RN’s out there. PLEASE DO NOT DO THIS.
Don’t write inflammatory things in the chart unless you are CERTAIN the patient is going to go down the tubes and the MD refuses to intervene. I know you are trying to be a patient advocate but writing something like, ” MD is too busy with other ED patients to attend to patient (the one in her zone she was charting on) and asks the ICU resident be called.” simply looks bad. If God forbid something happened to that patient EVEN if the ED attending was on top of it, the lawyers will POUNCE all over it and claim the care was disjoint and there was disagreement between staff. Write something like, “BP 80/palp. Patient appears comfortable with good saturation, ICU resident paged”.
This happened to me the other shift and as soon as I read it, I had to drop what I was doing (dealing with another patient with an MI) and chart something on my note like “at 8:46pm (one minute after the nurse dated her note), I reevaluated patient. SBP 80, breathing well, sat 99%, IV opened up for 250 cc bolus”. I knew the patient was fine at that BP but the RN was “not comfortable” with it so when I asked her to page the resident (since the patient had been admitted for 2 hours already), she wrote the inflammatory progress note.
If something is REALLY that important that I drop what I am doing, just TELL me firmly that I have to see this other patient NOW and I will do so. Don’t write that crap in the chart for Chrissakes.
Is that the same as charting MD said, “I don’t care so don’t call me again”? LOL.
Jeez, what a place to be passive aggressive.
Extremely unprofessional, and stupid to boot. That patient is more stable than many I’ve dealt with on med-surg, and I’ve never resorted to that crap to get a dr’s attention.
Please take that note to the nurse’s charge nurse and/or hospital’s risk management.
Someone failed her professional documentation class…
“M.D. to busy with other ED patients to attend to patient”..calls for speculation and will be stricken from record. Between you and WC, I’m up on legal lingo.
Yes, even if they may feel or act that way, do not chart that way.
That’s just bad form.
Keep in professional.
[...] is what not to do. (Shout Out to ER [...]
What a moron!
“Just the facts”, a la Det. Joe Friday, is documentation 101, boys and girls. This will bite her in the butt sooner or later.
Personally, I L*O*V*E quotes, and use them freely. With a problem diabetic patient who tried to sue over a wound that went bad, I firmly beleive that “Pt refuses dressing change” might not have convinced the attorney to go away, but “RN entered pt’s room with wound care supplies for 0800 drsg change. Pt in high fowlers with a large bottle of Pepsi Cola watching TV , stated “You ain’t touching my foot, you stupid bitch. Get the fuck out of my room”. may have weakened the “planitiff’s” case somewhat.
I once knew a doc that would take notes like that, rip them out of the chart, tear them into little pieces and ask the nurse “want to try that again”?
White Coat, I thought of that but then I would have had to rip the computer off the wall and smash it. Good effect but probably would not have endeared me to administration and IT.
It goes without saying.. objective, not subjective.
It is sometimes amazing how some doctors, nurses, medics, etc, will focus on a number. They are more interested in treating the number to bring it back into their comfort zone. This has nothing to do with the patient, but with the ability of the person to assess the patient.
Sometimes 80 is a wonderful systolic pressure.
Sometimes 80 is an acceptable systolic pressure.
Sometimes 80 is a horrible systolic pressure.
The assessment of the patient is what allows us to see the differences among these patients. 88/? is not unstable, while 90/? is stable, but that is what too many people have been taught.
[...] is a part-timer. Thank God. If you remember the rant/post from a short while ago about “what not to write in the chart“, you will get an idea of who I am dealing with. She, as well as two others have become the [...]
It’s interesting to see how critical people can be. Keep in mind this a doctor’s tell. As we all know first doc rule cya and cya himself only! The question comes to mind were you adult enough to speak to the individual? Im sure nurses are approachable. Needless to say not all doctors are. Some quite frankly are immature and will whine at the nursing station like a child prn. Did you express yourself so eloquently to the nurse????? As for nurses well as always criticize your fellow nurse bc you are so much better.
It’s interesting to see how critical people can be. Keep in mind this is a doctor’s side;one sided story. As we all know first doc rule cya and cya himself only! The question comes to mind were you adult enough to speak to the individual? Im sure nurses are approachable. Needless to say not all doctors are. Some quite frankly are immature and will whine at the nursing station like a child prn. Did you express yourself so eloquently to the nurse????? As for nurses well as always criticize your fellow nurse bc you are so much better. It seems rather cowardly to express yourself on a web site and not to the individual. Maturity and dialogue goes a long way. Sounds like the only reason you went to see the pt was because of legal issues and not because you cared. Maybe that nurse did not document well because she was stressed. FYI genius doctor nurses can be sued as well. I really cant have an opinion if I wasnt there, but one thing I know is that a nurse should not have to speak firmly to get your attention. She is a NURSE not your mother or your wife. Gee you seem a little immature, have you been told that before????
[...] me. The new RN that nearly had a toddler-style tantrum when her zone got really busy, and who also charted inflammatory things about me just got the [...]
Documentation and charting to cover one’s own ass is a horrible way for a passive aggressive Nurse to fall into their rut. More often thannot the staff doing the writing doesn’t communicate the whole picture to the physician (usually over the phone, or God forbid just doesn’t have the knowledge or care to recognise the problem, hence the sacking.
I’m an Rn and work in Emergency / Trauma. I am prefectly comfortable approaching a physician at any time (mid code even) if necessary to paint an a ccurate picture then ask for orders (make suggestions if needed).
My wife (physician) gets called for a new fractured hip.. for an order for ventolin nebuliser because he is sob…
why, he has never used ventolin before ?
he is satting 81 %… and she is on 100% NRB
but you don’t need to come in…
really, I think I’ll come in…
oh.. if you are coming in then you should know her heart rate is 145 bpm
!!!!
I can guess what she would have written in the chart.
H = 145, SpO2 81% NRB MD Aware, ventolin ordered will reassess in am.
factually true objective charting
Yes these people are caring for youyr family members…
Wow, that was unprofessional. I may have to sass some doctors who refuse to listen, but putting something in the chart like that puts the whole team at risk and ultimately we need to have each others backs.