Charting Question

[Sherie P.]

Hey everyone! 

I have been an ER nurse for the last 5 years in a level 2 trauma center.  Obviously the last 2 have been especially difficult. Between ER holds, increased patient acuity and short staffing there are times when I am in a critical patients room with no one else to cover my other patients.

Is there something I can/ should be charting to explain why I wasn’t rounding on the other patients?

I have heard of other nurses charting things such as Patient has been provided the best care possible given the limitations related to the covid-19 pandemic and crisis level staffing.

Would stating something like this actually help cover our butts if something went to court?

What are your thoughts/ suggestion? 

[iluvivt, BSN, RN]

I would personally never chart anything like that. It sounds like you are trying to cover for less than stellar care and if anything did happen,especially with a lawsuit, you are giving someone a reason on a silver platter. It's best to chart what you did do for the patient.

[Rose_Queen, BSN, MSN, RN]

What is going to cover you is hospital policy and procedures. Does the facility have crisis standards available and in use that specify what elements of documentation/care are temporarily suspended during periods of crisis?

[sleepwalker, MSN, NP]

21 hours ago, Sherie P. said:

Patient has been provided the best care possible given the limitations related to the covid-19 pandemic and crisis level staffing. 

While one may think this sounds "clever"...it's an acknowledgement that you're providing substandard care along with an attempt at "excusing" the provision of that care

[Sherie P.]

Thank you all for the responses. I  agree it sounds like an excuse for substandard care. I have never charted something along those lines, but was surprised at how many nurses do. 

[hardworkpaysoff, MSN, RN]

Another consideration is that most patient charting is visible to patients these days and that phrasing may not be perceived the greatest.

My hospital recently implemented emergency/abbreviated charting essentially  telling us during these critical pandemic times there are only certain charting categories/assessments that are necessary (which is a hospital-wide policy that should cover us).

[NewYork Nurse]

Since our hospital has union protection. In a situation like this we would file a protest of assignment. This protects us legally in that the hospital has now a shared responsibility for any negative outcome. It protects us by showing we alerted management to a potentially dangerous situation. Ie staffing and carried on our assignment to the best of our ability under duress. It shifts the responsibility where it belongs to the hospital and away from blaming the nurse

[amoLucia]

@NY Nurse - what you're talking about is initiating a 'Safe Harbor' response. Yes, management does share responsibility in adverse situations but that SHOULD NOT BE 'fuel or fodder' for nsg charting/notes.

You would be doing your "Safe Harbor' protocol with prerequisite timely notifications and documentation. But not in any individ chart (otherwise you'd have to be doing such a note for the whole unit!). I'm guessing you have a 24hr all-encompassing total shift report documentation. That's where that type of comments go. But again, any in-house facility documentation is subject to subpeona (sp?), so BE CAREFUL what you write.

Don't make it easy for an opposing attorney (or your employer) to run you under the bus. You could prob call your your malpractice coverage to ask their opinion. But I'll guess they'll say the same.

And welcome to AN.