Teaching a CNA how to chart

Nurses General Nursing

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I started a job as the DOC at an assisted living facility and I am trying to get my CNA's to start charting (they only have been writing in a communication book little notes to each other but nothing on legal documents). I just need help or advice on the best way to teach them how to write progress notes since none of them have any experience charting!

Thanks!

13 years as a CNA and I've never had to write progress notes. Mostly my charting has been in the form of flow sheets where we had to check off and initial how patients performed transfers and ADLs through the day (Extensive assist of 2, limited assist of 1, Total, etc), as well as how and how much they ate, if they had a shower/bath, bowel movements, I&Os, vitals, distances walked if they did with us, and behavior sheets, turning schedules, weekly/daily weights, etc. Nothing was written out...everything with the exception of vitals and I&Os were check/initial boxes. And everything was legally binding, hence our initials and a nurse's signature being required. These sheets were kept in their own binders organized by room number or alphabet so we didn't monopolize the nursing charts. A couple of years ago my current facility transitioned to electronic charting and the aides have access to the same system the nurses do (touch screen computers on the hallway walls felt so futuristic! Lol), and when we log in it's programmed for what we need to see and utilize. But it's still basically the same in that we just select the options for how activities through the day were performed. Except instead of sitting down at the end of the shift to go through all our sheets, we are supposed to continuously chart as we work...it doesn't always work so well on busy and short days, but we try.

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Specializes in LTC,Hospice/palliative care,acute care.
I started a job as the DOC at an assisted living facility and I am trying to get my CNA's to start charting (they only have been writing in a communication book little notes to each other but nothing on legal documents). I just need help or advice on the best way to teach them how to write progress notes since none of them have any experience charting!

Thanks!

Try to limit them to graphs,flow sheets or "fill in the blank from these choices" via electronic charting.No offense meant to any cna's on the board,I worked as one for years.

You would NOT believe the narrative notes our unlicensed staff have entered in the electronic medical record.Opens a big can of worms.Our admin had to stop it." Resident sitting on bed looking bad".No follow up,nothing reported to the nurse.

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Specializes in Critical Care.
At my hospital aids are allowed to put in a nursing progress note because it is appropriate to a certain extent. For example "Ambulated patient. O2 dropped down to 88 with activity". this is technically related to the progress of a patient and isn't appropriate for an RN, who didn't walk the patient, to chart this.

But it also says the title of the note maker after their name.

Those are charted observations, not a nursing progress note. A nursing progress note takes observations such as those and determines how those observations fit into the patients overall plan and progress of that plan.

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Plus, how desirable is it to have more than one person at a time charting on patients, regardless of their title?

Ask any cop, perfectly intelligent people will have differing accounts of the same situation. Do you really want CNAs putting their version of a patient fall in the medical record, alongside the licensed nurse's? Even a narrative note of a relatively uneventful shift will vary from nurse to nurse.

I'm curious what the precieved benefit is of having CNAs chart nurses notes. Even if the CNA in question is capable of writing proper narrative, it still seems like too many cooks in the kitchen.

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Hi,

I think there is a little confusion about nursing progress notes and charting. Just to clarify, I think NurseNicolexo is not talking about nursing progress notes, but charting. I think it's perfectly appropriate to write a small note (even if its under Nurses notes) or make notations in the chart if you did something and it's not available on your flow sheet.

I work in the ED, and there has been a big push for NAC/PCT's to chart as well as the nurses. If you didn't chart it, it didn't happen.” Regardless of whether you use flow sheets or blank notes it's important that we chart what we are doing. It's one thing to tell the nurse that so and so is behaving strangely, but what if they forgot to mention it when they do report at the end of shift? If it is also in the chart there's a better chance that important information like that won't get missed. I understand that in LTC facilities CNA charting might be limited, but at our facility we would go into the nursing notes and write things like pt BP is high. Nurse notified.” Or if glucose was low, I chart the results and what I gave them i.e juice or snack after notifying the nurse.

I think the best way to teach good charting is by example. If you can, I would provide examples of what good charting looks like, as well as bad. I would then discuss why good charting is important and how bad charting can lead to problems. For example, we had an issue in the ED where we did a set of vital signs and the patient was hypotensive. It wasn't charted that the CNA told the nurse (which happened) or that the nurses then told the doctor who was made aware of it. You might think well what does it matter? 3 hours later the pt was intubated and in the chart it looked like we did nothing. Charting not only protects you and provides evidence of care, it also helps you take credit for all the things you do for the patient. Also, many CNA's are looking to become RN's, why not get in the habit of good charting now?

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As a CNA myself, I can tell you that the way charting most affects me is when the other aides DON'T chart bowel movements and the resident is wrongfully placed on bowel protocol and explodes all night long.

If you're looking for a way to motivate your aides to chart, and you are trying to find a way to tell them that charting affects them, I would start there.

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Specializes in Float Pool - A Little Bit of Everything.
I'm wondering if CNA charting would be covered in your P&P's? I ask because I have worked in areas where CNA's are not allowed to chart, with the obvious exception of vitals, BS, etc. I never knew why but I always assumed it was due to the potential liability issues of someone without significant training in proper charting technique....what you say (and how to say it), and what you don't say.

I can just imagine an aide innocently charting that Mr. Smith fell to the floor when Nurse X forgot to do X, Y or Z.

I was thinking the same thing! IN all my facilities and hospitals, CNAs were not allowed to chart any notes, assessments, etc. I was an ER tech in Nursing School and I was taught that we were not allowed to chart in EMR for exactly the reason you mentioned.

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Specializes in Emergency, Telemetry, Transplant.
I'm not sure progress notes are appropriate for a CNA to chart.

That's what I was thinking. When I was a CNA, there was paper charting. There was a CNA charting book that basically had tasks for each resident. The CNA on each shift would initial that they were done on that shift. Examples would include "turn and position q2h,' 'bunny boots while in bed,' or 'encourage fluids.' The CNAs would also chart VS and I&Os.

I'm not trying to put anyone down by saying this--I think about how much trouble it can be to get some nurses to chart properly (when it was covered extensively in nursing school), and can't even imagine how difficulty it would be to give a CNA a 30 minute 'crash course' and expect the charting to be appropriate, legally sound, etc.

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Specializes in Emergency, Telemetry, Transplant.
For example "Ambulated patient. O2 dropped down to 88 with activity". this is technically related to the progress of a patient and isn't appropriate for an RN, who didn't walk the patient, to chart this.

If the aide does chart that, they also need to be charting that they followed up with the RN about it...

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Ramsey Bolton ⬅️ 😂😂😂

Lol

Maybe I've been reading too much Game of Thrones but I can't stop thinking you probably strike a resemblance to Ramsey Bolton.

I find throwing the comment 'Your ability to perform this skill, or not, will be included on annual reviews' effective if timed well and used sparingly. This does though use Carnegie's advice still lol

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