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We Need To Talk About Charting

Seriously, this is getting out of hand

When I was an NP wannabe, still in school, we had to practice charting on our patients and turn in the logs for review and feedback. We used Typhon; you probably did, too. It was a clunky software system, but as students we saw less patients per day than we would as practicing clinicians, so I don’t think most of us gave it much thought. We also had to chart at our clinical rotations, so we were charting twice on each patient; okay, well, we’re students, so that’s kind of to be expected? Right?

It'll be different when we’re out there on our own in our first jobs.

Truer words have never been uttered.

It was different on our own, and if you were actually warned about that in advance – congratulations, because most of us were taken by surprise. Charting is a major time commitment (drain) as a patient-facing clinician; it’s not unusual to spend a couple of hours a day on charting after you are done with patient care. Maybe not unusual, but is it right? Should we be essentially donating our own time to our employers, after already having worked a full day?

If you have admin time (a chunk of time set aside in your schedule to complete things like charting, following up on test results, etc), your employer is acknowledging that there is a significant amount of work to be done outside of the time spent with patients, and is making some kind of gesture to meet you halfway. It benefits them, too, because the sooner your notes are done the sooner they can send their bill and get paid. (Read that again: it benefits them.)

For those of you (like me, back in the day) that don’t have admin time in your schedule, prepare to go above and beyond and sacrifice some of your personal time to your employer. Kind of like how teachers pay for supplies for their classrooms out of their own pockets.

In the restaurant industry, this is called “side work.” If you wait tables, you don’t simply take orders to the kitchen and food out to the patrons; you also have to roll up bundles of silverware, clean stations, refill salt shakers, that sort of thing. This isn’t work that you can do if you have nothing else to do; it’s work that is officially unofficially assigned to you, and that you are expected to complete.

“Charting” is the “side work” of healthcare.

My things is that this is never really discussed. It’s bellyached about; we bitch to each other about it, we compare stories about how late we stayed, how many items were in our inbox, etc. We swap strategies for dealing with it; some people stay late, some come into the office obscenely early, others fall asleep over their laptops charting at home. This is part of the culture, and everyone fucking hates it. We may play along with the bravado of how much we have to do, but no one is happy about it. And it’s not healthy.

If you get admin time to get these things done, consider yourself lucky. The presence of admin time in clinicians’ weekly schedules varies widely by location and specialty; to be frank, some specialties need it more than others (I’m looking at you, family medicine).

If everyone hates it so much, why is it still a thing (and why is it getting worse)? I have some theories. One is that busywork keeps us, well, busy – too busy to complain about things, big things. Too busy to make demands until we are at our breaking point. Too exhausted to notice the pattern - hard to see the big picture when it takes everything you’ve got to just get through the day.

Another is that it’s job creep; over time, the cultural milieu of healthcare has creeped beyond appropriate boundaries, and has started to take more from us than our knowledge, skill, and expertise. It’s started to take our time – the time we have to recharge, to spend with friends and family, the time that we are not “on.”

Another theory is that it’s motivated by money (isn’t everything?). Hiring a scribe to help with our charting would be too expensive (would chip away at the bottom line); having providers see less patients per day in order to have more time for admin tasks would mean less revenue (which would chip away at the bottom line); having additional staff that could help with some of the paperwork burdens would also (you guessed it) chip away at the bottom line.

So what do we do?

Speak up. Not to each other – well, not exclusively to each other. To leadership. Be prepared; they’re probably not going to want to hear it, and they’re probably going to have a list of reasons why it has to be this way. Ask yourself – would any of those arguments be invalidated if enough of us spoke up? If we normalized having appropriate boundaries?

No one is going to protect your time for you. And you’ve probably heard it before, but it bears repeating: time is the only resource that can’t be regenerated or replaced. No one, on their deathbed, is going to say they wish they had spent more time at work, charting or rolling up silverware.

We advocate for our patients. We need to start advocating for ourselves.

In other news

2023 and it’s resolutions are right around the corner. I’m striking a balance; this newsletter is my just-under-the-wire 2022 resolution, and I’m starting my 2023 resolution early… I’m putting together a monthly subscription for you all. You know how there is BarkBox for dogs, where they get a couple of packs of treats and a new toy every month? Same idea, but for Nurse Practitioners. I’m still working out the details, but at this point, think: podcast, monthly Q&A session, merch (that you can actually use, not another coffee cup with a logo), self-paced time management focused workshops, and CONTINUING ED CREDIT.

If you have heard enough and want in already, click here. If you have some thoughts on what MUST be included, let me know! I’m excited about this one.

Take care,

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