Profanity in nursing notes

rjflyn, ASN, RN · May 18, 2006

Its like the most frequent saying in documentation- if you dont write it down it didn't happen. Goes with what a patient says if you dont quote it word for word when it goes to court it was never said.

Working in ED though like some of the other posters have mentioned profane langauge is very common and most people dont even think twice about what they are saying which really is quite sad.

RJ

ZASHAGALKA, RN · May 18, 2006

I just can't imagine that I would need, in Court, to point out the EXACT profane words that were used; it's enough to note that profanity was used at all.

Even if a defense atty decided to berate me about this issue; having a discussion on the stand about my feelings that not charting profane words is a matter of INTEGRITY simply bolsters that concept in the mind of jurors that tend to think of nurses in terms of halos, anyway.

Would a nurse that balks on printing curse words lie on the stand?

As a result, no defense atty in their right mind would push that issue. I think, in fact, that it's a non-issue.

If anything, every legal class I've been to has stated that the best recourse against lawsuits is a good rapport. If someone requests their chart, and sees what you wrote about their words when they were incoherent, the resulting embarrassment could go a long way towards destroying that rapport, leading to an INCREASED chance of being sued.

I think that repeating crude conversation is tantamount to contributing to crude conversation. It's just unnecessary.

And uncouth.

~faith,

Timothy.

Gompers, BSN, RN · May 19, 2006

Tweety said:
That probably is a time when I would use direct quotes, including the profanity, is when they are threatening. Good example Dale.

I'm glad to see this. Usually I'd write, "Patient's family very angry" in the nursing note if it was necessary...but one time I didn't. This baby had just come to our unit and just got sicker and sicker, so the parents started blaming us for making him worse and threatened to call their lawyer all night long. They kept swearing and screaming and saying how they would sue our butts off, so to speak, and that their lawyer was going to get their kid out of there in the morning. This was all over the phone. The docs tried to tell them what was going on, but they were just so irate. I was told by the docs to document everything in quotes, so I did. Got called into the managers office a few days later and was pretty much in deep doo-doo for this. Another nurse who'd been to court several times had seen my note and reported me because it was apparently very inappropriate. I just did what the docs said! We didn't do anything wrong - in fact, had the baby still been at the Level II nursery he'd come from, he probably wouldn't have made it through the night since his disease process was so aggressive. So the docs just wanted to show that the parents were litigious-minded from the start, just in case it ever went to court.

What should I have done?

The scary thing is that I have about 17 more years to fear this lawsuit since it was a baby and it was a few years back. I don't think they'd sue - when he got better they were sweet as pie and even came back to visit a few times to show how he's doing, which is very well. But still...I CRINGE at the thought of seeing that note blown up to poster size in a courtroom.

Tweety, BSN, RN · May 19, 2006

ZASHAGALKA said:
I think that repeating crude conversation is tantamount to contributing to crude conversation. It's just unnecessary.
And uncouth.
~faith,
Timothy.

Sigh......as we often do, I disagree with you, but respect your thoughts. You're putting some kind of moral superiority on not using direct quotes.

Direct quoting in charting is not wrong. Is it always necessary? No it's not. Read nurses notes and you're likely to see very few quotes, just a description of the events of the day, so why quote profanity?

Is it wrong or morally inferior to quote? In my opinion: no.

No, you didn't say this, but that's the insinuation I'm picking up.

leslie :-D · May 19, 2006

likemike said:
Nurses getting hurt is a big problem and the lawyer said to protect us by using factual statements, no innuendos, no opinions. Just the facts maam to quote Jack Webb.

Precisely.

I've always charted direct quotes from the pt. and will continue to do so.

This is what i was taught and this is what i was advised by an rn jd.

ZASHAGALKA, RN · May 19, 2006

Tweety said:
Sigh......as we often do, I disagree with you, but respect your thoughts. You're putting some kind of moral superiority on not using direct quotes.
Direct quoting in charting is not wrong. Is it always necessary? No it's not. Read nurses notes and you're likely to see very few quotes, just a description of the events of the day, so why quote profanity?
Is it wrong or morally inferior to quote? In my opinion: no.
No, you didn't say this, but that's the insinuation I'm picking up.

No, I didn't say that.

I said it was uncouth. But that is a reference to a specific behavior and not anybody.

For example, it's uncouth of me to pick my nose in my car, where people could possibly see it. But, I have done that from time to time. That doesn't mean that I'M uncouth in general; but that behavior itself - well it certainly qualifies.

I'm not saying it's morally inferior to quote word for word. I'm saying that I can't see how it's necessary.

And so, it's a tad 'uncouth'.

uncouth (n):

1. Crude; unrefined.

2. Awkward or clumsy; ungraceful.

Just to recap; I wasn't making, per se, any moral equations there. My comments belong more in a 'ms. manners' column than it does a pulpit.

~faith,

Timothy.

Tweety, BSN, RN · May 19, 2006

Thanks for the clarification. I still disagree with you.

To be honest, as many times as I've been cursed at I've rarely quoted the profanity in my charting. I'm trying to think of a time where I have and I can't think of it recently. However, just last week a teenage girl gave me an earful and I bumped into the MD right outside the door and the doc asked "what did she just say", and I quoted her word for word. I don't think I was crude, unrefined, awkward, clumsy or ungraceful.......just brutally honest in answering a question. This is not the first time I've quoted a patient verbatum to a doc or collegue. I don't care if someone thinks me uncouth or not. Usually, it's just to report the patient means business and I've tried to therapeautically communicate on my end. Did I run to the chart and quote the patient word for word? No, it really had no relevence whatsoever to her care. She was just a brat.

I do all this with plenty of finesse (which you imply can't be done when directly quoting a patient).

Finesse (n.):

1. Refinement and delicacy of performance, execution, or artisanship.

2. Skillful, subtle handling of a situation; tactful, diplomatic maneuvering.

ZASHAGALKA, RN · May 19, 2006

Current Quote on a local church sign:

"Profanity is the lifting of heavy words by weak minds."

Certainly, our finely tuned, educated, professional minds are stronger and have more range and depth than that.

I'm not casting aspersions on people that do use quoted 'profanity'. Many nurses have been taught that this is not just acceptable, but required documentation. I disagree.

And many disagree with my take. Touche'.

But, I just think that professionalism dictates a decorum that should AVOID repeating crass and crude remarks. Surely, we are ALL professional enough to get the idea of the exchange across without resorting to the same level of crudeness.

It's not the end of the world, nor a major faux pax to quote; but. . . I think ms. manners would agree with ME on this. . .It IS impolite to do so. Quoting PRESUMES that everybody agrees with you about the appropriateness of including such quotes.

(And since we document for legal purpose, IF something ever came of this chart as a legal case, quoting profanity PRESUMES that the PT would be okay reading this. Either that, or it serves to rub that pt the wrong way. And loss of rapport, in many ways, is the single biggest factor in being included as a suit moves forward.)

~faith,

Timothy.

royr · May 19, 2006

findingmywayRN said:
In nursing school we were taught to write exactly what the patient says in quotes in our nursing notes to get a better understanding of the patient. Although I have written profanity in quotes in my notes, I see nurses writing a letter with a line after it indicating profanity. Is it more common for nurses to censor the patient's statements in their notes or are more nurses writing profanity? I'd really like to know! Thanks.

I am not sure how a paying employer would want you to handle this - look for guidance in the employee handbook or conduct manual. However - in one of my clinical situations I was instructed by my teacher to put in " " exactly what the patient said at the time about killing my %$#@##$@**& witch of a teacher and her little dog too! And refusing her care, but asking me to stay so I could be available to kill later. I felt it best to follow directions to the letter just to be safe. However, I did stay with the patient to keep him safe untill the teacher returned with staff to assist. I never felt to be in any personal danger, as I felt that the patient was not physically capable of carrying out the threats, but was seeking attention.

Tweety, BSN, RN · May 19, 2006

ZASHAGALKA said:
Current Quote on a local church sign:
"Profanity is the lifting of heavy words by weak minds."
Certainly, our finely tuned, educated, professional minds are stronger and have more range and depth than that.
~faith,
Timothy.

You imply that those who quote profanity are as bad as those using it. I disagree.

I'm glad you're not casting aspersions, but still I think because you're quoting a church, you are bringing your own personal morality and trying to use it to influence those who don't think as you do, with the subtle implication that your view is morally superior. That's fine with me, I don't have a problem with that. It's what we all do. ?

Where we agree, is that it's not always necessary to quote profanity in charting. Where we disagree is that it's never appropriate and it's akin to cursing yourself.

leslie :-D · May 19, 2006

Quoting on a pt's vulgarity is not a reflection of the writer or his/her character.

When I chart verbatim, I do so in the event the notes ever end up in court or a deposition. If I charted "pt upset, vulgar with staff", that would be my observation and leaves room for speculation. When I chart and quote verbatim, there's much less wiggle room.

And that's just plain silly to think said vulgarity reflects on writer's character.

ZASHAGALKA, RN · May 19, 2006

Tweety said:
You imply that those who quote profanity are as bad as those using it. I disagree.
I'm glad you're not casting aspersions, but still I think because you're quoting a church, you are bringing your own personal morality and trying to use it to influence those who don't think as you do, with the subtle implication that your view is morally superior. That's fine with me, I don't have a problem with that. It's what we all do. ?
Where we agree, is that it's not always necessary to quote profanity in charting. Where we disagree is that it's never appropriate and it's akin to cursing yourself.

My take on this isn't based in religion. It's based in manners.

If you quote a curse word YOU ARE cursing yourself. If someone else has to read a curse word BECAUSE you quoted it; then that word came to them THROUGH YOU.

I don't know how you can say that if you repeat something someone said, you didn't really say it. You repeated it; ergo, you said it too.

Your INTENT might not be the same, but nevertheless, strong language is invented for a reason. The taboo on saying it is there PRECISELY to engender strong feelings about their use. We discussed this some on the 'use of the n-word' thread awhile back. It is the RARITY of the word, based on taboo, that gives a word its power.

And, because of its relative rarity, as a result of the taboo, the power of such words come in their MERE USAGE. So, whatever YOUR intent, by using the word, you play into the taboo.

If you use them, whatever your reason, you employ the taboo.

Think of these words as 'language' grenades. Use of the word is the pulling of the pin. Surely, you can comment on the use of such grenades by your pts without being forced to detonate a few of them yourself to prove your point.

From a language point of view, to employ a societal taboo, a language 'grenade', on your co-workers, without forewarning or permission; that's bad manners.

Tweety, you know that I'm religious. But. I have been known to use a curse word from time to time. Who hasn't? But here's the key; I make a point to know my audience and try not to use a word around someone that I feel might be offended by its use.

My point is this: you can't make such distinctions in a chart that your co-workers are REQUIRED to read and follow up on. Some have argued that quoting profanity is sometimes necessary. I disagree.

And because I disagree, I therefore think it's uncouth. You claim that I am making a religious stand here. But what did I do to encourage this claim? I quoted a church sign. So, by quoting that sign, are you saying that it is akin to announcing my own religious beliefs? So, you are saying that merely quoting someone else has implications to the character of our own speech? But, my INTENT in quoting it might not be the same as that church. Right?

I think quoting profanity is unnecessary, and, because you don't know AND CAN'T KNOW the potential and required audience of that chart, it is therefore simply ill-mannered.

~faith,

Timothy.