My Kingdom for a Backrub: Freeing Nurses from Documenting Care to Give Care

A few years ago, the first author had a hip replaced. During the operative night, she was really very uncomfortable—not from the operative site, but from her back, which she can’t lie on for very long without lower back pain. She asked if someone could rub her back, but was refused.  Today the first author was repeating this tale of woe in a nursing documentation workgroup—and they laughed.  No nurse has time to give a backrub any more (obviously, the first author is an antique) because they are too busy documenting patients’ pain! 

We find this very sad.  How can documentation be streamlined so nurses have time to respond to patients’ real needs, rather than just adhering to their medication and treatment regimes?  In other words, can nurses’ documentation be reduced to just those items necessary to tell the patient’s story in a way that all disciplines—and even patients—can understand?  Yes, details of care must be documented for legal purposes—but that means documenting according to the policies of our agencies. Perhaps those policies too need to be reviewed.     

As concerns about our current opioid crisis grow in number, we anticipate that there will be increased reticence on the part of physicians--and perhaps even nurses—about giving them. Without opioids, nurses will need to rely more on their interaction with patients to determine what other medications or therapies can help to reduce or control their pain. Are there alternative therapies (e.g., meditation, yoga, massage, therapeutic touch, acupuncture, nerve blocks) that can be used?  The first author supervised a pain unit years ago where the staff were highly successful in reducing patients’ pain—without narcotics. Perhaps we need to adopt such methods more widely. 

More research is needed so that we can learn how best to manage patients’ pain. Researchers engaged in one study note that their work is made more difficult because nurses document pain medication in a consistent location, but not the patient’s response to the medication. Only when both patient therapies and their responses to therapies are documented consistently can they be studied and the results provided to nurses so we can learn how to better manage pain and other conditions.

We end on a note of hope. Nurses involved in the Nursing Knowledge: Big Data Science project are working on potential solutions. Other nurses are working in their own practice settings, many of them as part of vendor user/developer groups. The changes needed are taking place—but slowly and one step at a time. Change can come more quickly when ideas are shared. To that end, as part of Big Data effort, our project team has proposed creating a repository for Best Practices in Nursing Informatics that will be housed in the Virginia Henderson Library.  As part of that library, our repository will be open to everyone—even non-nurses—and will house materials in any format (audio, video, text papers, reports, policies, procedures, and even coding). A nurse must be the first author, and authors will retain copyright of the materials they submit.  Two or three nursing informatics experts will review the materials submitted, and their reviews will be posted along with the material. When others use the materials, they will be asked to post their own evaluations. These multiple evaluations will make it much easier to assess the utility and usability of submissions in multiple contexts, something that has always been difficult to do.

We hope that sharing solutions more widely will help nurses again be able to meet individual patient needs without feeling that the time needed for documentation precludes this. If you were part of an initiative that worked to reduce documentation time in your workplace, please contact us and we will let you know when the Repository for Best Practices in Nursing Informatics is ready for your submission.