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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Charalambous L (1992) Write to care. Nursing Times; 88: 50, 47.
Francis R (2013) Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry. London: The Stationery Office.