What is charting?

Nurses General Nursing

Published

What is it that you chart as a nurse and how long does it take?

Just curious is all since I see a lot of nurses on allnurses say how they love nursing but not charting.

Specializes in Case mgmt., rehab, (CRRN), LTC & psych.

I have written extensively about nurses' charting. Click on the links below if you have time to burn.

https://allnurses.com/geriatric-nurses-ltc/ltc-charting-a-899111.html

https://allnurses.com/medical-surgical-nursing/nurses-charting-part-1042642.html

https://allnurses.com/nursing-issues-patient/nurses-notes-guidelines-913714.html

Specializes in Reproductive & Public Health.
Nurses Now Required to Chart When and What They Are Charting | GomerBlog

Basically, we chart what we see and do. We're charting assessments, interventions, and interactions with the patient and the healthcare team.

For example, we chart what is physically going on with the patient. We chart things like breath sounds are normal, heart rate is irregular, there is swelling in the ankles, stuff like that.

Then we chart what we do to and for the patient, like giving medicine, taking them to the bathroom, starting an IV, etc. We chart about the equipment that's in use, like different pumps (IV, feeding, sequential compression, etc.)

We also chart what we talk to them about, like the plan of care and education about medicines and whatever.

We chart about where they go, like to get an MRI.

We chart what we talk to the doctor about.

We basically record the patient's stay.

+ Add a Comment