all sorts of negative terms we can use to judge this nurse, But in reality, she or he is taking the path of least resistance. Not charting, unless something, is wrong is easier. For a while, that was actually the type of documentation I was taught to do. It had a name: charting by exception. Nurses only documented abnormalities. If it wasn't documented, then it was normal. It left a lot of room for omission errors.

Today's hospital culture has shifted into electronic documentation.  The time saving capabilites and potentials are often proven to be a myth. In fact, many experienced nurses struggle to utilize the tool, ending up overwhelmed and exhausted.  Good nurses cut corners not only because they can, but because they have to, in order to survive.

How do we fix this? I think first, we need to recognize the behavior. Electricity will naturally choose the path of least resistance. Humans, I believe are no different.  

I believe it's the job of nurse leaders to not only esure a job is done well, but to strive to make success as easy as possible. How do we do that? Does anyone have any ideas or things that they have tried that worked?

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When Iworked at Hanover Hall we were just changing to elelectronic charting,e-maiing physcians for orders etc.   Under some situations, I feel elelectronics can save time but for the most part it just causes chaos. For example: if you are having acute problems with a patient an you e-mail the physcian, receive orders and then the patient's situation changes. You have to document the first e-mail,orders,cancellation of the orders, then start with the next set of e-mails etc.If I can call and discuss the patient, problems, etc. I have made one call , discussed the problem with physician and received one set of orders.Seems more effcient to me.

Janet, Vent Unit - RN March 27, 2014 10:05 PM
East Berlin PA

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