In room charting?

[amyjm333, RN]

Hello! I am a new nurse and I had a question about in-room charting in the ED. We have computers in every room in our ED (well actually throughout the hospital). Do you all chart in the room or do you prefer to chart at the nurses station? What are the reasons why you choose to do it the way you do? Are there benefits to being in and out quickly when doing the initial assessment?

I know that at clinicals we could chart either place and up until the last semester I always charted at the nurses station. That last semester I decided to try something different and do all my charting in my patients' rooms. I found that I loved doing it that way for a few reasons: it seemed faster, and I got to spend a few more mins with my patients. I also felt that I was doing a more complete assessment as there were things in the EMR that I could simply ask my patient about, but would not have returned to the room to get the information as it wasn't vital to the patient's care.

I want to be as efficient as possible in my new role as an RN, and I totally believe in working smarter not harder. Do you have any insights you can share with me?

[JKL33]

A lot of this may come down to personal differences/preferences, in addition to the various set-ups we all have.

Very generally-speaking, when feasible I prefer to get out of the room as fast as I reasonably can; be assured I am gathering pertinent info and doing an appropriately-complete but concise assessment, in addition to whatever tasks can/should/need to be done immediately. After that I leave. Why? Well frankly a good portion of the time I am unable to "appreciate" whatever else is going on in the room. Visitors, kids crawling/climbing around, listening to a story 10x longer than it needs to be, being asked off-topic questions or even trying to maintain "polite conversation" while I'm trying to concentrate (on charting), fielding ongoing inappropriate requests, and...basically anything "extraneous" slows me down and distracts/mentally annoys me. I am pleasant, make good eye contact, get all my info, offer comfort items as appropriate....but when I am satisfied that I know what's going on (or where we need to go from here), I'm outta there.

*If there is ANY reason (psych/soc, pain, sick pt, etc., etc.) that I need to remain at the bedside, that's different than what I'm talking about above. Basically I'm there as long as I need to be, and after that I'm out ASAP.

Staying there to chart, I've tried it and so far more often than not the negatives have outweighed the benefit, for me personally. Some problems I have in my particular set-up (other than those in mentioned above)

- I hate feeling like I don't know what is going on outside of that room

- Can't see other monitors easily/quickly/with just a glance

- Don't really like the "milieu" of all RNs being sequestered away, not interacting in person as much/helping each other/interacting with providers

- I personally feel a little claustrophobic (?) in this situation, though I'm not that way in general

- Some nurses stay in rooms....for a very...long...time. That can be problematic depending on the set-up and expected work-flow

- I don't like the message I send to the patient, the endless clicking...I prefer to 'communicate' that I am focused on the patient while I'm in the room. On the other hand, if/when opportunities arise for me to chat w/ patient or family, I prefer to not be on the computer while I'm doing that.

Looking forward to others' responses. Every once in awhile I re-experiment with bedside charting and I'm guessing I'll try it again after hearing positives from some here....

[amyjm333, RN]

Thank you for the reply. I hope others chime in too.

This actually got my wheels turning thinking about how it is also super important to be available to help the team, and not be long gone for any extended amounts of time.

Thanks for your input!

[bgxyrnf, MSN, RN]

I rarely stay in the room to chart because I am then removed from everything else that's going on and unavailable to respond to phone calls, call lights, narc wastes, questions from the doc, urgent calls for help from colleagues, etc.

It also feels awkward to blatantly ignore the patient in favor of the computer.

I walk in, do my assessment, do my tasks, and go out to chart. As an experienced ED nurse, it's exceedingly rare for me to forget something which I need to address in the chart. If so, though, I just go back in.

[AZQuik]

Depends on what I'm charting and why. I do intakes/assessments I usually chart in room unless there is a reason I don't want to be there. Flow and discharges I usually chart out of room.

Meds are tricky because as er nurses we can get away with charting without scanning, but I try to cart meds floor fashion unless emergent or super busy emergent is next doorway