Charting when there are nursing students

[kjnsweets]

I have a question. We have students that are present at our facility for clinicals. We still do paper charting. Some of the nurses that I work with do not chart the whole time that the students are here. I choose to do my own narrative charting because of cya and not charted not done. I figure it something goes to court and I don't document that I was in the room at any time that the students are present then I wasn't in the room at all. I was told that it was an understanding that the instructor is responsible for the patient. If that was the case why do I get report on these patients in the morning when the students have them. I guess I'm answering my question myself but I want to know legal issues where this is concerned. I have been in a deposition behind another nurse before and it wasn't anything nice. Don't want to go there again.

[loriangel14, RN]

It's probably different at each place.We have computer charting where i work and the students chart on the patients they care for.We just check over their charting and of course chart anything that we actually do.

[dudette10, MSN, RN]

Instructor responsible for the patient? Is there a policy on that? If so, I would refuse to take report and tell the off-going nurse to report to the instructor. After all, the patient is not really yours, right? If there is no policy, nurse the patient and document as you normally would.

When I have a student, I even document in my notes the tasks they completed with my supervision, and state such. That way, if the instructor has supervised a task, and it has a bad outcome, it's her butt, not mine. For example, "Foley inserted using aseptic technique by nursing student Jane under my direct supervision, immediate urine output noted, statlock placed on R thigh, bag to dependent drainage, pt denied discomfort during insertion."

ETA: My only shortcut is this: if I am running short on time, I will review the assessment data input by the student and input assessment data only if it disagrees with the student's. Then in my notes, I will state, "Concur with assessment nursing student Jane input on flow sheet at 0745, with noted exceptions input by me on flow sheet at 0750."

[kjnsweets]

Exactly. That's what I do but none of the other nurses I work with do this. I would think there are big legal issues with this.

[dudette10, MSN, RN]

Exactly. That's what I do but none of the other nurses I work with do this. I would think there are big legal issues with this.

Good for you! It's your practice, you do what you feel is safe and accurate, despite the practice of your co-workers.

[classicdame, MSN, EdD]

Bet er check the NPA in your state. In my personal opinion, and it is just that, the only charting that really counts is that of the licensed person. I would not want my patient's chart to have dcoumentation gaps. Students do not take the place of the RN.

[HouTx, BSN, MSN, EdD]

Legally, the hospital/facility is ALWAYS responsible for the patient's care. That patient has engaged the hospital to provide services, not the nursing school. The organization MUST have processes in place to ensure that everyone providing services is competent and legally permitted to do so. Unless that clinical instructor is actually an employee of the organization, the Staff Nurse (assigned to the patient) is still 'in charge' and responsible for the care of all his/her assigned patients.

Side note: If instructors are performing or supervising care, the organization needs to have some type of competency validation process. As a staff nurse, you should have access to this information so that you can fulfill the professional responsibilities associated with delegation & assigning care.

[ecf1972]

The instructor is not responsible for the patient. The instructor is responsible for the STUDENT. RNs should document anything and everything relevant to their patient. When I was a student, the hospital where we did clinicals had electronic charting. Each student had their own login. We charted our I/Os, assessments, vitals, etc. as well as any procedure/treatment we may have done. We only did treatments if the nurse agreed to LET us do it. That RN was never "let off the hook" because they had a student nurse.... because they were just that... a student. And... any charting that a student did had to be signed off by our instructor.

Being a RN now, I would never assume that someone else has documented anything on one of my patients and not at least reference it in my documentation. My preceptor told me "When I do my charting, I write it as if I am saying it right to the judge". And that was very wise advice.

[psu_213, BSN, RN]

At my hospital, all student charting must be cosigned by a licensed nurse. That nurse can be the instructor of the students. However, for various reasons, I would still chart something along the lines of "Head to toe physical assessment completed by this RN. Reviewed charting of Sally Student, SN and agree with charted findings."

[KelRN215, BSN, RN]

2 different situations:

1. I am the nurse working the floor. There is a group of students on the floor. They are being supervised by their instructor. One of them is assigned to one of my patients. I document my full assessment and follow-up assessments, regardless of what the student documents. They can document things like VS and I&O and there's no need to double document those things but a student documented assessment would not cover me in the event that something happened. Especially when the student and I are not assessing the patient together and I am not responsible for him/her. If the day is uneventful, I won't necessarily write another note in addition to the progress note the student writes. If something happens, you bet I'm writing my own note.

2. I am precepting a senior year nursing student doing her final clinical. We do everything together. I allow her to document the assessment and then I review it, make any changes necessary and co-sign it in the appropriate location. Same with her narrative note. Students were not allowed to fully sign notes in our computer system, so I would write something at the bottom to note that I agree with her note and sign my name/credentials.

[SherluckyRN]

One thing CYA...at the end of the day that's your patient your license. The student nurse is learning and under your supervision one way or the other. Always check their documentation before they write it in patient chart by doing a rough draft then you come along with your documentation concurring and adding your info. Cover your ***

[poeboy]

I just graduated in december. When we were on the floor and charted on our assigned patients, the nurse would still chart every 2 hours and chart "agree with student nurse" or they would not chart and rely on students to cover it. We still had to report to the nurse any changes. As a working nurse now, it is my responsibility to chart on my patients regardless of what students chart. Like stated above, it is our license and they don't come easy. I'm not sure if students would be called in to court. If you didn't chart it-you didn't do it!!