families with clipboards/notebooks

EmilyCCRN · Apr 9, 2006

I'm wondering how you could 'avoid' taking care of a patient whose family is taking notes on everything. Somebody has got to care for the patient regardless of the clipboard situation. Perhaps as a student you can more easily accept or refuse an assignment than a staff nurse?

wooh, BSN, RN · Apr 9, 2006

I think as a student or brand new grad it's a good idea to avoid such pts/families. They're looking for you to do something wrong which just makes the nerves of being new even worse. (Of course, occasionally it's just a family taking shifts that wants to keep everyone informed, but assume it's the "prepare for the lawsuit" types we're talking about here.) Anyway, students and new grads are nervous enough without someone waiting for them to mess up, not to mention, with experience comes skills in covering your rear. Why ask for trouble?

As for when I get them, I just do my thing. Although, when they do the, "What was that pill again?" I'll sometimes spell it for them, letting them know that yes, I know they're writing everything I do down, and no it doesn't intimidate me in the least.

Most of the time, these folks have had something bad happen, and they're scared it's going to happen again. They're preparing for that. Show them confidence, and it will ease their fears. If writing everything down makes them feel better, why shouldn't they have writer's cramp right along with me?

ZASHAGALKA, RN · Apr 9, 2006

Some family members think that if they write stuff down, that scares you into being more meticulous.

In reality, their notes are meaningless. They aren't 'legal' documents. It doesn't make their version of events any more credible because it's written down. And the few times I've had a manager actually ask me to 'justify' somebody's 'notes', the fact that they are a lay person introduces so many errors in their perception of what happened, they aren't even credible.

In fact, I'm as meticulous with EVERY patient as I can be.

The note-takers annoy me, but not because I'm scared of them; because I take it as an implied threat. A meaningless threat, to be sure, but a threat none-the-less: I'm watching you and keeping records to tell on you.

I don't like being threatened. If anything, by sticking to the rules 'for their benefit', they lose something in the process. I consider rules to be negotiable if the best interests of my pts dictate such. But not if they are going to write it down.

So fine, you want things 'by the book'. Your loss.

~faith,

Timothy.

pickledpepperRN · Apr 9, 2006

I kept record of the staff who cared for my husband.

It enabled me to write thank you cards to them and letters praising exceptional staff to their managers and the VP of nursing.

An ICU RN was the most excellent preceptor for a new grad just out of a critical care course.

They let me stay most of the time too. I bathed him. Asked but they did NOT want me to suction.

He played golf yesterday.

hrtprncss · Apr 9, 2006

I've ran into a few people that just goes over the top with the note taking, but after awhile you get used to them, and they get used to you. Actually, sometimes they lighten up after awhile. It's the real overly nice ones you gotta watch out for;)

jalvino1 · Apr 9, 2006

Haha, call me naive, but when I have patients or family members taking notes, it never occurred to me that "they're preparing for a law suit." I was always glad that they were participating in their care.

ex #1. One patient was very particular in getting his pain meds every three hours, but he had a horrible memory, so he would write down everything he took and at what time. How could I complain? Instead of him ringing his call bell every 5 minutes asking when his next dose was (which does happen with some patients) he knew when he was due.

ex #2. On discharge instructions I always go into more detail than what is written down, so the family member started writting down what I was saying. It made me kind of nervous, but I knew it was good information, so there's no reason to be nervous.

In my experience, the stuff they write has more to do with the meds their taking and things they have to do, not opinions.

But honestly, if it makes you nervous DOCUMENT DOCUMENT DOCUMENT. You're documentation is a LOT more credible than there's.

EricJRN, MSN, RN · Apr 9, 2006

Many times you'll hear patients complain that the docs come and go so quickly that they never have a chance to ask questions. Many patients just want to have some organized thoughts, so that they can ask the appropriate questions in a timely manner.

If you're really curious about the intent of the notes, you can always say, 'You're being really observant about your care. It's nice when patients stay informed about what's going on.' Then smile, pause and listen for their reaction.

Maybe I'm biased on this issue. My mom actually took down some brief notes from my several childhood hospitalizations (related to spina bifida and hydrocephalus). When I read them, I never think that they were recorded with the intent of building a legal case, but rather were just an attempt to stay on top of things. They're an interesting read now, and as a NICU nurse I can better empathize with the families I care for, because I remember those notes and think about how stressful things must have been for my parents!

Alex3 · Apr 9, 2006

My partner's CA has just returned. I take notes when the consultants come round because I'm tired and when it comes to updating the relatives, I can simply rattle my notes off and it's less effort - rotton memory due to exhaustion. I make notes of all those who look after him so that I can send cards etc... and keep a journal, which is more for me and his family. It's not a law suit in my case and as a nursing student, I've seen another nurse do this for her terminally ill patient. In my case, it's my treasured book.

Alex3 · Apr 9, 2006

Oops - meant for her husband - not her patient.

ZASHAGALKA, RN · Apr 9, 2006

My partner's CA has just returned. I take notes when the consultants come round because I'm tired and when it comes to updating the relatives, I can simply rattle my notes off and it's less effort - rotton memory due to exhaustion. I make notes of all those who look after him so that I can send cards etc... and keep a journal, which is more for me and his family. It's not a law suit in my case and as a nursing student, I've seen another nurse do this for her terminally ill patient. In my case, it's my treasured book.

There's a difference between keeping notes for yourself and making a show of keeping notes for the nurses.

If I was in your situation, I'd keep notes to keep myself clear. I just wouldn't make a show of having my notebook out, pencil in hand when the nurse comes in the room.

I don't think the OP was talking about making personal notes, but about the family members that make it a point to take very public notes - so the nurse KNOWS they are taking notes.

~faith,

Timothy.

Alex3 · Apr 9, 2006

I agree to disagree on this one. When your loved one is facing death - it doesn't matter that your'e scribing a diary, making notes - Nurses/doctors shouldn't feel threatened - why hide your feelings, your writings? In my mind - it's insecurity on the 'professionals' part if they are feeling anxious on seeing people scribing. Respect the patient - respect the relatives.