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.

[No Stars In My Eyes]

Not quite the same problem in PD cases. Our legal charting goes on a designated form and is turned in to the office. We also keep a shift log narrative for just us caregivers, otherwise continuity is all to hell. The first time I read someone writing in the shift-log using the third person, I thought, "This nurse? No other nurses are there! Who else would it be?" It's a private duty shift in a private home where the patient lives alone.

Nothing wrong with the third person charting; I just think it is awkward. Don't like using "I" in the legal charting, though.

Hospital-wise, the only rationale I can think of is that it is one of those things trotted out to "simplify and provide clarity" that doesn't actually accomplish anything except getting someone in admin (the one who proposed it in the first place) a nice little bonus for being proactive, and to add a little more hassle to a nurse's already gommed up day.

[No Stars In My Eyes]

Not quite the same problem in PD cases. Our legal charting goes on a designated form and is turned in to the office. We also keep a shift log narrative for just us caregivers, otherwise continuity is all to hell. The first time I read someone writing in the shift-log using the third person, I thought, "This nurse? No other nurses are there! Who else would it be?" It's a private duty shift in a private home where the patient lives alone.

Nothing wrong with the third person charting; I just think it is awkward. Don't like using "I" in the legal charting, though.

Hospital-wise, the only rationale I can think of is that it is one of those things trotted out to "simplify and provide clarity" that doesn't actually accomplish anything except getting someone in admin (the one who proposed it in the first place) a nice little bonus for being proactive, and to add a little more hassle to a nurse's already gommed up day.

No nurse has ever gone into nursing for the paperwork.

[SierraBravo]

I remember in nursing school something about being taught to state, "this nurse (writer) performed...". To be honest, it has always sounded awkward to me. Actually, for me, it's like nails down a chalkboard; I cringe every time I read that type of language in a nursing note. Just one of my peeves. I state everything objectively such as, "foley inserted at xxx per provider order, patient tolerated well".

[michlynn, BSN, RN]

Hmm... this is a very interesting topic. I chart in the 3rd person fairly often I guess when I'm charting about conversations I had. It would seem that you would be the obvious RN charting if you wrote "RN spoke with so and so..." but it could also be interpreted as you charting about a fellow co-worker that spoke with whomever instead of yourself which is usually why I type "this RN spoke with pharmacy..." or whatever.

[BrandonLPN, LPN]

I like to chart in the second person.

[ChipNurse]

I have only seen one nurse write in the 3rd person and it weirded me out big time? I was never taught to do that in school. It seems strange and unnecessary.

[Spidey's mom, ADN, 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.

I was taught that it is common practice and industry standard to use third person. The rationale I was given is that it is formal and necessary for legal language, in case of a suit. I find it ironic that a lawyer is questioning it.

I was taught this in nursing school and in a risk management presentation during onboarding in a hospital in the Southeast.

I'm in California - and we were taught to chart in the third person. As stated, takes ourselves out of the picture and focuses on the patient. I always chart that way.

[SubSippi]

Using "this nurse" does sound weird, I've never seen anybody use it until now. If I ever refer to myself in charting I use "primary RN."

[Dogen]

I'm working in a community mental health clinic, so I see notes of various specialties. I've never paid much attention to it until now, but noticed the therapists also write in this pseudo-third person style, though they refer to themselves as "this writer."

"Client mood improved when she and the writer walked outside."

[MunoRN, RN]

I would turn it around on the lawyer and imply that their job knowledge is unsound if they did not know this already. Perhaps you should consult risk management or a malpractice insurance company.

Malpractice insurance lawyers would definitely be able to help you out with this one.

I did ask my Risk Management department and they said are well aware of the use of "this nurse" and "this writer" and have tried to educate staff about it in the past. They said notes should be written using what they called "passive voice" where no reference to the writer is made, but that nurses seem to mistakenly believe that "this nurse" or "this writer" is not first person. They referred me to few nursing grammar textbooks, including this one:

This involves avoiding the use of the first person 'I' or the second person 'we' or 'you' and instead writing in a more impersonal way. Note that the use of the words 'the author' or 'the student' instead of 'I' should be avoided as this does not change the sentence into the third person.

She said that while we could argue these terms are frequently used, one of the worst arguments you can make before a jury is "it's how a lot of people do it", so most likely we'll just need to 'take our lumps' for the mistake and try to keep it a non-issue.

She added that while "passive voice" should be the prominent style, references to the writer are sometimes necessary in which case they prefer the accuracy of first person and is sometimes an absolute legal requirement.

[canigraduate]

I did ask my Risk Management department and they said are well aware of the use of "this nurse" and "this writer" and have tried to educate staff about it in the past. They said notes should be written using what they called "passive voice" where no reference to the writer is made, but that nurses seem to mistakenly believe that "this nurse" or "this writer" is not first person. They referred me to few nursing grammar textbooks, including this one:

She said that while we could argue these terms are frequently used, one of the worst arguments you can make before a jury is "it's how a lot of people do it", so most likely we'll just need to 'take our lumps' for the mistake and try to keep it a non-issue.

She added that while "passive voice" should be the prominent style, references to the writer are sometimes necessary in which case they prefer the accuracy of first person and is sometimes an absolute legal requirement.

That's good to know. I don't use "this nurse" personally, because I think it sounds stupid, but I never would have thought that a lawyer would use that as a way to imply the nurse was incompetent.

I would think that it being an industry standard type of thing wouldn't hurt if presented that way in front of a jury, as most law is just based on precedent, anyway. (Right? I'm not a lawyer and don't play one on TV. The closest I've come is lots of jury duty.) So to me, the argument that because it has always been done that way would be valid because case law is based on what verdicts came before, not necessarily on evidence. I don't know, I'm grasping at straws here. Most jurors are as law illiterate as I am (at least the ones I served with were), so I don't really see as much of an issue as I think the lawyers do.

[dudette10, MSN, RN]

I did ask my Risk Management department and they said are well aware of the use of "this nurse" and "this writer" and have tried to educate staff about it in the past. They said notes should be written using what they called "passive voice" where no reference to the writer is made, but that nurses seem to mistakenly believe that "this nurse" or "this writer" is not first person. They referred me to few nursing grammar textbooks, including this one:

She said that while we could argue these terms are frequently used, one of the worst arguments you can make before a jury is "it's how a lot of people do it", so most likely we'll just need to 'take our lumps' for the mistake and try to keep it a non-issue.

She added that while "passive voice" should be the prominent style, references to the writer are sometimes necessary in which case they prefer the accuracy of first person and is sometimes an absolute legal requirement.

Now I'm totally confused. They want passive voice without reference to the writer? This is what passive voice looks like:

"Pt was educated on medication dose, route, frequency, timing, side effects, and adverse effects."

This is the same sentence written in active voice, which necessitates first person:

"This nurse educated the patient on medication...."

The passive voice has no one doing the action. If brought before the court, how will the nurse prove that he/she was the one who actually carried out the intervention?