A Nurse With Attitude

Where Dark Cynical Humor, Nursing Issues, and Politics Seem to Merge

(EPIC) Electronic Documentation goes live

I review current events and the news almost every day.  As a nurse,  I perk up at anything that comes across the board about the bureaucracy surrounding medical care.  Because of the enhanced government regulation of health care,  for every hour spent actually delivering care, there is an hour spent on documentation of that care.   That’s a 1:1 ratio of paperwork to patient care.


This is utterly ridiculous and incredibly frustrating for most nurses.  As care givers, we are paired down to only giving half of the actual care that we did only a few years ago with the same number of nurses.  Somehow our lawmakers are under the illusion that enhanced regulations add to the overall quality of the care delivered.

Did you know that there are six ICD codes specifically for water ski injuries. There are 12 codes for injuries related to parrots.  The lawmakers don’t seem to ever  do anything constructive.  Congress makes hundreds,  if not thousands of laws each session.  Do they resend any of the past laws before making new ones?  Not hardly.   How about, for once, let’s give a try with less restrictions, less regulation, less bureaucracy in health care.

Recently, Obama has mandated that all health care facilities go to “paperless documentation”.  This was sold as a way to “streamline” healthcare and make things “better and more accessible”.   At my current place of employment, I work in the operating room.  We just shifted to “EPIC  online” medical documentation.  This takes at least twice the time to do the same documentation we were struggling with doing on paper.  Well, the good news is with this system,  the billing department is said to be able to “better capture cost and expenditure.”  Unfortunately, it is horrible for all hands on caregivers that are involved.  Since the onset of EPIC, we have implemented having one extra nurse designated  as just the “documentation nurse” in each room. .. ridiculous.  This is expected to change back to only one nurse as soon as “the line nurses get comfortable with EPIC.”

The latest mandate that came out this morning… The management team has determined that EPIC is “unreliable in capturing charges.”  So, to make sure that implanted items, such as with hip, knee, spine and most all orthopedic surgeries,  are properly charged for, we are to double document the items.  Yes, we are to document all implanted  items in EPIC and on the old paper charge sheet.  This is to insure that  “all charges are captured”.  Will this insure proper charges and accurate documentation.  Not really. Most nurses are patient centered instead of budget centered. That is , when stressed and short for time to give adequate and safe care, the first thing nurses  slouch on is charging the patient for surgical items.  Nurses feel that they can’t compromise on quality care, and most patients don’t complain for a few extra free items at the end of the day.  I try very hard to make the charges correct, but when asked by my manager how it was going with the charge system.  I responded honestly, quite accidentally, and a little sarcastically.  Just like in the comic strip “Dilbert”,  managers are as far from actual physical work and hands on health care as they can possibly get.  So,  by the same token, they have practically no real understanding of  nursing issues.  Knowing that she would never really understand,  I answered her question with an old Cajun parable… “a man with one watch knows exactly what time it is all the time.  A man with two watches never really knows, for sure, the exact time.  So, with this double documentation thing… I think that this institution is ripe for a fraud investigation.  “Oh crap… did I just say that out loud?”



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