using names when charting

djsrn · Dec 18, 2004

thanks for all the responses. I too chart "charting nurse saw" or "LPN" reported to me". One of you responded you chart the person's name cuz if there are 5 nursing assistants on duty how would they differentiate who they were talking about in court" I just don't see putting a person's name down and making it easier to get someone in trouble. Just like when you have a med error. you don't put it in the patient's chart, you make out an incident report.Does this make sense to anyone?

djsrn · Dec 18, 2004

thanks for all the responses. I too chart "charting nurse saw" or "LPN" reported to me". One of you responded you chart the person's name cuz if there are 5 nursing assistants on duty how would they differentiate who they were talking about in court" I just don't see putting a person's name down and making it easier to get someone in trouble. Just like when you have a med error. you don't put it in the patient's chart, you make out an incident report.Does this make sense to anyone?

Kudra · Dec 18, 2004

for routine procedures that another nurse has done for me (foleys, IV starts, drsg changes), i chart who completed the procedure (first initial, last name, designation) and any thing reported to me (J. Doe, RN, reported to writer that wound appeared free of signs of infection and healing)... anything more complicated and i ask the person to chart themselves...

Kudra · Dec 18, 2004

for routine procedures that another nurse has done for me (foleys, IV starts, drsg changes), i chart who completed the procedure (first initial, last name, designation) and any thing reported to me (J. Doe, RN, reported to writer that wound appeared free of signs of infection and healing)... anything more complicated and i ask the person to chart themselves...

RN92 · Dec 18, 2004

Just remember, this is your chart as well. If you are sitting in front of a judge and jury ten years from now - you need to be able to use that nurses note to recall the days events. If you are charting factual information, it shouldnt matter if you use names.

RN92 · Dec 18, 2004

Just remember, this is your chart as well. If you are sitting in front of a judge and jury ten years from now - you need to be able to use that nurses note to recall the days events. If you are charting factual information, it shouldnt matter if you use names.

Burnt Out, ASN, RN · Dec 18, 2004

If someone placed a foley for me (if I am tied up in an emergency or whatever), I chart the person's first name, last name and credentials. Or sometimes I will use the first initial of their first name along with their last name.

Burnt Out, ASN, RN · Dec 18, 2004

If someone placed a foley for me (if I am tied up in an emergency or whatever), I chart the person's first name, last name and credentials. Or sometimes I will use the first initial of their first name along with their last name.

LPN1974, LPN · Dec 18, 2004

Hi,
Example: Bob, nursing assistant, placed foley. Or do you just chart nursing assistant placed foley?
QUOTE]
I realize this is off the question you asked, but I was wondering if the state you live in, are nursing assistants allowed to do catherizations?

LPN1974, LPN · Dec 18, 2004

Hi,
Example: Bob, nursing assistant, placed foley. Or do you just chart nursing assistant placed foley?
QUOTE]
I realize this is off the question you asked, but I was wondering if the state you live in, are nursing assistants allowed to do catherizations?

Bjo · Dec 18, 2004

thanks for all the responses. I too chart "charting nurse saw" or "LPN" reported to me". One of you responded you chart the person's name cuz if there are 5 nursing assistants on duty how would they differentiate who they were talking about in court" I just don't see putting a person's name down and making it easier to get someone in trouble. Just like when you have a med error. you don't put it in the patient's chart, you make out an incident report.Does this make sense to anyone?

I don't think it is about getting someone in trouble. I think the real issue would come down to ownership of your nursing practice. I agree with meownsmile. If they do their own work, they need to document it. If I am charting in reference to something I've done, I simply document "Foley cath inserted ....." then finish the note. I feel that it is implied that if I am charting it, then I did it.

I would absolutely document a name if I was charting about what another nurse did, saw, said, or was involved in.

Bjo · Dec 18, 2004

thanks for all the responses. I too chart "charting nurse saw" or "LPN" reported to me". One of you responded you chart the person's name cuz if there are 5 nursing assistants on duty how would they differentiate who they were talking about in court" I just don't see putting a person's name down and making it easier to get someone in trouble. Just like when you have a med error. you don't put it in the patient's chart, you make out an incident report.Does this make sense to anyone?

I don't think it is about getting someone in trouble. I think the real issue would come down to ownership of your nursing practice. I agree with meownsmile. If they do their own work, they need to document it. If I am charting in reference to something I've done, I simply document "Foley cath inserted ....." then finish the note. I feel that it is implied that if I am charting it, then I did it.

I would absolutely document a name if I was charting about what another nurse did, saw, said, or was involved in.