OG Nurses: How did you use paper charts?

Home Health Columnist / Guide · Aug 28, 2025

Thinking back to 1979 documentation when I worked nights.... Our forms came form Briggs Medical --can do image search for different forms.

1. + 4. New physician orders were flagged by unit clerk days/middles or night nurse by folding order sheet 45 degrees to stick out of chart to review and sign off. They were duplicate so copy could be removed and placed in pharmacy bin for pickup --no fax machines til 90's. Nurses signed off beneath orders indicating review q 8hr shift (colored pens red, green, black); night nurse signed off 24hr check below last physician order to make sure all orders reviewed: " 24hr order check / Nurse name LPN/RN _______________________" black ink line to end of page so doctor couldn't enter another notation afterwards. Stat orders --nurse paged overhead by unit clerk if not in view of unit clerk.

2. RN tasks were kept on separate nursing kardex folded in metal file by room# and added to chart upon discharge --admit nurse started form, updated q shift as needed --remember using pencil on some sections that could be changed like diet, VS frequency, daily labs etc. wound orders were in black on back side of form. Kardex used to give shift report + check if covering for meals.

https://allnurses.com/kardex-what-used-t333360/

3. Med administration were separate form: 30 days listed. When med changed --list "ended (if for specific # days/ or stop" draw line through remaining days. Separate line for each time administration OD (daily), BID, TID, Q4/Q8/Q12 if specific time interval-often antibiotics. Skipped line between each med on form so med stood out.

PRN meds were listed on bottom or separate sheet

5. Ancillary dept --notified by unit clerk or nurse on nights for Resp therapy, lab,, EKG tech, radiology for stat CXR etc.

nursej22, MSN, RN · Aug 28, 2025

We had 24 hour med admin sheets. Scheduled and PRN meds on separate sheets. The current sheets were kept in a 3 ring binder in the nurses station, old ones placed in chart. New sheets were printed by pharmacy in the late evening. Night shift nurses checked the new sheets against the previous ones for changes, errors.

The chart always went with the patient to X-ray, or procedures. And if it didn't come back with the patient, it seemed that it was always up to the floor nurse to fetch it.

When I first started nursing in 1987, the chart covers were metal and held the chart forms by Spring. Woe to you to drop one and spread papers everywhere, especially on someone with a prolonged admission.

In the mornings, there would be huge stacks of charts on the clerks' desk after doctors rounded, while the ward clerk plowed their way through, to find the stat, now and ASAP orders and get them processed quickly.

greener22, BSN, MSN, RN · Aug 29, 2025

Been a nurse since the mid 80s I'm definitely OG and I definitely remember how to use paper charts and I can answer all of your questions.
We were notified when they were new orders in the charts because of position would flag it and put it at the desk. The charts had a little mailbox type of flags that could be extended at the top like a bookmark.

Yes the Mars were on paper and it depended on which one you used if it had three days or seven days or 30 days on them. Paper charting for 30 day format or sometimes still used in long-term care.

If I needed to communicate something with another department I picked up the telephone tell them that the patient in room seven or whatever needed a new x-ray or that the diet order had changed...

Nursing tasks were kept on a Kardex, similar to what is in the brain on epic. It was a cardboard 8 x 11 or sometimes 8 x 10 paper that we wrote out in pencil things like the patient's IVs, dressing changes, when vitals were to be done etc. and then those were updated every shift or with every order written by the doctor.

The night shift staff would update the paper MARS.

The world is much safer now with ESR but much slower. I'm happy to have a longer discussion with you if you DM me.

JoFloRN · Aug 30, 2025

I too am a nurse from the 80s - and the posts are an accurate account from the time of paper charting from various places I worked as well. I love the graphics from NRSKaren, BSN, RN - the visuals takes me back! Nursing documentation (other than on the MAR or Kardex for nursing care plans) was narrative charting, usually on a progress note. Entry notations needed to be timed, so if you were unable to do your documentation immediately (maybe the provider had the chart or chart was with the pt off the unit), then hopefully you kept a good record in your pocket of the day's events and times of occurrence. The transition to computerized charting was difficult for me, going from a narrative to checklists. I felt like I could paint a more accurate picture in narrative form. But fortunately, I got over it and adapted and really like the EMR we're using now.

Advanced Practice Columnist / Guide · Sep 2, 2025

I worked both as an RN and NP during paper charts so here's what we did:

1. When new notes, orders are added to a chart, how were you made aware?

You flag the chart either with a tab on the chart itself that says "new order", bring the chart to the unit clerk, or if there is a chart holder - the holder has a color coded flipper (like a mailbox) that signifies that a new order is written on the chart. As for new notes, you just expect that a new one is written when a provider finishes rounds. They also communicate their plan better than nowadays.

2. were RN orders ( or RN tasks) placed on the blank Dr order sheet or was there another location for RN orders such as vitals, wound care etc?

The order sheet forms have 2 columns - the first column is for "care orders" such as VS, diet, telemetry, etc. The second column are for med orders and are faxed to the pharmacy by either the unit clerk or the RN. If a wound care order involves a medication it is written in the med column.

3. How were active meds kept track of? In the paper MAR? The ones Ives seen only have 3 days worth of dat, so did that have to be transcribed again and again?

I remember at least 5 days of med columns. Nurses put a line on discontinued meds. There is a whole list of "legends" used to signify a med is discontinued, not given, held, etc. There are places that even asked for specific color markers to mean something on the MAR so a lot of RN's had pens of different colors.

4 when a Dr placed orders, how were you alerted to review or check the chart?

see my answer to #1

5. If an order was for an ancillary dept, who's job was it to let them know?

The unit clerk and the RN both can execute those. Usually a fax is what they do. In other cases they actually enter it to an antiquated DOS-based computer system.

mdsRN2005, ASN, BSN, RN · Sep 3, 2025

Not an OG but came into nursing at the end of the paper chart era. I worked ER at the time so many of the questions you ask didn't pertain to us. But much of our communication over new orders/tasks/etc had to do with the location of the chart. For example, when we triaged a new patient, it was put it a rack by the ER physicians. This alerted them (loudly - it was metal on the bottom!) that there was a new patient to be seen. (Obviously if a patient was critical, we'd verbally tell them). If they were going to see the patient, they'd get the chart and take it with them or put it by their computer to keep another doc from grabbing it too. To that extent, if you knew that one doc had already seen the patient, (maybe he came into the room when the ambulance arrived), you'd give it to that doc versus putting it in the rack.

After the docs wrote their initial orders, they'd give it to the unit secretary to make/print lab slips. The secretary would then pass it on to us nurses. If it was just meds no labs, the doc would give it straight to the nurses. There was a shelf above our desks with racks that corresponded to each section of rooms. After we'd drawn blood, given meds, etc, we'd give it back to the docs. This process would be repeated anytime new orders were added, including finally discharge or admit orders. The key to this process is verbal communication of anything urgent, as well as a constant awareness of making sure you're putting the chart in the right place to get it to the person who needs it. Much like we now do with various computerized alerts now. Hope this helps, it's fun reliving that time and I truly enjoy reading these comments from the nurses who have more experience with it than I do!

Word of advice, your facility should do a trial down time run some time. We once had to do it for an entire day when the power was off after a storm (the generator powered all the crucial stuff but somehow the computer system didn't come back up). It was crazy all the things we didn't know how to handle! By that time all the OGs had retired and I was the only one on my shift who vaguely remembered it! Although since I'd come in between phase 1 and 2 of the transition there was a lot I didn't know either! So we were truly winging it. After that we did drills every year.

Ruby Vee, BSN · Sep 3, 2025

What's an "OG Nurse?"

heron, ASN, RN · Sep 3, 2025

Ruby Vee said:

What's an "OG Nurse?"

Old guard

Ruby Vee, BSN · Sep 3, 2025

heron said:

Old guard

What happened to COB? (Crusty old Bat?). I prefer Crusty Old Bat — I *chose* that.

Ruby Vee, BSN · Sep 3, 2025

Crusty Old Bat here: I'm the only person in my unit who has ever worked with paper charts except for that one time there was an IT Oops and Epic was down for most of our shift. The newer folks were utterly lost. Even though I worked with paper charts for decades, I wouldn't want to go back. Short of an apocalypse, I don't know why anyone would want to go back.

1. When new notes, orders are added to a chart, how were you made aware?

New orders were "flagged" by folding the page over. Nurses weren't "expected to" read physician notes, so they weren't flagged. The house staff who had rounded with the attendings knew what the attendings were thinking, planning or wanted done and the nurses were expected to find out when the house staff wrote orders (or, in the ICU, informed them face to face). I preferred to read them for myself, so I looked every time I spotted attendings on the unit, had new orders or had a chance to look.

2. were RN orders ( or RN tasks) placed on the blank Dr order sheet or was there another location for RN orders such as vitals, wound care etc?

All orders were placed on the same order sheet, and sometimes you'd have six lines of pharmacy or RT orders, one RN order another six lines of something else. So you had to pay attention. Orders are orders.

3. How were active meds kept track of? In the paper MAR? The ones Ives seen only have 3 days worth of dat, so did that have to be transcribed again and again?

Paper MARS — one day's worth for the ICU, and the night shift was responsible for copying the active orders onto a new MAR. Stepdown had three days worth of meds, and again, night shift copied the new orders over. The floor had 7 days, and rhab had 30 days. Some rehab units started a 30 day sheet on the first of the month, so that you had all of January 1977 on one sheet, February on the next, etc.

4 when a Dr placed orders, how were you alerted to review or check the chart?

ESP.

Seriously, if you saw an attending on the unit, you checked your orders. Or the unit clerk would page you to the desk for new orders. If you were expecting new orders, you swung by the desk to check again and again until you found them.

Or ESP.

5. If an order was for an ancillary dept, who's job was it to let them know?

The Unit Clerk/secretary would schedule it, if you had a good unit clerk. If you didn't have a one or they weren't a good one, it fell to the RN. In truth, everything fell to the RN. If something fell through the cracks, it was always the RN's fault. I've seen RNs fired for "failure to supervise.” Back in the day, you picked up the phone and called the ancillary department — a LOT. When you changed jobs, you carried a little notebook or card in your pocket with the most frequently called numbers for that unit. I knew the Blood Bank, pharmacy, radiology, the OR and the three cardiology practices by heart, and could call the operator and ask to be transferred to any place I didn't know the number for.

As much as I dreaded Epic — to the point of changing jobs and moving cross country two weeks before they were scheduled to go live in my ICU — I would not want to go back to paper charts.

In a teaching hospital, the house staff would hog the charts and then be upset because the q 15 min vital signs weren't charted after they'd taken the chart off the unit for an hour.

I've seen attendings come to actual blows because one service had the paper chart when the other service was rounding. (Usually cardiac surgery was one of the combatants. Anesthesia was a frequent offender, and pulmonology was another. Cardiology would just ask me whatever they wanted to know if another service had the chart, including things like "What does renal want to do?” and "did they (primary service) write for a neuro consult?"

Someone transcribed the MAR incorrectly and the patient got three days of the wrong medication/dose/route/whatever.

Someone's handwriting was illegible or they used the wrong abbreviation and the nurse or unit clerk who transcribed the order transcribed what they actually wrote rather than what they meant.

I could go on forever, but I doubt anyone wants to read that.

heron, ASN, RN · Sep 3, 2025

Ruby Vee said:

What happened to COB? (Crusty old Bat?). I prefer Crusty Old Bat — I *chose* that.

One of the young'uns got all thin in the nose over it. Too disrespectful, she said. There was a short-lived attempt at a COB forum over in the breakroom but no go - too many of us are no longer posting.