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.

[dudette10, MSN, RN]

Another thing: What I don't get is why this lawyer for this case is attacking this nurse based on the way she (and millions of others of nurses) have charted for decades. This is a completely new legal strategy, it seems, that has very flimsy argument. The usual way of charting = incompetency? Really?

For the record, I use first person when necessary. Either active voice, e.g. "I educated the patient on..." or passive voice, e.g. "Pt educated on ... by me."

I have never bought into all the reasons for leaving me--the nurse--out of my own charting; the arguments for it are flimsy. It is not more objective to use "this nurse" for reasons that Muno already stated, and the patient is not secondary just because I use "I" instead of "this nurse."

[dudette10, MSN, RN]

BTW, that part of the nursing textbook you (Muno) linked was referring to academic writing, not charting. Do your risk managers not understand the concept of context?

[MunoRN, RN]

BTW, that part of the nursing textbook you (Muno) linked was referring to academic writing, not charting. Do your risk managers not understand the concept of context?

The textbook refers to "Academic writing style" as what should be used in nursing notes, which isn't uncommon.

I get the context criticism and it's a valid one.

[Adele_Michal7, ASN, RN]

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."

This nurse has always thought it sounded bizarre too. 😅😅

[MunoRN, RN]

Another thing: What I don't get is why this lawyer for this case is attacking this nurse based on the way she (and millions of others of nurses) have charted for decades. This is a completely new legal strategy, it seems, that has very flimsy argument. The usual way of charting = incompetency? Really?

For the record, I use first person when necessary. Either active voice, e.g. "I educated the patient on..." or passive voice, e.g. "Pt educated on ... by me."

I have never bought into all the reasons for leaving me--the nurse--out of my own charting; the arguments for it are flimsy. It is not more objective to use "this nurse" for reasons that Muno already stated, and the patient is not secondary just because I use "I" instead of "this nurse."

The role of the opposing attorney isn't to create a reasoned, fair discussion about the complexities of nursing practice. Before my first deposition I clearly remember our attorney starting my prep with what to expect after being questioned by the opposing lawyer; "I recommend you not have deposition before your shift because afterwards you're going to have an overwhelming desire to curl up in a ball in the shower with a bottle of scotch." And it wasn't even me that they were after, they were just hoping to trip me up in questioning.

Particularly in a jury trial, the attorney's goal is to create a narrative, false or not, that can give the jury enough doubt in your story or your competence to find in favor of their client. Coming to an understanding of what is actually proper care isnt' really on their list of goals. Picking on things that can easily be portrayed as being nonsensical is pretty common, even when there actually is a valid explanation.

I typically use "passive voice", or impersonal third person, but yes, there are times when to be accurate and complete you need to reference yourself, in which case I use "I" or "myself". The major focus should be on the patient but you also can't pretend like you don't exist, that's when things get weird.

[Spidey's mom, ADN, BSN, RN]

This nurse has always thought it sounded bizarre too. ������������

I've used it for so long, it sounds perfectly natural to me.

[LobotRN, BSN, RN]

Mmmmm.....thinking of the future, I wonder how, "The nurse writing this entry witnessed the patient displaying increased levels of agitation as evidenced by tremors, fidgeting with bed linens, pulling at hair, and repeatedly stroking facial hair. Patient states that home medication regimen includes Xanax TID PRN. Medication verified with admission medication reconciliation and verification with patient's pharmacy. Call placed to hospitalist re: orders."

But ohhhh my goodness, really, REALLY? I'm all for accurate assessment and documentation, but to have a nurse's judgement questioned as to the "author" of any entry when precedent includes the use of "this nurse" meaning the author of the entry (in a situation of EMR only! because the attachment of the user ID to the patient record is independent and not in the control of the user).....talk about nuts! We don't see respiratory, physical therapy, or doctors battle this, do we????? Grrrrrr.

[AllieSparksRN]

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

Me too. "Writer spoke with MD, new orders received and noted..."

[applewhitern, BSN, RN]

I write in the first person. I was taught this way back in the 80's. It seems silly to me to use "this writer" or "this nurse." Really, who else is writing the note besides you? Either you sign your name after the note, or you use computer charting, in which case nobody else should be able to log-on and pretend to be you.

[PMFB-RN, RN]

If I have to refer to myself in a note its as "author" or, if for example giving a recommendation will write is as "RRT recommends transfer to a higher level of care". (I am the sole member of the rapid response "team" responding to the situation.

I find reading the notes written by our respiratory department painful as apparently they are not taught neutral writing. To many "I did this, then I did that".

[TTK RN]

I agree that this is an interesting thread. I have used the awkward expression, "this RN," for years. It has always felt strange to type that, but I was taught to never, never, never, under any circumstances use the words "I" or "me" in the chart. I don't type it often--only when clarification is necessary. I like the idea of replacing "this RN" by "primary RN" when clarification is necessary.

Perhaps it would be good to request an official position paper on this by the ANA. It seems like most people posting on this thread do not like the expression, but I'm curious how many nurses (like me) are charting this with ignorance of the legal ramifications.

[klone, MSN, RN]

I think the terminology people are looking for is "passive voice" vs "active voice".

Example:

"Wound was debrided and dressing was changed" (passive voice)

"This RN (or 'I') debrided the wound and changed the dressing" (active voice)

Sorry if that has already been mentioned