November, 2005 Archive

November 27, 2005, 1:41 pm

Charting the Course

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

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

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

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

hhhhhhhhhhhhhhhhhh

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

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

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. I have claimed a small corner desk as my “office”, to the distress of my fellow nurses, for that is the desk they use to surf upon the internet. 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.

I’m not kidding!

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

  • Legible
    • Doctors may be notorious for illegible handwriting, 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, I want my writing to reflect that I am a professional nurse, not a literary slob.
  • Complete.
    • You might be Nurse of the Year but as the old saying goes, “If you didn’t chart it, you didn’t do it.
    • Check every box, chart every response, write N/A where applicable to show that a topic was at least considered

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

  • Times
    • Time that patient was roomed.
    • Time that the doctor evaluated the patient.
    • Times of each test (lab, 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, 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, I will note that it occurred. I don’t go into detail, perhaps I’ll just write, “EDMD at beside, case discussed with patient and family”.
    • When I update the EDMD with patient information (medication response, a change in vital signs, etc.), I document what I said and when I said it.
  • Patient comments and behavior.
    • Verbal abuse – I will chart what the patient said, verbatim, including the foul language, in quotes.
    • A threat to sue – if a patient makes a threat to sue while in the emergency department, I will quote it, again verbatim, in the record.

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

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

Pretty impressive.

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

I do it every shift.

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

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November 26, 2005, 1:30 pm

I’m So Vain, I Probably Think This Blog Is About Me

I wonder if anyone has informed the American College of Cardiology that Bayer Aspirin does not affect the heart! Boy, what a relief that must have been in 1928. And don’t forget to demand it!

hhhhhhhhhh

I finished a twelve-hour shift in the wee hours of this morning. Everybody who has ever worked in an ER knows that the day after Thanksgiving is unadulterated hell. Friday was no exception. It reminded me of a story about Joe Montana who, near the end of his football career, took a particularly hard hit. As he lay on the turf he looked up and told the guy who sacked him, “I’m too old for this s***!”

I believe I shall take that as my personal motto.

I’ll chalk up a few post-shift aches and pains to age. I’m mean, I’m not in my twenties anymore, my thirties are but a memory and while I’m still on the sunny side of fifty I thought I was holding up pretty good. Anyway, I come home, grab the computer and lay on the floor catching up on some blog reading. After about an hour or so, I decided I had better get to bed before dawn.

I couldn’t get off the floor.

Every bone in my body ached , my spinal cord was my personal torture rack, my biceps devolved into a gelatinous mass and while I know I came home with my quadriceps, they seemed to have disappeared. Thank god I was able to use a table for support or I’d still be lying there.

When did I turn into such a wimp?

hhhhhhhhhhhhhhhhhh

Nothing will humble you faster or make your stomach sink lower than a med error.

I made one last night. I hadn’t made one for many years but you never forget that sickly, nauseated feeling in the pit of your gut when you realize you screwed up. I didn’t even realize I had made an error until I saw the written order.

Beware the verbal order! What I heard is not what the doc said (I heard a different dosage) and he didn’t hear my repeat as I rushed to the med room.

The patient is fine and the doctor was totally cool (as ER docs usually are).

I’ll probably be a bit queasy for awhile…..

hhhhhhhhhhhhhhhhhh

While thinking of blog topics the other day, I was considering writing about my worst experiences with doctors. I’m talking about in-your-face-screaming fits. I’m talking sarcastic, arrogant jerks. And then I realized that:

  1. All these episodes happened over twenty years ago.
  2. All the doctors were men. Old men.
  3. All of the doctors were men who had gone to medical school in the 1940s and I’m sure, to them, female nurses were one step above bottom feeders.

And none of them happened in the ER.

I was stunned at how I could recall, today, my anger and frustration at not being able to stand up for myself; the humiliation and injustice of getting screamed at in front of other doctors and of holding myself together until I could make it to the break room to cry. It was as if had just happened yesterday instead of twenty years in the past. As if I was 22-years-old again.

It’s funny. My body may be falling apart but there is a lot to be said for the self-esteem and maturity that come with age. Boy, would I love to give those jerk doctors a piece of my mind.

Nah. I think it’s time to let it go.

For good.

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November 24, 2005, 2:43 am

Thanksgiving: An American Tradition

Abraham Lincoln said :
“[It is] announced in the Holy Sciptures
and proven by all history,
that those nations are blessed whose God is the Lord…
It has seemed to me fit and proper that… [God's blessings]
should be solemnly, reverently, and gratefully acknowledged,
as with one heart and one voice,
by the whole American people.”

So as I head to work on this holiday of Thanksgiving, I’ll be solemnly, reverently and gratefully acknowledging my thanks to God for my country and my freedoms.

I will also be thankful for our men and women serving in the armed forces and for the millions of people are newly able to embrace the freedoms that I take for granted every day.

I’ll also thank God for my family, our health, and for my wonderful profession and for the continuing ability to make a small difference in the world.

Happy Thanksgiving!

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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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