How is ER charting different than floor?

Well for me, we chart the minute things happen - as you know, everything is STAT so times are important. If I can't document it right away, I write the time on my hand. Needless to say, by the end of my shift, I've got some pretty inked up hands and arms.

But I typically do - 1) nursing assignment note (who endorsed the pt to me, what time I first saw the pt in my zone, etc.) 2) RN initial assessment (full head to toe) 3) if they're intox, I'll do a CIWA and SAD person's assessment 4) a "receiving note" focus note that gives more detail into my initial assessment 5) anywhere from 1 to 6 additional focus notes covering anything noteworthy that might have happened (I usually include an "IV access" note) 6) a discharge note, or an SBAR if the pt is transferred or admitted.

In our critical area we have a separate "Critical Care Note" which combines the initial assessment with any focus notes, critical lab values, etc. mixed in there.

We don't have much in the way of care plans, but we do document a lot of restraint and 1 to 1 flow sheets and take photos of ulcers. :)

Assessments are done based on what the patient is presenting with. Everybody gets a generalized head to toe assessment along with a falls risk assessment and assessing for communicable diseases. Then, based on the CC, you add to it. I don't look into every crack and crevice of a patient's skin like they do on the floor, unless the patient is a trauma patient. If the patient is a neuro patient, they will get a more detailed neuro exam including an NIHSS score if they are presenting with stroke-like symptoms. If they are a psych patient, they will get a psych assessment and an intake assessment from a psych RN or social worker. You are constantly evaluating and reevaluating in the ER but typically the initial assessment is performed and then we just chart a nurse's note for any changes (or none if there aren't any).

As a former floor nurse, I would say the biggest difference is that in my ER we are expected to document on the pt at least once an hour. For ER pts this is easy enough because there is also something going on every hr, be it pain reassessment, charting that they went to a procedure, etc. When we board med-surg pts that are stable, we are still expected to chart every hr, but if there is not as much happening hour by hour we can document rounding logs on these pts instead of an actual note

I found the biggest thing is that your constantly writing nursing notes, but you don't have to deal with charting the prevention methods such as incentive spirometer etc. you also don't have to worry about charting on the person every 2-4hrs depending on your hospitals policy. personally ER charting to me is 10x easier compared to floor because your charting is less frufru and fluff and more common sense and priority... :)

I found the biggest thing is that your constantly writing nursing notes, but you don't have to deal with charting the prevention methods such as incentive spirometer etc. you also don't have to worry about charting on the person every 2-4hrs depending on your hospitals policy. personally ER charting to me is 10x easier compared to floor because your charting is less frufru and fluff and more common sense and priority... :)

Totally agree with you. I imagine er charting more like using nurses narrative notes instead of doing all nonsense fluffs that no one really cares for (ahem care plans...). If bp high, put it, what intervention, will reassess in 5 minutes or whatever. I feel like medsurg is more catered to doing administration's bs and beaucratic nonsense that are just done to meet regulating body standards and their hoops, while ER does things to save lives and do the most important and critical things... and just that.

I feel like medsurg is more catered to doing administration's bs and beaucratic nonsense that are just done to meet regulating body standards and their hoops

No, we have that in the ER too.

ED charting tends to be more problem-focused.

No, we have that in the ER too.

Ya i totally understand that, but you know what i mean. Obviously er has to follow regulations, but i think couple things get overlooked since its er and only real important things need be done, and you guys are already running crazy. Of course thats not why i want to get into er or anything but the "cutting bogus and tend to most important thing" is very attractive thing.

Well I used to love ER charting.....until we went to the colossal turd of a charting software we use now. It was easy to use, focused on the need and no fluff.

In my ER the "care plan" for a patient is very slimmed down, and straight forward. I would love to say it doesn't force us to double chart, but sometimes it even forces triple charting. On the med-surg floor, the care plans have you documenting interventions up to six times, it's totally overboard and causes enormous excessive resource drainage.

Typically I would guess that most of my ER colleagues chart 10-15 min/hr and take care of patients the remaining portion of the hour. When the **** hits the fan, and we have critical patients, someone becomes the scribe and the documentation is a hand written note. I have often placed the entire handwritten note into a nurses note and been done with the documentation for that patient, all interventions by several staff in one note.

On the floor, I've seen many nurses who spend more time at the 'puter than in the room. In fact, I would think it's typical, and as I said, they often chart the same intervention in several screens.

I don't chart care plans. I chart my initial assessment, reassessments per floor policy, reassessments when change in condition is noted, interventions and discharge instructions. This could be simple and fast on a benign belly pain or one nurse's sole job on a crashing patient.

From experience, it's best to always chart a mental and respiratory status, ambulatory status and then the CC and its associated s/s. It's best to chart in a way where you can look back in a week or years and be able to grab a mental picture from your narrative. When they came in, was their skin pink, warm, dry, were they at ease? restless? tachpneic? Were they limping, red in the face? I always think of my charting in terms of conveying what I see for the future nurse, or myself, if need be. And of course charting to CYA. I have been called in the office for things that are out of my control, so if one is in a brief and it's clean and dry before they go to the floor, chart that. If it's not charted, it does not exist. Defensive charting. Ridiculous, but it's the sad state of our affairs. Nurses love to write up other nurses, especially floor nurses (majority, not all!) who hate ER nurses for a multitude of reasons, but mainly because we take care of the emergency then move them out.