We were talking about the problems in health care. I pointed out that I believe nurses have to spend entirely too much time charting. They have less time to care for patients because of it. We all get less care and nurses can’t give all of the care they wish to.
The National Institutes of Health commissioned a time and motion study of 767 nurses at 36 hospitals. The study found that nurses spent the vast majority of their time (35.3%) in documentation, med pass (17.2%), and care coordination (20.6%) for a total of 73.1%. Only 19.3% of their time is spent on patient care and 7.2% of their time on patient assessment.
I brought this concern to nurses, and they believe they have to chart excessively because of the danger of lawsuits.
Is there a real threat of lawsuits against nurses?
Historically we think of malpractice lawsuits as being against doctors or institutions. That is no longer the case. Nurses are frequently named in malpractice suits. Multi-million dollar awards from malpractice suits aren’t unheard of. One source claims that Illinois malpractice case fees collected by attorneys exceed $200 million a year. This amount is only a portion of the total money awarded. Nurses are often part of those lawsuits.
The threat of lawsuits is a real danger to nurses. The professional nursing associations encourage nurses to carry malpractice insurance. The fear of lawsuits may influence how they have to perform their jobs. Because institutions fear lawsuits, they may demand an ever increasing amount of documentation to protect from lawsuits.
What is the root cause of excessive charting? As I’ve stated, I lean towards lawyers causing this disruption. I approached one of my former professors from SIU. He’s the most analytical and methodical person I know. He never makes assumptions and always follows the data to its conclusion. He’s not convinced that this is the root cause of excessive documentation by nurses. When I announced to him that I’d identified the cause, he asked how I determined that the threat of lawsuits causes excessive documentation by nurses. He teaches to repeatedly ask why until you run out of “whys”. At that point you’ll be closer to the answer.
In this case, why is there a threat of lawsuits? There is a threat of lawsuits because people want to sue. Why do people want to sue? Because either they have been wronged or are looking for a payday, or both.
It should be noted that lawyers only do what the client allows them to do.
I know that some people sue to make money. There was just a story on the news about a policeman that was getting free coffee at a business and was burned by that free coffee. He sued. We all know similar stories. Some people sue because they can. It’s further verified by the fact that when the Illinois economy goes down, malpractice suits go up. It appears that you can supplement a lowered income with the proceeds of a lawsuit.
I’ve pointed out what I see as a problem. I’ve tried to start a discussion that someday may contribute to a solution.
How bad is it anyway? Is excessive time charting enough of an issue to even care about? Are there novel solutions to the problem?
Next week in my final installment I want to look at the results of all this paperwork. Has it really protected nurses? What is the impact on the patient? What can we do, and what can nurses do?
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