Behaviors and Failing to Chart Them

[Tired_Mommy]

I work in a LTC facility. We have quite a few residents with behaviors. We have special forms to document these behaviors but no one does so...except me. End of shift report includes "no behaviors this shift" and there certainly ARE behaviors. I'm the only one that will chart them and report to the on-coming shift. Other nurses are fully aware of the behaviors but just shrug them off. This frustrates me to no end! Anyone else dealing with this? Any advice?

[AngelofLTC]

I work LTC also and I find that I chart these behaviours when they are new, have gotten worse or are out of control. I can't chart every time one of my 32 residents display a behaviour. We can also start a more focused assessment that the health care aids can use to track behaviour. This would come in handy for the doctor or specialist and can help to determine if there are any tiggers or alleviating factors. I have also learned that I can only do my best and I try not to think about what others are not doing...its just too time consuming.

[Nurse Mentor Nancy, MSN, RN, NP]

Don't let the behavior of other nurses affect your own. Keep charting. Meanwhile, you can help solve the problem by being proactive.

First, ask yourself how you would like to be treated if you were not doing something one of the other nurses thought you should be.

Next, think about all the reasons the other nurses might not be charting behaviors. Lack of time? No effective system? Too easy to not do it? Unsure how to describe behaviors?

Then, brainstorm some solutions. Is there a policy on charting behaviors? If not, write a list of what would be important to include. Can you come up with a system that would make the charting easier and quicker? Maybe a checklist?

Lastly, talk with your supervisor, not to complain about the other nurses, but to help solve the problem you have identified. Having a meeting with your fellow nurses to discuss the issue might be the first step.

You will then be seen as the professional that you are. You can be proud of yourself as a positive team player and enhance your relationship not only with your supervisor but just as importantly with your fellow nurses.

[JZ_RN]

The only thing I WILL stay after work to complete charting on is behaviors. My job won't pay me to work off the clock, but I always protect myself by charting on behaviors. I chart every act of aggression, name-calling, spitting, hair-pulling, scratching, kicking, punching, slapping, grabbing, swearing, etc. which happens far too often where I work. We nurses are treated as punching bags by patients, who, I don't get upset with the ones who are cognitively impaired, they don't know better, but I still don't deserve to be hit nor should I have to put up with it. We had one pregnant nurse get kicked, hard, right in the stomach by one lady because she didn't want to be woke up (at 4pm from her nap, she sleeps all day) for her medicines. I understand she was upset, but she knows that kicking someone in the stomach is WRONG. And as for the A+O ones who just want to get their way, not a chance. I am not there to be abused by anyone, I don't tolerate abuse in any area of my life, especially not at work. And if it takes charting about how some of the patients really are so the MDS nurse, the doctor, and managers, and the other nurses can flat out see what they did, so be it. I don't get paid enough to get hit or abused. I don't abuse patients, physically or verbally and they will not get to abuse me. Sorry you're frustrated or upset, you still need to behave like an adult.

[ALina19]

I know what you mean, I am a new nurse and I always chart what happened during the shift. I managed to start 24-hr charting on a patient and ask the next shift to talk to the MD and maybe change her meds because I had to medicate her twice during a shift....if everyone charts as 0 change in behavior and i chart one or two, then I will do something about it!!!

a piece of advice is talking to your DON about an inservice of staff and increasing awareness about the importance of behavior charting!

[nursetiffany.]

I document the behaviors I see on our behaviors form. It then gets turned into Administrator, DON, ADON, SSD, & Careplan Coordinator. Saves my behind, the residents behind. :)

[MelissaLPN, ASN, LPN, RN]

When I was a new nurse I used to document behaviors all the time but a few nurses pulled me aside and said I was opening myself up for liability because I was not including that I did anything that relieved the behavior. For some of my people, all the interventions in the world do not seem to help and the behavior continues.

Maybe the nurses feel trapped by family who do not want the resident medicated but they still act out, then it looks like the nurse is negligent even though she has little say on the pharmacological treatment of the patient. Self soothing techniques only go so far. I feel like I might chart more if I did not feel like it made me vulnerable to a lawsuit.

An example may be " 'Resident crying out " help me help me help me.' Toileted before and after meals. Clothing nonrestrictive. Po fluids and snacks offered. Placed a nurses station for monitoring. Psychotropic drugs given, no adverse drug reactions." Then the resident who is a thousand years old, full code, has a massive MI 3 months later even though this behavior happens every day they will say the resident might have been expressing the impending MI and you as the nurse did not call the MD and have her properly evaluate. While this may seem far fetched this is how I see it.

I have another resident who cries every day. MD aware, no new orders. Daughter is upset but MD wont budge on her treatment. I am the nurse charting she is "suffering" in her daughters eyes but beyond the current treatment, I as the nurse do nothing.

I am open to doing everything the right way but I would like to be taught whats acceptable to chart and what will land me in the courtroom.

[chrisrn24]

This is an older thread, but interesting to read responses.

I chart any "behaviors" I see. Some people I chart on every night. Others I chart on when different behaviors happen. If one resident who is pleasant every night suddenly starts acting much different and crying, I'll chart on that and what I did to help the resident.

I'm a new nurse, but my former preceptor was big on charting so I think I got that from her. Maybe I over-chart, but I do it anyway to save myself - that was drilled into my head. My preceptor also told me "take credit for what you do" nursing-wise, so PRNs I give I make a note about what happened and why I gave it, any behaviors, any incidents, etc.