Nurses shouldn't have to pick between integrity and compliance, one writes, calling for a standard national work system

The writer is a nurse in Central City. She wrote this for The Leader-News.

By Dara Bratcher

Integrity is one of the most important qualities a nurse should possess. We must perform our duties completely and accurately. We should be talking to our residents with the intention of hearing what they have to say, treating the person, not just the wound or illness.

We must take the time to ensure our residents have the sense of security they long for, treat our elderly with dignity, and work to improve their quality of life.

Sometimes these goals come into conflict with another important part of nursing – compliance, which is the option nurses are conditioned to choose in the workplace these days. It is implied that we should make sure everything is signed off on, and then if there is time, go back and do the work. We are expected to comply with state and federal regulations within the nursing budget set for the facility, or face disciplinary action.

State and federal regulations implemented to protect residents of long-term-care facilities have created so much redundancy in the workload, nurses find themselves being pushed away from nursing and into clerical roles. It may not seem time-consuming to type in a set of vital signs or write a progress note, but the ratio of nurses to residents adds up when one nurse has dozens of patients under their care.

We are left to make a decision, the ultimate dilemma nurses face: Do we maintain our integrity and face reprimand, or remain compliant and leave the work of caregiving undone? With little money for overtime in most nursing-home budgets and paperwork necessary to remain in compliance, corporate officers encourage us to fill in the blanks first, then do whatever tasks time allows before the end of our shift.

The majority of nurses care as much as I do, but choose to comply. Can you blame them? People choose job security over fighting a losing battle. I don't believe we have a shortage of nurses who care; I believe there is a problem with the system.

I have always been strong willed, but the spark I have in me when it comes to the type of care I give is now a flame.

My dad, also known as Grandad to my children, was usually my babysitter. He complained daily about me coming home from work late. After my 12-hour shift was over I should “pass it on to the next shift” and come home, he would tell me. I would try to explain to him why my 12-hour shifts often turned into 14, 15, 16 hour shifts.

It wasn’t until my dad became a resident of a nursing home that he was able to truly understand what I had been trying to tell him all along. On one of the last days he was able to communicate before he passed away, in his own way of apologizing, he told me he could finally see the difference in how I talk about the way I do my job, and how other nurses do theirs.

He said, “Dara, I see now what you mean about not only treating your patients, but also treating them like human beings.” His words were, “Do not let the world change you, you fight to change the world!” After six years of hearing how much he hated the career I chose because it took me away from my family, it had turned to respect in just a few short weeks.

I know these regulations and their enforcers are meant to serve as advocates for residents, to ensure they receive the level of care they deserve, but at some point we lost sight of who the Number One patient advocate should be: the nurse.

We should build a nationwide operating system that eliminates redundant work and improves communication. This should include features such as linking data to appropriate assessments, evaluations, notes, etc. and standardizing forms and protocols. All nursing homes and long-term-care units should follow the same protocols, with the same required forms in the same format, whether documenting a new admission or a patient discharge, and everything in between.

This would not only reduce time spent at a computer, but reduce the margin of error in documentation. It would make for easier transitions when a resident transfers from one facility to another. It would also make it easier for nurses when changing employers, cutting down on orientation time, by bringing their career-long knowledge of documentation along with them.

Doing this, I believe we can ensure better patient outcomes, improve resident satisfaction with nursing-home care, and improve overall satisfaction with the nurse’s role in the workplace. I also believe when we are given the opportunity to actually perform the work of nursing, the shortage of nurses we are experiencing will eventually fade away, as the perception of nursing changes along with us.