1. Hader, Richard RN, CHE, CPHQ, NE-BC, PhD, FAAN

Article Content

Regulatory agencies such as The Joint Commission, the Centers for Medicare & Medicaid Services (CMS), and local Department of Health agencies continue to require RNs to document patient-care activities in alarming detail, taking the caregiver away from the bedside and chaining them to the medical record for an inordinate amount of time. Nurses are struggling with balancing the need to deliver care to high acuity patients with often unnecessary, mandated documentation requirements. The goal of regulatory agencies is to ensure optimal patient care, yet they're actually impeding the quality of care that can be delivered because of the enormous amount of time it takes to complete the ludicrous amount of paperwork that's required. Will these agencies continue to be allowed to require unfunded mandatory documentation requirements without scientific evidence that they improve the care given to patients?

Figure. No caption a... - Click to enlarge in new windowFigure. No caption available.

Healthcare reform needs to start at the bedside, not in legislative chambers around the country. Our elected leaders should be required to spend a day with a practicing RN to visualize firsthand the unnecessary information that regulatory agencies require nurses to document. Much of this documentation wastes precious time and resources that could be better allocated for teaching and administering nursing care to patients. Unfortunately, most of the required documentation is process, not outcome, oriented. Details of each encounter with the patient clouds the real healthcare issues and needs of the patient. When documentation is useless to the care delivered and valuable information is buried in voluminous pages within a medical record, it makes finding the necessary data to appropriately care for the patient difficult.


All healthcare organizations that are recipients of Medicare reimbursement are closely monitoring the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey results. This is a survey of patients' perception of the care and services they received while in the hospital. It's predicted that the results of this survey will shortly impact the amount of funding a hospital will receive from the CMS. Failure to do well on the survey could present severe economic concerns for healthcare organizations.


However, the HCAHPS survey doesn't address the completeness of the medical record, but rather focuses on the amount and quality of "touch points" between the caregiver and patient. I recently received a complaint from a family member of a patient that each time he needed a nurse, he would find her "playing on the computer." There's no explaining to a patient or his family and friends when he requires attention that there are countless documentation requirements and that this is a large majority of the workload for the nurse. The CMS expects both a high level of patient satisfaction and detailed documentation of each aspect of the healthcare received. A perfect storm is brewing-if there aren't significant changes made to the workload of the bedside practitioner, the system is bound to produce horrific hurricane effects.


As we've moved into an era of evidence-based care and protocols rooted in science, we must also investigate the workload associated with documentation that may provide no substantial healthcare gain to the patient. Nurse leaders, practitioners, and researchers must join forces to develop a system of documentation that improves the care delivered to patients and maximizes the limited resources available. Nurses should spend most of their time delivering care, not writing about it.


Richard Hader

Figure. No caption a... - Click to enlarge in new windowFigure. No caption available.