Here's a new one: chart assessments before midnight.....

[mom-wife-nurse]

So the facility I work for is now requiring that night shift finish our documentation by midnight bc if we don't "it looks like we're not documenting". This irritates the crap out if me!!

#1 We can't chart until we've done our treatments, so how are we supposed to complete a whole shift's worth of work in less than 6 hours? Our HS Med pass is not huge but it's heavy.

#2 Why do we have to finish our charting by midnight when day shift often stays after their shift has ended to chart? I realize that day shift is more hectic, but come on!

#3 Residents who we have to chart behaviors on may not have behaviors before midnight but often will after midnight.

Thoughts?

[xoemmylouox, ASN, RN]

You cannot chart what you have not done yet. You can document something, but not everything by midnight.

[BrandonLPN, LPN]

I'm not sure I understand. All you can document by midnight is what you've done up til that point.

[SleeepyRN]

Exactly. I work 3-11:30 and as soon as the night nurses cone in, they chart the TARS (treatments performed) and Medicare documentation.

[anon456, BSN, RN]

Um good luck with that. I will keep up on my meds, I&O, and VS but I don't get to anything else until much later in the shift, sometimes after the patient is handed off to the next shift. I am sure if enough RN's give feedback about it affecting patient quality of care it will change back to what it was before.

[mom-wife-nurse]

We have this really weird charting system where day shift is assigned certain residents that we chart on every day and night shift has a different set of residents we chart on every night. It has to do with payment, not Medicare but Medicaid I guess. It's weird. They want all of these to be done prior to midnight. So like it was mentioned, you can't chart what you haven't done. Taking this into consideration, we have to do all of our treatments done before midnight so we can chart them. They're basically asking us to do 12 hours worth of work in less than 6 hours.

[RNGriffin]

So, there is no room for error? Also, what's the nurse-patient ratio?

What is your documentation consisting of? Because, I've had a nurse chart ahead on a patient who was in a safety bed. Needless to say, by the time report came she charted the patient was asleep & respirations noted but the patient had eloped. In a longterm care facility your patient could be deceased while you're trying to beat the clock for a couple of dollars.

[Sam J.]

Sounds like they want to be sure every patient has documentation to justify daily skilled need, and the day ends at midnight. If nights has a schedule to chart on skilled patients, then technically if it isn't done by midnight, there may have been no documentation for the entire day, ending at midnight. Some places have this schedule to provide an overview of the patient throughout the day, rather than the same shift charting the same information at the same time every day. Some places take it to the other extreme (rather than dividing up skilled charting by shift), and require 'every' shift to chart on every skilled patient. If the daily skilled need is a treatment, IV, etc. that is assigned to nights, if it hasn't been done by midnight, then also it's possible the patient went 24 hours without justifying a skilled need for that day. But does signing off treatments, more so on 11-7, mean the treatments were done before midnight? Always risky to sign anything or chart anything before the fact.

[T.H.R.N.]

What the what???? That makes no sense at all. Agree with every one above. How can they even ask license holding nurses to something like this? We are good... but clairvoyant?

[KRVRN, BSN, RN]

It may "look you're not documenting" if you chart after midnight... but upon closer scrutiny, it's there right?

[BrandonLPN, LPN]

We have this really weird charting system where day shift is assigned certain residents that we chart on every day and night shift has a different set of residents we chart on every night. It has to do with payment, not Medicare but Medicaid I guess. It's weird. They want all of these to be done prior to midnight. So like it was mentioned, you can't chart what you haven't done. Taking this into consideration, we have to do all of our treatments done before midnight so we can chart them. They're basically asking us to do 12 hours worth of work in less than 6 hours.

ok, i think I get it.

Medicare (or Medicaid or whatever) apparently requires your facility to chart a note on everyone qday. So, they decided days would do half the residents and nights the other half.

I guess they want the note "timed" before midnight so its on that day (the day you come in).

Fair enough.

Seems like they're confused about third shift. I've found that many day-shift managers are easily mystified by what day is what when it comes to third shift. I had one manager who giving report to in the AM was like an Abbot and Costello "whos on first" bit.

"when did this happen?"

"last night."

"yesterday?"

"No, tonight, I mean last night. THIS last night, not LAST last night"

and so on... :)

If they really need that note before 12am, just chart a note about what happened up to that point. As other "noteworthy" events happen after midnight you can chart those accordingly. That way facility protocols are met and you're not falsifying documents.

[Here.I.Stand, BSN, RN]

How the heck is that supposed to work?? Especially if it's an 11-7 night shift? I work 11-7 and while we chart an assessment for midnight, between 11:30 and 12:00 we're not only doing assessments, but looking up when the pt has labs and meds, drawing said labs and giving said meds if any due at midnight (they'll have q 6 hr labs if on hypertonic saline or mag drips), doing oral care if they're on a vent (we do that q 2 hrs), turning them, getting outputs from their various drains... Plus we're charting some stuff MINIMALLY q 2 hrs like pain, hygiene care, restraints, neuro exam... In practice the midnight stuff almost always gets charted later.

Like PPs have said too, we can't chart ahead.