families with clipboards/notebooks

[shock-me-sane]

i am a first year nursing student (3rd quarter) and have been recently warned against taking care of patients whose families have clipboards and take note of everything you do. previous quarters there wasn't much of an issue because we typically didn't run into visitors/family, but we are at the hospital for an extended time this time around.

so, are these families just looking to file a lawsuit? how do you feel about caring for the patient, does it make you nervous?

[Antikigirl, ASN, RN]

I have had this many times and typically I start at square one on the legal matters as to IF they are allowed any information according to confidentiality! Most often I find they are not assigned as a medical rep for the patient, and I document that. As far as their questions towards me, they will have to gain medical rep status before I will answer their questions...and I explain that very nicely to them and the fact that this converstation has been documented as well by me. Then I typically give them a copy of a blank HIPAA form so they can understand.

Basically to me, after that point they can write down anything they wish for any reason they seem fit...I have covered myself and my patients right to confidentialty and that is documented legally!

I do thank them though for their involvement and encourage involvement...ie, if the pt needs help...call me.

Most times I do find it is medication they are documenting for various reasons...fear of overdose or conflict with home meds, to remind them of times like PRN's, a change in meds they wish to look up or ask the MD about, or my favorite "they take this med at home, why not here???".

There have been a few times I know it was for legal reasons...you can just tell! Control freaks like this, and like the intimidation I guess...makes them feel less powerless over the situation. I don't show fear, and try to implement other things for getting them involved to decrease feelings of powerlessness.

But no matter the reason, I make it clear if they are not a medical rep for the patient, then I can not tell them anything about the care of the patient, and they will have to ask the patient...or have the patient okay them as someone that needs to know via the HIPAA documentation legally.

[Antikigirl, ASN, RN]

I've never had one of 'em "you best better be careful or it's a lawsuit in the morning" types so far, thank goodness. Trust is a major part of nursing care - it's hard to deliver 100% care when you know that you're being treated like a suspicious, incometent thug than a trained professional.

Makes you want to go to their work or home with a clip board huh? LOL! Bet they would feel pretty intimidated!

[mommy2boys]

When my grandmother was dying from ovarian cancer whoever was staying with her (one of four of us were with her 24/7) would take simple notes. It was what meds and when they were given, what the nurses did to make her comfortable, etc. We would then share the info with the "oncoming" family member. Or if we had any questions for the doctor it was there so we wouldn't forget.

When she was sent home w/ hospic we had a better idea of what to expect, to do for her, the meds, etc. We took notes strickly for our education on how to take care of her. The nurses were wonderful in telling us what they were doing and why. We made sure that we weren't getting in the way or over stepping our bounderies, but we wanted to help care for her.

We would ask for the names of the nurses just because they treated her and us so well we wanted to make sure that the hospital knew what wonderful people they had working for them. So I know that everyone who takes notes are not trying to build a malpratice case against the hospital. Sometimes they feel like that is the only way they can be useful.

JMO

Erin

[Ruby Vee, BSN]

there are a lot more families sitting in the room ostentatiously taking notes than there were a decade ago. part of it, i think, has to do with the women's magazines warning their readers to "prevent medical errors from harming your loved one" by spending every moment at the bedside and taking copious notes. neither patients nor their families are as trusting as they were a generation ago. people in general are more lawsuit happy, and that doesn't change when they're hospitalized.

someone who wants to keep track of the nurse's names so they can thank them later comes across much differently than someone who is taking note to prepare for a lawsuit, and i think most of us can tell the difference.

a couple of months ago, i had a patient who was circling the drain. i was doing my best to keep up with the physical aspects of her care when the live-in boyfriend announced "i'll take a look at her chart now."

"excuse me?"

"her chart. i read it every day," he said, notebook and pencil in hand. "i'm ready to look at it now."

by some miracle, my charge nurse happened to be standing right behind me, and before i could say a word, she informed him that since he was not the power of attorney (and the patient was comatose) he was not entitled to read the chart.

"i read it every day," he said. "her brother lets me." (the brother was poa).

come to find out, they'd been picking up the chart and reading through it, and none of the nursing staff had informed them of the proper procedure for reading the chart. once i talked to the brother, he understood perfectly and was very nice about it. the boyfriend, however, continued to be a jerk about reading the chart for the rest of the hospitalization. fortunately, he's got no legal standing.

ruby

[ARLadyRN]

I make notes all the time and sometimes others do to in the hospital. They do it for various reasons, hopefully to help them to remember later. Just do your best if they are taking notes. I had someone in the hospital lately and I did that, but after they left, but not for bad reasons but I could have when the nurse wanted to take out the central line sitting up

[sharann, BSN, RN]

My dad is terminally ill and at home now that he is no longer seeking chemo treatment(too far advanced). Whenever he was in the hospital my mom or he himself would write down every vital sign and med as well as what the doctor said. They also asked for and recieved copies of every lab test done. They never had the intention of sueing anyone nor did they do this to scare the staff. They did this to know themselves what was happening. When in the hospital the spouse has no sense of control and feels pretty helpless, and this is one "job" they have that is "helping".

Now that he is home, my mom CONTINUES to make notes on this same notebook. She writes hes vitals and meds he takes daily. It helps her tell the doctor and hopice nurse what his days are like.

So don't judge people before you know why or what. As was said in an earlier post, these documents are not legal but may help prevent an error. Errors occur in hopitals belive it or not!

[Pepper The Cat, BSN, RN]

Rather than presuming a family is taking notes with the intention of sueing, why don't you just ASK them why they are taking notes? Many people here have indicted good, valid reasons they may be note taking. We had one family that wrote everything done so that the next person who visited would know what was happening and wouldn't have to bother the nurses with excess questions. It was great. When nurses needed something from the family and they weren't present, we would write notes back. (ie - Your mom needs more soap, or clean nightgowns). Too often we think the worst of people without knowing the full story.

[Blee O'Myacin, BSN, RN]

I have patients who like to track their blood counts, make sure they get every one of their pills, etc. Some like to know the rate of the IV Fluids. I'll even spell my name for them so they get it right. To us, invasive medical treatments are as natural as breathing, but to most people, its overwhelming. So if the little notebook gives them a sense of control, so be it. I haven't encountered anyone malicious - yet - but I'll just take it as it comes.

Blee (that's O - apostrophe, Capital M...)

[P_RN, ADN, RN]

Mama is in a nursing home. I keep a journal there mostly to remind her I was there, or my sis was there. I write what she was wearing. I write weather rain, sunny, hot cold. My sis also writes in the book as she and I live 40 mi apart from Mama in different directions.

[purplemania, BSN, RN]

I agree with Timothy, notetakers can be intimidating. Ask them what the notes are for. Give them only the bare minimum info. If you are still a student and have the option, avoid that room altogether.