Do you keep a personal journal?

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I am a new nurse in LTC. I am going to make kind journal just to note something that happened on my shift a few days ago... just in case I am asked about it some day in the future, since I have read from other nurses that its a good thing to do. Anyway, it got me thinking about journals... do some nurses make a personal journal of every shift or just CYA stuff?

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Specializes in most anything's in corrections.

it is a good idea to keep a journal of extra ordinaries that happen during your work shift. a journal is a legal document if you need to use it in the future.

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Specializes in cna x10 years.

Our nursing instructor recommended we keep a journal of significant happenings. If something were to be questioned that you were involved with or knew about, it would be difficult for you to recall the specifics. Especially considering court proceedings can take months to years to be heard. Personally I don't remember what I had for breakfast a month ago.

I think journaling would be a good idea. Just remember confidentiality issues.

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journaling is a very good idea for personal growth etc....If it involves work etc just make sure that the data is deidentified...

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Specializes in LTC/Rehab,Med/Surg, OB/GYN, Ortho, Neuro.

I was also told to keep a running journal. That if I only ever wrote about that one incident, and got called to court on it, it could seem like I just wrote it down. W/ a running journal, it shows a consistency w/ what I'm doing. Was told this right after nursing school. I've used up several notebooks since, just in case.

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Specializes in Med/Surg, Geri, Ortho, Telemetry, Psych.

I usually only keep a journal for work when something out of the ordinary happens, especially since you can't go copying pages out of a patient's chart. I also keep all of my personal report sheets that I write notes on all shift, they can go a long when in court.;)

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IMO, if it needs to be written down, it needs to be in the patient's chart. And if I get called into court, I'll have access to the chart.

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Specializes in Gerontology, Med surg, Home Health.

I don't think a journal is a legal document. I could make up all sorts of things and write them in my journal. I never did keep a journal. The charts will always be there if I need to refresh my memory.

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Specializes in Med/Surg, Geri, Ortho, Telemetry, Psych.
The charts will always be there if I need to refresh my memory.

I agree with you on this, but I personally take down notes all day that wouldn't be part of the chart. I would just like to keep them handy just in case bad things happen. ;)

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No way. I am amazed that anyone would think this is feasible. It seems to me that there is way too much happening in a shift. I would never even try to keep my own journal. My feelings, too, are...put it on the chart...that is all I would choose to remember anyway. If I am asked years down the road what happened....I can say "just like the chart says, that's all I know."

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Specializes in Med/Surg, Geri, Ortho, Telemetry, Psych.
My feelings, too, are...put it on the chart

What do you mean by this? Charting has nothing to do with your feelings. It's only facts. :nono:

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Exactly! Feelings have nothing to do with the facts. The facts on the chart are all that will matter.

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