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'A culture of mass paperwork has set nursing staff up to fail'


Firstly, I should make clear that I am a physiotherapist who has spent the last eight enjoyable years working in an outpatient physiotherapy department of a busy acute hospital.

Chris Tuckett

Chris Tuckett

But recently, my new falls prevention role has meant venturing back onto the wards.

Being on the wards again, I have a real sense of how the hospital is fighting to survive in a climate of cutbacks and funding crises, while still trying desperately to offer safe and effective healthcare.

Battling on the front line are the nursing staff who are, as in many trusts, under intense pressure. This can be blamed on a number of factors ranging from low salaries to growing workload, increasingly complex patients and a lack of qualified new staff.

As such, the priority should be to ensure current nursing staff are able to work as efficiently as possible. Instead, the sheer volume of paperwork that nurses are expected to complete is shameful – and it all has to be done while standing at a nursing station or the foot of a patient’s bed amid constant interruptions.

This paperwork is all deemed important and necessary to preserve patient care. When mistakes occur (as they inevitably do and always will), the huge paper trail we have developed means there will inevitably always be a piece of paperwork that is missing or incorrectly filled out that can then be used as evidence of why the mistake happened. I guarantee that if we audited every single patient’s documentation, at any hospital in the country, there would always be something missing or something that had been done “incorrectly”. Most of the time, however, things do go smoothly and so such omissions never come to light.

Filling out forms in the present NHS climate counts as patient care. The situation is unfair – it creates a climate of fear and distrust. This culture of mass paperwork has set nursing staff up to fail. Importantly, it gets in the way of delivering actual, real patient care.

If nurses are completing documentation all of the time, then they are not engaging with the patient. And nurses are currently not completing all of the paperwork for the simple reason that they are choosing to offer true patient interaction instead. So what’s the answer?

I would suggest that trusting medical staff and scrapping the bulk of documentation would empower them. Such a move would free up time and allow staff to demonstrate their hard-gained nursing knowledge, rather than relying on pre-printed forms and checklists to provide prescriptive knowledge.

Does a qualified nurse really need a risk assessment to know that a patient should wear non-slip, correctly fitting slippers to reduce their risk of falling? Does a doctor need a form to tell them they should consider compression stockings when a patient might be at risk of deep vein thrombosis? And does a nurse really need to be told that moving a patient regularly will reduce the risk of tissue viability issues arising?

There should, of course, be documentation but a single set of integrated patient notes should be enough. All professionals contributing to this shared piece of decision making would make for a linear patient journey and patients would experience better care.

Nationally, nursing staff are heroes, performing the toughest job in the country against a backdrop of understaffing, financial cuts, low pay, long hours and a lack of trust from both their bosses and the public. I salute them and feel very lucky to be an allied health professional instead.

Chris Tuckett is falls coordinator at The Princess Alexandra Hospital Trust, Harlow



Readers' comments (4)

  • Thank you for this. Sadly it is so very true. We have been bludgeoned into the 'if it isn't written down it didn't happen' fallacy. We are fighting against the straight jacket of one size fits all tick box protocols and paperwork. I am about to retire but have been battling to achieve just such streamlined interdisciplinary patient-centred record keeping as you describe and every time it's nearly been achieved someone - usually a manager - comes up with a reason to subvert it. It's tragic.

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  • Thank you for this article. Nurses are drowning in paperwork. I previously worked in inpatient settings and the amount of paperwork we had to complete was ridiculous. And I agree with the previous comment - there is a fear of "what if" if something is not written down. My colleagues and I have become accustomed to completing documentation to save our skins in any future disciplinary action rather than for actual patient planning and care.

    It's a sad state of affairs.

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  • Astute reflective observation...thanks. As for the managers don't trust us. Well it is sad because we do actually care. if we weren't running abut like headless chickens we might have more time to ensure mistakes don't happen

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    Very well written. I really enjoyed reading it and agree completely.

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