June 26, 2016, 1:41 pm

Viagra Cream

Viagra cream Made it to the Notre Dame/Stanford game this weekend. Viagra cream I walked into the Stanford stadium thinking the Irish would grind the Cardinals into the turf, viagra cream but by the time I left I would have accepted a hefty dose of IV Valium. Viagra cream I like my football nice and calm. Viagra cream A 30 point lead in the first quarter, viagra cream a nice half-time show by the marching band and fluffy pom-poms to wave at the appropriate moments.

Viagra cream Last night was gut-wrenchingly close. Viagra cream Stanford played their heart out, viagra cream but the Irish pulled it out in the last two minutes. Viagra cream It was the last game Stanford would ever play in their stadium. Viagra cream Right after the game, viagra cream literally, viagra cream they began to tear down the old stadium in preparation for what looks to be a fantastic replacement.

Viagra cream I could write an entire blog entry on the differences between the Stanford and Notre Dame cultures, viagra cream both campus and football. Viagra cream Having experienced both this month, viagra cream it was like visiting two different worlds.

Viagra cream If Stanford had been playing any other team, viagra cream I would have rooted for them. Viagra cream But they were playing Notre Dame. Viagra cream ‘Nuff said.

hhhhhhhhhhhhhhhhhh

Viagra cream I love charting! A well-written chart is a piece of art; every entry a chapter in the book that becomes The Medical Record.

Viagra cream Nurse’s notes are my passion. Viagra cream I must chart in blue and I must have a medium-point, viagra cream gel-ink pen that does not scratch the page as it flows. Viagra cream I accept no substitutions. Viagra cream I carry a small, viagra cream six-inch ruler so that my lines are straight.

Viagra cream I do not chit-chat while charting; I eschew the tantalizing temptation of socialization with my colleagues until my nursing narrative is completed to my exacting specifications. Viagra cream I have claimed a small corner desk as my “office”, viagra cream to the distress of my fellow nurses, viagra cream for that is the desk they use to surf upon the internet. Viagra cream I daresay that my attempts to construct a medical work of art supersedes their need to (1) check their cell phone bill or (2) make bets on the NFL.

Viagra cream I’m not kidding!

Viagra cream I really do enjoy charting as part of my nursing responsibilities. Viagra cream A well-written nurse’s note acts as a timeline of the emergency visit. Viagra cream I make sure mine are:

  • Legible
    • Doctors may be notorious for illegible handwriting, viagra cream but I know a lot of nurses who make doctors’ writing look like calligraphy.
    • If that note gets blown up poster-size to sit in front of a jury, viagra cream I want my writing to reflect that I am a professional nurse, viagra cream not a literary slob.
  • Complete.
    • You might be Nurse of the Year but as the old saying goes, viagra cream “If you didn’t chart it, viagra cream you didn’t do it.
    • Check every box, viagra cream chart every response, viagra cream write N/A where applicable to show that a topic was at least considered

Viagra cream And, viagra cream in addition to charting my actual nursing care, viagra cream I make sure to chart:

  • Times
    • Time that patient was roomed.
    • Time that the doctor evaluated the patient.
    • Times of each test (lab, viagra cream radiology)
    • Times that the patient was out of the department.
    • Time of discharge
  • Consultations/Communication
    • If I hear the doctor on the phone in consultation with another physician concerning my patient, viagra cream I’ll verify who they were speaking with and document it on my notes with the time of the call.
    • When the EDMD goes back to the bedside to discuss the case with the patient or family, viagra cream I will note that it occurred. Viagra cream I don’t go into detail, viagra cream perhaps I’ll just write, viagra cream “EDMD at beside, viagra cream case discussed with patient and family”.
    • When I update the EDMD with patient information (medication response, viagra cream a change in vital signs, viagra cream etc.), viagra cream I document what I said and when I said it.
  • Patient comments and behavior.
    • Verbal abuse – I will chart what the patient said, viagra cream verbatim, viagra cream including the foul language, viagra cream in quotes.
    • A threat to sue – if a patient makes a threat to sue while in the emergency department, viagra cream I will quote it, viagra cream again verbatim, viagra cream in the record.

Viagra cream Of course, viagra creamthe goal is to document, viagra cream as objectively as possible, viagra cream what is happening during the patient’s time in the department. Viagra cream The nursing record is really the only part of the medical record that gives “real time” information. Viagra cream It pulls together and reinforces all the other documentation, viagra cream including the EDMD dictation.

Viagra cream I’ve worked with doctors who do medical-legal chart reviews. Viagra cream They have story upon story about how a single entry in a nurse’s note stopped a lawsuit in its tracks.

Viagra cream Pretty impressive.

Viagra cream It doesn’t take any more time to document thoroughly, viagra cream clearly and legibly than it does to scribble what looks like incoherent mumbling on a page. Viagra cream It does take organization, viagra cream focus and good management of your time. Viagra cream It isn’t rocket science.

Viagra cream I do it every shift.

Viagra cream With a medium-point, viagra cream blue gel-ink pen and a six-inch ruler.

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14 Comments

  • kenju
    kenju

    November 28, 2005 at 4:36 am

    Kimn, you are probably the envy of every other nurse at your hospital and doctors would no doubt kill to have you do their charts. Too bad not everyone follows your example.


  • angry doc
    angry doc

    November 28, 2005 at 6:15 am

    Some of the nurses I worked with were such dedicated charters, they wouldn’t stop to give you a hand at the resus…


  • Jenn
    Jenn

    November 28, 2005 at 7:37 am

    I did chart reviews and appeals for an insurance company for awhile, and I can’t tell you how much accurate, complete, nurse’s notes help.


  • Moof
    Moof

    November 28, 2005 at 8:08 am

    First, I want to take a (hopefully) well aimed *SWAT* at “Angry Doc” … –> Play nice! 😉

    Secondly, I think careful charting can save a tremendous amount of grief later. It’s a shame that more medical workers don’t think the way you do.

    That said … Blue pen? Medium? Liquid Ink? … Although … perhaps you just might enjoy is a bit *too* much … have you had a talk with “Shrinkette” lately? 0.o


  • The Platypus
    The Platypus

    November 28, 2005 at 9:14 am

    Computer charting has made my life a lot easier, and my handwriting a lot sloppier, but I’m amazed at how many of my peers don’t bother to document the obvious,

    And right on with the threats to sue. If a patient mentions the intent, whether to sue me or the hospital or whatever third party (s)he thinks will provide a stream of income, I always write that up in detail. I’m sure their attorney appreciates it when they pull the chart in preparation for court.


  • Kim
    Kim

    November 28, 2005 at 12:07 pm

    LOL Doc – I am the de facto scribe at all the Code 3s unless it is my patient and then I’m working the bedside.


  • DawnCNM
    DawnCNM

    November 28, 2005 at 12:12 pm

    I loved your note about charting, since it’s so true from the insurance point of view (I have worked on both sides, hospital/office and insurance company). More charts like yours from doctors and nurses would make our jobs reviewing for medical necessity much easier. However…would you consider using BLACK ink instead of BLUE? Blue just does not copy or fax well for some reason.


  • Kim
    Kim

    November 28, 2005 at 12:49 pm

    Dawncmn, Oh no! Black ink bad! LOL!
    I get anxiety attacks just thinking about black ink! LOL! Seriously, I have worked in facilities where black was required but thankfully I’m at a blue-ink ER now. I knew a doctor who wrote in purple! And got away with it! My absolutely favorite ink color is Teal, but I won’t push my luck!


  • angry doc
    angry doc

    November 28, 2005 at 4:48 pm

    *Ouch!*

    But it’s true! Especially just before the 2pm change of shift…


  • Third Degree Nurse
    Third Degree Nurse

    November 28, 2005 at 6:41 pm

    I love it! I am actually getting the hang of charting. Coming from the legal field, I recognize the value of medical records. You’re my role model on this one: I have my six inch ruler and am ready to go. However, we must use BLACK ink in our area.

    I’m DETERMINED to get my assessment done and all charting complete and accurate by 0830 tomorrow. No matter how bad the patient’s diarrhea is. And today it was pretty bad.


  • Jodi
    Jodi

    November 29, 2005 at 5:52 pm

    You are an excellent role model for us students as well. I may move to CA to your facility just so I can write in Blue though. I’m jealous, Black is required here. However my pen has to be the gel type also, My hand camps with the ball-points, I write too hard with those.


  • Unimum209
    Unimum209

    November 29, 2005 at 11:19 pm

    Oh how I long to be able to write with my blue pen… I am a fine point girl myself though. I am a SN in Australia and we are only allowed black pens.

    I loved your blog on charting. I wish everyone was as concerned about getting it right as you are. I am such a newbie that I gratefully accept all the advise I can get – especially on issues like charting.


  • Dave Harmon
    Dave Harmon

    November 30, 2005 at 8:55 am

    I’ve got no argument with careful documentation, but, speaking as an outsider — perhaps you could explain why black ink is so bad?


  • missbhavens
    missbhavens

    November 30, 2005 at 2:54 pm

    A ruler? Right ON! Now THAT’S taking charting seriously. Alas, we cannot chart in blue. My charting fantasy pen is a fine-point gel roller (0.5, please!) with ink as black as a labrador retriever. I think we’re not allowed to use blue because we chart on pink sheets. Blue on pink doesn’t xerox well, or something like that…but who xeroxes charts?

    Thanks for the bloggy visit and the kind words! (I’ll tell your engagement story and then maybe she’ll cut me some slack!)

    keep up the uber-charting! You do us proud!


About Me

My name is Kim, and I'm a nurse in the San Francisco Bay area. I've been a nurse for 33 years; I graduated in 1978 with my ADN. My experience is predominately Emergency and Critical Care, and I have also worked in Psychiatry and Pediatrics. I made the decision to be a nurse back in 1966 at the age of nine...

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