24° Chart Checks

[NayNeyRN]

How does your facilities handle 24° chart checks? Other places I have worked, we just verified orders were entered and signed off. But at the facility I work at now, we have a new form we must complete that wants us to also verify that previous nurses have done their charting. This seems excessive to me, as when I posted on here before others told me that I am not in charge or responsible for what others have or have not charted. I don’t think I should be policing whether or not my coworkers are doing their jobs. Does anyone else have any thoughts?

[Golden_RN, MSN]

This looks like SNF level of care, and only for new admits, right?

At my last LTC job we did a 24 hour audit that was much more comprehensive than this, and then we did a 7 day audit, which included more chart checks AND a follow up on anything found during the 24 hour audit.

In a perfect world everyone would do their jobs 100%, but sometimes the details get lost in the chaos, especially when admits come in at shift change!

[NayNeyRN]

12 hours ago, Golden_RN said:

This looks like SNF level of care, and only for new admits, right?

At my last LTC job we did a 24 hour audit that was much more comprehensive than this, and then we did a 7 day audit, which included more chart checks AND a follow up on anything found during the 24 hour audit.

In a perfect world everyone would do their jobs 100%, but sometimes the details get lost in the chaos, especially when admits come in at shift change!

Definitely not a SNF facility. We are a specialty surgical hospital, very rarely do we have patients that stay more than a day but occasionally we do. We have a very high patient turnover rate, and we have to do these on every single one of our patients, daily (but only on night shift).

I get frustrated because we have done these before (and were ineffective), then they went away, and now they’re back. What’s even more frustrating is that we have been fighting a losing battle for years because there are some nurses that walk out the door without having charted a single assessment or rounding note all shift. One in particular always says “I’ll do it tomorrow” and frequently forgets entirely, or will spend all day charting what she should have charted yesterday and so we won’t even have an admit assessment on a fresh surgical patient. When we would bring this to the attention of shift supervisors and our manager, nothing was done, and we got given more work because “if you have time to tattle you aren’t busy enough”.

[FolksBtrippin, BSN, RN]

Night shift charge nurse always did this when I worked inpatient psych.

She made a list of people and tasks and put it on the "the wall of shame."

If that's your job, then that's your job.

[JKL33]

1) Employees of the type who won't (or consistently don't) finish their work for a variety of person-specific reasons, or 2) Situations where everyone on duty every shift is fully engaged in patient care for the entirety of their shifts such that no one can rightfully prioritize housekeeping items - - - are not the problem of the next nurse on duty. In reality both of these problems are management-level problems that stem directly from administration-level decision-making.

8 hours ago, NayNeyRN said:

When we would bring this to the attention of shift supervisors and our manager, nothing was done, and we got given more work because “if you have time to tattle you aren’t busy enough”.

This is simple. Don't complain unless it's reaaalllly worth it/necessary (major safety or ethical violations), and don't accept being roped into others' problems.

Obviously in nursing, tasks frequently pass to the next shift due to the prioritization that had to happen. This is fine; it happens between all shifts. It's only not fine when people are repeatedly choosing not to complete work they could've completed. If a supervisor assigns audits or says that others should have once again completed the tasks that so-and-so chose not to do)...??‍♀️ No. There are a number of creative and usually pleasant ways to rebuff that conversation. Stay above the fray and/or under the radar.

Is there time to audit on your shift? If so, you just have to decide whether the principles are involved are acceptable to you. If so, do the audits. If not, look for another job. I say you faithfully complete a basic audit for each of your patients' charts (initial the things that are complete, circle the rest). Assuming there isn't time to correct deficiencies, write on the back "no time to correct deficiencies." [If you do have time on your shift to correct all the deficiencies and are just resistant because you feel certain other people are lazy....well then you have a personal choice to make with regard to your overall job satisfaction].

[Golden_RN, MSN]

9 hours ago, NayNeyRN said:

Definitely not a SNF facility. We are a specialty surgical hospital, very rarely do we have patients that stay more than a day but occasionally we do. We have a very high patient turnover rate, and we have to do these on every single one of our patients, daily (but only on night shift).

I get frustrated because we have done these before (and were ineffective), then they went away, and now they’re back. What’s even more frustrating is that we have been fighting a losing battle for years because there are some nurses that walk out the door without having charted a single assessment or rounding note all shift. One in particular always says “I’ll do it tomorrow” and frequently forgets entirely, or will spend all day charting what she should have charted yesterday and so we won’t even have an admit assessment on a fresh surgical patient. When we would bring this to the attention of shift supervisors and our manager, nothing was done, and we got given more work because “if you have time to tattle you aren’t busy enough”.

I'm shocked at this behavior and I totally see why you're so frustrated!!!

[JKL33]

1 hour ago, Golden_RN said:

I'm shocked at this behavior and I totally see why you're so frustrated!!!

Yes. It is ridiculous and that's why the answer to this "police your peers" junk is "NO."