can your DON tell you to completly change how you chart?

[Animal House R.N.]

I recently got a new boss. She reads the nurses notes that were written the day before. I have no problem than that. The thing that I am unsure about is we are now being told not to use any words that are in the past tense. I work 12 hour shifts it is impossible to sit down and chart for the first four hours because I haveto pass my own meds. Thoughts please.

[Animal House R.N., ADN, CNA, LVN]

I have 40 patients. I get report and then start my med pass. During this time I'm also dealing with families and having to answer the phone. Then bolus feed. Then I do mu treatments. I start at 6 pm and by the time I finish it is 10 pm. Most nights I don't take a lunch. I guess I need to have another nurse show me how to do it.

[Here.I.Stand, BSN, RN]

I've never worked as an RN in LTC, but I worked in one as CNA for 3 yrs. I have worked in rehab as an RN where the standard pt load was 10; I had as many as 17 with a TMA though, when the combined census from the two rehab floors fell below a certain level. In the nursing home where I worked at as a CNA, the nurse-to-resident ratio was roughly 1:30.

Your ratio is 1:40. That is a huge load! Based on my above experience and observations, I honestly don't know how it's reasonable to expect all charting to be done in real time. Heck I only have two patients and can't manage for it all to be in real time. I mean if I titrate a drip I record that immediately, or I's & O's since it takes two seconds to enter the numbers...stuff like that, sure. But I have days where I haven't charted my assessments until 6-7 hours into my shift, just because the feces hit the fan and I had to prioritize actual pt care.