I don't like charting.

  1. I just finished my second clinical day and it has been a real eye opener. We were assigned our patients and told to do a skin assessment along with the ADL's. I absolutely loved the contact with my patient. He was a very pleasant man to work with. He was oriented to name and was very patient with me. I made a mistake because I forgot to use isolation precautions on him at the first. I totally missed the big red stop sign beside his door. :imbar Anyways, once the nurse came in and gave me a gentle reminder to gown up and put my mask on, all was well. I even noticed a new Stage I decub on his foot. He was ordered a bed crib.

    Every 2 hours, though, I had to chart everything that I did. First of all, it is something that doesn't come easily to me. I can't seem to get a flow to it. It's all choppy. Second, I don't want to be sitting there charting when I could be with my patient! Third, it seems to take an awful lot of time. I keep wondering exactly how much time am I going to spend charting and documenting once I have more than one patient? At the rate I'm going, I will need to do a 16 hour shift to complete all of my work! :uhoh21: Ok, ok, I KNOW that I need to chart. It's a big part of my job. I just don't like it. Do you think that this might change with time?
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  2. 17 Comments

  3. by   Mystery5
    Welcome to the club!!!
  4. by   PJMommy
    I remember charting my first days on a unit when I started working there.... It was computer charting and took me at least an hour to chart an assessment on one person. You get used to it and becomes more second nature. I can now chart full assessments on two patients in about 10 minutes.
  5. by   Antikigirl
    Practice practice practice...it will come easier in time. I too was like "okay at this rate can I even look at my patient for more than two minutes?!?!?!". But after doing it for a while...I got my own routine and got it down to no time!

    I am still accused of charting too much, but if there ever is a question or lawsuit, my charting will be one of the better ones! The thing that gets my other nurses is how fast I do it, and they can still actually read my writing..LOL! I just do a form of SOAP charting every time...a condensed version...and it really goes much quicker with a format I can do quickly and get it all down!

    You will get it...just like you will with making assessments quicker and still cover it all!
  6. by   DelightRN
    Who does?

    Seriously, I don't know anyone who *really* enjoys it. Wherever you go, you'll develop a routine for documentation and you'll be fine. Its harder in school because you jump around to a bunch of facilities (at least I did) and documentation is different everywhere you go.
  7. by   VivaLasViejas
    As the saying goes: Documentation does not improve our nursing care.......it PROVES it.

    Just think of charting as giving yourself credit for all the good work you do and the observations you make during the course of a shift. And if all else fails, remember: IF IT'S NOT DOCUMENTED, IT WASN'T DONE .
  8. by   UM Review RN
    I once calculated that I spent more than half my shift doing chart checks, charting, reading docs' handwriting and fixing errors from other shifts.

    Nope, not fun. But necessary. You'll get faster at it. A good book on charting essentials can make you more efficient too.
  9. by   Roy Fokker
    Hmmm, seeing that I will soon be thrown like fresh meat to the wolves :

    Quote from Angie O'Plasty, RN
    A good book on charting essentials can make you more efficient too.
    Anybody got any suggestions on this?
  10. by   VivaLasViejas
    Yes! Try "Charting Made Incredibly Easy", it's one of many books in a series called, not surprisingly, "Incredibly Easy". You can find it at any major bookstore, e.g. Borders, or you can purchase it online. These books are actually fun and easy to read, yet they cover complicated topics such as fluid and electrolytes, EKG interpretations, critical care, and so on.

  11. by   HappyNurse2005
    it gets faster as you get used to it. you say it is your 2nd day in clinicals, if you mean your second day EVER in clinicals, then you have plenty of time to get faster. and you do. you get used to the system, you get more comfortable with what needs to be said and how to say it.
  12. by   Mystery5
    I worry the most about my nurses notes. I don't agonize over the flow sheets. I try to alway mention any teaching I did and do problem oriented nurses notes.
  13. by   SarasotaRN2b
    [font=Comic Sans MS]Thank you! I appreciate these little hints. Though I have a while to go, it is never to late to be aware of what is coming up.
    [font=Comic Sans MS]
    [font=Comic Sans MS]Kris

    Quote from mjlrn97
    Yes! Try "Charting Made Incredibly Easy", it's one of many books in a series called, not surprisingly, "Incredibly Easy". You can find it at any major bookstore, e.g. Borders, or you can purchase it online. These books are actually fun and easy to read, yet they cover complicated topics such as fluid and electrolytes, EKG interpretations, critical care, and so on.

  14. by   lisamc1RN
    Thanks for suggestions and the support! I'll look for the book online! I have Nursing Assessment Made Incredibly Easy and it is an excellent book, so I'm sure the Charting one will be too!

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