Notes in 3rd person style

[MunoRN]

We've been asked by our legal team why some of our nurses chart their notes in 3rd person ("This nurse notified the MD...").

Does anyone know of what the purpose of 3rd person narrative in nursing notes is? A rationale is preferable, but any reliable source that advocates using 3rd person would help as well.

[Oh'Ello, BSN, RN]

How would you phrase it if someone threw an IV pole at you?

Although it is off topic, "Observed patient throwing equipment" the fact that its at me is an issue for riskmaster, not their medical record.

[Adele_Michal7, ASN, RN]

How would you phrase it if someone threw an IV pole at you?

Patient combative; threw IV pole at licensed staff? 😩

[nlitened]

I have never seen or heard anyone chart like that. And thankfully, they aren't teaching us that way in my nursing program. It just seems.....awkward....

[icuRNmaggie, BSN, RN]

Patient yelled "I'll kill you !@#$%" and then picked up the IV pole and threw it across the room in my direction.

[MunoRN, RN]

...In the end, I don't think it is necessary to chart in the third person, although I'm not sure I see the harm in it. To the OP, why is the legal team taking interest in this?

A nurse is getting deposed for a court case, it doesn't sound like there is anything deficient in the care she provided, so the opposing lawyer is trying to create an argument that her charting is unreliable or at least is potentially confusing due to an awkward use of english and use that to question her overall competency. If we can provide some sort of benefit 3rd person charting provides that outweighs the potential confusion then we're fine, but we're not sure what that benefit is.

[MunoRN, RN]

I usually chart as writer. Example. Writer spoke with residents daughter who is concerned re abc.

The problem is that this is one likely scenario for how that questioning will go:

Lawyer: "Do you follow established standards of nursing care?"

Nurse: "Yes"

Lawyer: "Is this because you believe following established standards will help ensure the best care possible?"

Nurse: "Yes"

Lawyer: "In your note you mentioned that a "writer" spoke with residents daughter who is concerned re abc..., was this writer a licensed caregiver or a scribe?"

Nurse: "I was referring to myself"

Lawyer: "Isn't the established standards in the English language to write "I spoke with the residents daughter...."

Nurse: "I guess, but that's not how I refer to myself in my notes"

Lawyer: "You don't think that could be confusing to someone reading your note?"

Nurse: "maybe"

Lawyer: "So even though the purpose using standardized English is to ensure accurate communication between caregivers, you chose to communicate in a non-standard format? If you don't believe in ensuring accurate communication by using standardized methods, how are we to believe that you also adhere to standards of care?

[BrandonLPN, LPN]

How is "this writer" confusing? It seems crystal clear to me....

[KelRN215, BSN, RN]

How is "this writer" confusing? It seems crystal clear to me....

I think it seems clear to us because that is how we nurses are taught to chart. I can see how it would be confusing to someone outside of nursing. In general conversation you might say something like "this guy said" or "this girl did" and you're not referring to yourself but some random guy or girl... That said, I was always taught to chart "this RN" when referring to myself instead of I or me but it's not consistent across professions. Ever read an MD note? They write in the first person.

[icuRNmaggie, BSN, RN]

https://owl.english.purdue.edu/owl/owlprint/922/ Do not use the first person.

In narrative charting, avoid the use of I” and me.” Instead of I observed . . .” use This nurse observed . . .” I change the dressing daily,” becomes Nursing changes the dressing daily.” This helps to maintain the impersonal tone discussed above.

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According to these guidelines, nurses are still being taught to chart in the third person in order to be "objective" and "dispassionate" and to avoid writing in a "subjective" manner that could be construed as a personal bias.

I thought that it must be a regional thing because no one charts like that in my area of the country.

[Oh'Ello, BSN, RN]

Again more quasi-off-topic-borderline-irrelevance. Saying "This nurse observed"... or "this nurse changed a dressing" is essentially still writing in the first person, just substituting "I" with "this nurse".

I really expected a better interpretation from OWL.

This nurse feels too invested in this thread and backs away slowly..................

[JustBeachyNurse, LPN]

Third person would be actions and observations such as " trach site is clear and intact, no s/s of granulation, infection or irritation observed. trach care completed per protocol using clean technique, clean split 2x2 gauze placed around trach tube to absorb extra secretions"

Patient is yelling, agitated and pacing hallway. "Get out of my room!"and threw IV pole at staff. Patient guided back to bed by staff. 5 mg haloperidol administered IM left vastus medialis per order for increased agitation and aggressive behavior.

[MunoRN, RN]

https://owl.english.purdue.edu/owl/owlprint/922/ Do not use the first person.

In narrative charting, avoid the use of I” and me.” Instead of I observed . . .” use This nurse observed . . .” I change the dressing daily,” becomes Nursing changes the dressing daily.” This helps to maintain the impersonal tone discussed above.

------------------------------------------------------------------------------------------

According to these guidelines, nurses are still being taught to chart in the third person in order to be "objective" and "dispassionate" and to avoid writing in a "subjective" manner that could be construed as a personal bias.

I thought that it must be a regional thing because no one charts like that in my area of the country.

Thanks, I'll pass that along, hopefully they find it helpful.

I can't say I really understand OWL's rationale, since it's not that part of a sentence that determines if it is objective vs subjective or that it contains bias. If a nurse writes "I told the patient they were acting like a wuss", it doesn't seem like changing it to "This nurse told the patient they were acting like a wuss" makes it better in any way, except for making it both confusing and subjective rather than just subjective.