EMR co-signing for students

classicdame, MSN, EdD · Aug 7, 2007

Texas does not allow co-signing, unless you were there and witnessed everything said/done. My facility requires signatures and printed names of nursing students (retrieved during orientation). Since the primary nurse is responsible for the patient regardless of whether or not a student was involved, the primary nurse still has to review the chart. Sometimes the instructor will have the student chart on a fake nursing note (with no patient identifiers). Sometimes they just read the chart or discuss with the student what will be written beforehand. But we do not co-sign.

vickynurse · Aug 7, 2007

Wow, that it interesting. In Missouri we are required to co-sign. The primary nurse will sometimes co-sign, but will usually chart her own assessment, etc. As I said, some facilities require an instructor electronic signature with each entry at the exact time. Guess I get off easy just signing at the end of our 'shift'. I also have students chart on a 'pretend' chart until I have confidence in their ability.

BBFRN, BSN, PhD · Aug 14, 2007

I have to co-sign each med at the time of administration.

TNRN37 · Aug 21, 2007

We are implementing McKesson's Paragon EHR at our hospital. So far, we are only using the OE system. We start to "build" our own nursing documentation system in September. Any ideas or suggestions about what is going well at your hospital with students. Do you traing the nursing instructors on the computers? Do you train the students, too? I also have a question about how you have used Paragon in your Education Dept. It looks like we would have to go in under "Payroll" to enter data, but I'm not sure we can turn off the filters that we wouldn't need access to (like salaries), or that we could pull this information back up in reports. Any experience with this?

BBFRN, BSN, PhD · Aug 21, 2007

The clinical site where I teach also happens to be the hospital where I work. We use the Carelink program there.

I set my students up at the beginning of each quarter for the Carelink class. Upon finishing that, they get limited access, where they can only chart in the E-MAR, but they can view all other patient information. Their user IDs are useful only during that quarter.

I am already familiar with the program, but if I weren't, I would have to take the class as well.

vickynurse · Aug 22, 2007

Our faculty attend the same Meditech inservices as hospital staff. Students have a 2 hr introduction so that they will be able to view information and enter nurse notes. We do not alter the care plan or do anything r/t processing physician orders. However, we do have total access to the electronic chart.

The first several days of clinical, students do not chart on the EMR. Instead, they document in writing for me. Staff continue to complete all EMR documentation during this time. When I feel comfortable with the quality of their work, I turn them loose.

If you are involved in building the system, I would recommend asking for the ability to review and "co-sign" student entries once a shift. My data entry box includes the student name, hours the student cared for the pt, and my name. After I review all of the student entries, I write " have reviewed and agree with entries of this student". If need be, I add an addendum or clarification.

The facility nurse is also responsible for adding a note that she agrees with the assessment, or not, in a separate area.

Hope this helps!

classicdame, MSN, EdD · Aug 30, 2007

I need to amend my previous post. Clinical instructors are asked to co-sign medication administration and/or procedures but ONLY if they were present at the time. You can't swear to something you did not witness.

vickynurse · Aug 31, 2007

You can't swear to something you did not witness.

This is very true; however, we are still held responsible. I think that is the reason we have to sign, so they know who to sue