I was invited out to dinner with some folks from the department, including a couple of nurses and one of the resident low-level paper pushers who is also a nurse. She is a nice person, but has more interest in paper pushing. Plus yelling at all of us when our BLS is about to expire. I call her Bean, short for Beancounter. Every day there is another directive or rule change. Or a new "checklist.
Bean was bemoaning the fact that people were not compliant using the newest checklist devised for stroke patients. I found stacks of them placed in specially labeled folders at each triage desk, in the critical rooms, and at every single computer in the department. Yet nurses were not using them consistently and Bean was frustrated.
"What can I do to get people to use these checklists?" Bean asked plaintively.
Ok, since you asked:
"It's another stupid thing, Bean. Just another thing to do that takes the focus off the patient places it on the paperwork".
Bean (horrified): "But these are so important, like doing neuro checks every 15 minutes!"
Me: "Bean, seriously? Do you really think these things aren't being done for the patient? Do you think we aren't assessing continuously? Shouldn't the focus be on the what's going on with the patient and not simply writing it down and wrapping it up pretty?"
Bean (piously): "If it isn't documented, it isn't done".
Me: "Right. I've seen you doing the postmortems on all these checklists, and never in recent memory can I recall anyone being told that they have done a good job, either with the patient or on the checklists. Each time we get a STEMI, stroke, trauma in which the paperwork is more of an issue than the care of the patient, we grab the paperwork and say "yep, wonder how long it will take for someone to yell at me for what I did wrong, or I get a nastygram from administration". See, we're damned if we do and damned if we don't. There is little motivation to get the paperwork done to order. We're beat up with this shit, Bean".
Bean: (stunned): "You don't understand with pressure we get from above…"
Oh, please. Boo fucking hoo.
Me: "I get that you take heat from admin, and then you have to torture us. I do. It's a suck job I wouldn't want, but you asked how to get people to fill out your checklist; I've merely told you we do the best we can. But what you haven't asked is how to help us be in two places at once, doing paperwork in real time and being at the bedside. That's all"
Since I appeared to be ready to get on the table and jump up and down, one of the other nurses agreed with me then promptly changed the subject.
Probably won't be invited to dinner again.