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Practice comment

''Paperwork is important but some of it must be culled''


The Francis report (2013) has sent the message loud and clear that “statistics, benchmarks and action plans are tools, not ends in themselves; they should not come before patients and their experiences”

It is my suspicion that patients and nurses have known this for many years.

Twenty years ago I passionately defended the use of nursing documentation in Nursing Times, insisting that it does indeed affect the quality and delivery of nursing care (Charalambous, 1992). I have since extolled the virtues of documentation to student nurses who pass under my tutelage, insisting that we adopt a “master” rather than a “slave” approach and ensure we own it before it owns us. We must use documentation as a tool to help us care for patients rather than seeing it as “just another task” that needs to be completed. I can spend at least an hour of my working day filling out assessment tools, signing care plans and evaluating care - but now I wonder: do these things really affect patient care? Has the nursing profession gone full circle again?

I came into nursing to help people, to alleviate their suffering and to offer them comfort - offering a drink to a patient with parched, dry lips; going to a patient who is in pain, on wet sheets and upset. Walking away knowing that they are clean, comfortable and settled is my bread and butter. It makes me happy to know that I have done a good job.

But then comes all the paperwork that I have to complete. I wonder whether anyone will actually read any of it - unless, of course, there is a complaint because, as nurses, we all know we have to cover ourselves and if it isn’t written down it could not have happened.

I still extol the virtues of nursing documentation, but call for a cull. We need to master it, we need to take a universal approach and reduce the amount of it so that we can spend more time with patients. Time spent at the bedside is what nurses and patients want - ask anyone.

A large amount of what we do cannot be measured and no price can be put upon it, but interactions are the valuable side of nursing. Holding a patient’s hand to reassure them, gaining the trust of a person with dementia so they will allow you - a stranger in a scary place - to help them in the most intimate of ways is a privilege that cannot be described on paper in any way that is meaningful to an auditor or finance manager.

So, 20 years later, I still feel privileged to work in a way that is committed to planned, individualised care, but I would love to spend less time with paperwork and more time with patients. Heed my warning: we are in danger of knowing the cost of everything and the value of nothing if we do not take control now and downsize documentation.

Liz Charalambous is staff nurse, Queen’s Medical Centre, Nottingham.

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Readers' comments (4)

  • We have a ridiculous amount of paperwork in our unit, and it could be pared back quite a bit, but as soon as we get rid of one piece another two appear. What is this obsession with endless paperwork implemented by managers who don't have to do the work.

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  • The managers never come on the ward to see the understaffing and the problems for themselves.

    This is to protect them by stopping them seeing problems.

    Nurses have too much paperwork implemented by managers. "If it isn't recorded, it isn't done"

    This is also to protect managers. They must have some way, by proxy, of knowing that things are done without them actually seeing them done else they will have to walk on the wards, something they wish to avoid at all costs. There is fear of what is actually going on - managers know there is a mess on the wards and people are dying.
    Until they are forced to admit there is a problem, they won't act. All this paperwork stops them from admitting there is a problem.

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  • so a 45 page admission document, plus additional charts. Then add in an A4 form to complete for cleaning a bed, Forms to be completed to clean a cupboard.
    Then we move to accounting for discharge drugs in the same way as Morphine on top of filling in the discharge paperwork.
    Is considered reasonable?
    There is no control over who is introducing paperwork for nurses to fill in we have had 3 forms one from specialist nurse, one from dietitian and one from speech and language thearapist all asking the same questions and all refusing to accept the information is recorded elsewhere.
    I wonder how much money the NHS wastes every year on forms duplicating and triplicating the recording of the same piece of information as well as all the other useless pieces of paper that clog up wards these days.
    Given all the variations would it not be safer to have standard paperwork across the NHS.

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  • Anonymous | 28-Mar-2013 9:45 am

    It seems it would be far safer to have standardised paperwork for all NHS facilities to avoid ambiguity, duplication, misunderstandings, the risk of it being ignored and filed, extraneous costs and a waste of everybody's time which could be more usefully employed.

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