The Challenges of Healthcare, Part III

The Challenges of Healthcare, Part III

By Charlie Melton

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 give.

We were discussing why so much documentation is required of nurses. Some even have to chart that they washed their hands and put on gloves.
Nurses do acknowledge the need to document patient care that contributes to patient management and treatment. This communication between caregivers is essential. We’re not talking about the necessary charting. We’re talking about excessive charting.

We went through the belief that the threat of lawsuits is the driving factor for excessive charting. I said that malpractice suits are brought by people that feel they’ve been wronged or are looking for money, or both.

Why are people suing due to being wronged or looking for a payday?

The answer is that the state allows, and even encourages it. The state is complicit in excessive paperwork by nurses. In Illinois, the limits on malpractice suits are mostly non-existent. The caps enacted were ruled unconstitutional so there is really no limit on how much you can be awarded. This in itself is very enticing and very dangerous for nurses. It should be noted that states that have limits on malpractice awards have fewer lawsuits. I do not know if this equates to less charting by nurses.

Illinois also lets you sue in counties other than where the incidents occurred. Many cases end up in St. Clair, Madison, and Cook Counties because the counties give out more money.

Against my best efforts I ended up on a malpractice jury in St. Clair County when I lived in that county. The medical practice and the home of the injured party were in Monroe County. The attorney followed the money, and expected an enormous amount of it. After the longest 2 weeks of my life, we gave the person and his attorney absolutely nothing. That case, which should have been in the home county, was the exception. Most juries gave huge awards in that courthouse.

Lawyers are part of the cause of nurses being under fire. Greedy clients are part of the problem. The state itself is at fault as well. With all things being equal, I think the state limiting money available in malpractice suits will reduce a lot of the fear of lawsuits that causes excessive documentation by nurses.

I spoke to an attorney about my concerns. He doesn’t see a problem with nurses documenting so much information. His opinion is that as a professional you document. He relayed that he spends a lot of time documenting his actions. I thought it was funny that part of the reason is to protect himself from being sued by a client.

In my unqualified mind I think the medical establishment is to blame as well. Medical organizations are notoriously top-down. They give instructions and mandate actions often without input from any staff members affected by the mandates. Leaders make sweeping policies and have no patience with any dissenting opinions.

The issue of nurses’ reduced opportunities to care for patients is “standard practice” and taken for granted. It doesn’t have to be. Other industries have developed and embraced all sorts of process improvement techniques. Systems like “Lean”, “Six- Sigma”, and other methods have saved entire industries from oblivion. Some medical corporations have embraced process improvement, but not to the extent they’re needed. Leaders have to give up power to embrace the changes needed to free up nurses to do what they’re supposed to be doing. Leaders must learn that decisions need to be made at the lowest level possible.

We’ve talked a long time about excessive charting being required of nurses. We should be concerned because we want better care and more expedient care. Nurses are concerned because they want to care for people and heal. They know, and we know, that paperwork never healed anyone.
This is an opportunity for us to improve our lives. This is an issue to bring to legislators. This is an issue to bring to your medical providers.

I want to urge the state to enact limits on lawsuits. I want cases to be tried in the appropriate county. I want to get the care I need. I want to go home without waiting on a ton of paperwork. I hope you want the same thing and help achieve it.