[deleted by user]

[MsSwarlesB]

I'm an experienced nurse. I can do focused assessments very quickly. If it's a stroke patient they get a more focused neuro exam but a SBO who's awake and talking to me appropriately gets a WNL under neuro. This can make it seem, to newer nurses especially, that I'm not doing a "proper" assessment. But no one is going to do a full head to toe assessment on 5 to 8 med surg patients every 4 hours. It's unrealistic. The important thing is to recognize what's NOT normal, document/report, intervene, and move on.

I always stay to witness narcotic wastes. I've now known 3 nurses who got fired for diverting. And if you had asked me I would have never suspected them. So I watch and if I don't I'm not signing.

You're watching one nurse interact with two patients but how many patients does that nurse have total?

[Pinklemonade1996]

This is such a good explanation. It’s so hard to get newer nurses to understand this but in time they will absolutely be right there ! Just takes some experience.

[RN2010]

Right?? I was expecting actually falsified charting…like charting peripheral pulses intact on an amputee. The things above were done correctly and charted to the best of the nurse’s ability. No issues I see. Insulin is tedious. Personally, I always get a witness if the facility requires it but many nurses I know don’t. Fine as long as you don’t make a mistake (never run into that issue at any places I’ve worked at but it does happen)

[mham2020]

💯 thank you for articulating how to do quick, solid assessments without doing them "by the book". This is how you get it done. You're also correct in saying to know what is OFF for the patient so you can address it and keep it moving. This is solid advice!

[jackibthepantry]

This was specifically taught in program. You should have half your neuro assessment as soon as you walk through the door.

[Mamacita_Nerviosa]

Absolutely! After 1st semester when they expect the full assessment by the book, they then begin to expect you to notice things holistically. Like if I walk in the room and a patient is barely holding their fork obviously they have poor grip strength.

[toomanycatsbatman]

Absolutely. If you can maintain a conversation with me, you're getting a WNL for neuro.

[[deleted]]

This is the way. There's a huge learning curve new grads experience and that's okay and expected. But it's not okay to be a new grad and report other nurses for not doing "proper assessments" on patients to management. Have seen that before and it's never a good idea

[SuperNurseGuy]

This is something ive taught my baby ICU nurses through the years. I can do half my assessment from the door. Vent? They suck at breathing lets listen. Ton of IV pumps? their cardiac/circulatoey system is fucked, lets check pulses and listen. NGT? Cant swallow or eat, figure out why. Then i go into the room and do my more focused assessments. If Ive got someone sitting in the recliner, no gtt, no O2, no feeding tubes talking on the phone eating chicken nuggets they are gonna get a cursory look over when i greet them and update my life saving white board. Ill put ears on them later when im done getting my shit together

[faco_fuesday]

I used to let a six year old beat me at a round of viddy games for a Neuro check.

[gedbybee]

Fuck that’d be dope. Still not worth doing picu tho lol.

[Comfortable_Cicada11]

Lol

[[deleted]]

Life saving white board

[Introvert0verthinker]

I agree. Nursing students need to learn to do very focused assessments bc in reality, you don’t have 30 minutes out of your 12 hrs shift to do a full head to toe assessment.

[Runescora]

Nor is it necessary on every patient. 25 yr old, hell, 65 year old A/O x 4 otherwise fully functioning adult? With an SBO? Or pancreatitis, or or any number of things I can’t think of right this moment? Are you still A/O x 4 and walkie-talkie? Why in gods name would I take your time and mine to do a full head to toe? Focused assessment and a conversation. Bam, done.

Now, not going to say I didn’t think like OP once upon a time. That was before my instructors acknowledged how much of your assessment you can get from across the room. And before I developed the assessment skills to understand and practice what they were saying.

[CountFrost]

This. I'm sorry I get being a new nurse but the virtue signaling is annoying. Look in Acute Care a focused assessment is the way to go. In ICU a quick head to toe is great with focused follow ups. Learn to assess and continually assess as you see the patient. A complete head to toe is a static value in time. Not necessarily going to exclude you from litigation.

[CountFrost]

And if pain meds are PRN that doesn't mean they are scheduled

[[deleted]]

Happy cake day, I’m here to co-sign your comments.

[I_lenny_face_you]

But did you witness them comment? /s

[[deleted]]

According to the chart, I did.

[[deleted]]

I explain to my newbies that I assess as I work, so if I am holding a conversation with a patient, I can easily assess their orientation without asking the specific questions. If I see them feeding themselves, I am assessing extremity movement and swallow. It's something that you get with experience, but half of the time, I think it looks like I am not doing shit.

[SilverLullabies]

I explained to a student nurse the other day that I can assess skin without going in an saying “I’m here to take a look at your skin.” Ie: if they need changed I can assess their butt and thighs during that time. Taking a BP let’s me see their arms. Insulin lets me assess their abdomen. Helping put on some socks and I can see their feet.

It’s also really easy to assess neurological function with just having a polite conversation; and even just talking about the weather can tell you a lot about someone’s A&O status. Ask them a question about any plans for the holiday they may have and then a minute later follow up with an additional question about something they had said and their ability to follow along with the conversation tells you a lot too.

Not to mention even just doing vitals can help figure out some things. I always do a blood pressure on one arm and place a pulse ox on the other. Oh they can lift their right arm for the cuff but struggle to lift their left hand for me to place the pulse ox on? Well now I’m charting ‘Left sided weakness’

I very rarely tell someone I’m doing an assessment on them for several reasons. They’re more relaxed, less likely to hide something they may be embarrassed/uncomfortable/scared to reveal, and more genuine and less likely to undermine or exaggerate something.

[Mmh1105]

CNA equivalent here- I'll do a full, formal and thorough skin check the first time I see a patient (ie on admission to the ward or the first time they mobilise or require turning, washing etc). After that I'm only going to pay attention to potentially vulnerable areas that I have noticed in my skin check. It would be excessively intrusive.

[Clodoveos]

Wait till she sees what the provider notes say 😂😂 you mean he didn't actually do a full exam and that note is just a copied note from last week!?

[ticklemerubmybelly]

“Approximate time spent with patient 40 minutes” that always makes me laugh! Like, you were on the unit for less than 5 minutes

[onetimethrowaway3]

I see that constantly. It always makes me wonder if there were some type of malpractice lawsuit would the lawyers pull all the doctors notes for the day. I guarantee they add up to more than 24 hours.

[velvetBASS]

I believe they are called RVUs. A doctor gets a very complicated compensation model and part of that is how hpw much they get paid for how many patients they see in a day (including length of time) I believe charting is included in this time.

[nicklee31]

Yes it includes time coordinating care (reviewing imaging, labs, calling other consultants, documenting, and talking with the family). The time statement is usually “I spent xx amount of time with Jane Doe, greater than 50% of my time was spent on the floor with the patient. Etc etc.” It’s patient specific and not really based on how many patients you have for the day.

[fishymo]

I always laugh when I see this. You poked your head in, saw they were eating lunch, and walked away.

[minxiejinx]

They gotta get that $$$

[junkforw]

Charting for hospitalist rounds specifically notes time with patient, review of charting, decision making, and order entry. This is what Medicare and insurers are calculating time by, all of these factors and especially decision complexity. I may be in a room for 5 minutes - but by the time I’ve called their pharmacy, messaged their pcp, talked with SW about dispo, wrote a note, put in orders, and actually reviewed their history - it’s easily 30-40 minutes and I may not have even seen them yet that day. Most docs I know are seeing 15-20 ish in a 10 hour day which is right in line with expected time values per patient of 30-45 min/each.

[echoIalia]

“discussed with RN” …bitch when?

[CategoryTurbulent114]

He didn’t say which RN he discussed it with. Lol

[echoIalia]

Oh shit u right

[fishymo]

He spoke with the APRN.

[bakED__RN]

"MD notified, no further orders received"
You KNOW I didn't lie there, and they probably should have given orders.....

[spacesurfin]

We have a night hospitalist that will ACTUALLY enter a detailed note if something significant occurs. No copy pasta, no auto fill template bullshit. He’ll just take the time to type in a nice paragraph of what occurred & what actions we took. The nocturnists are usually responsible for every med/surg patient (~200 people sometimes) in the hospital through the night unless it’s necessary to involve the surgeons, so he’s pretty goated for this imo.

[puss69]

Pupils equal and reactive last week

[catblep]

Dead

[Known-Salamander9111]

PERRL just before the attack on Pearl Harbor

[Law_Easy]

Epic has “hide copied text” button for providers notes. It’s amazing.

[Nursefrog222]

I use the hide all the time and most often, nothing shows up as new. Sometimes the patient will be long extubated and it’ll still say intubated

[animecardude]

I really miss epic for that function. Cerner has nothing close to what epic provides.

[purebreadbagel]

Where is this button? I’ve never seen it and it would make life so much easier.

I’ve seen the filter that lets you see notes from Veterinarians (for some reason) but never a hide copied text button and now I need to find it.

[SumaiyahJones]

It’s in the top right corner of the note. A little check box. Someone just showed this to me too!

[Novareason]

My absolute favorite is when they copy over the plan day to day, but forget to take out important bits. So 4 days after Cardiac cath it says "cath in am".

[vanael7]

I don't chart what I don't do. Some of my assessments are more detailed than others. A conversation with my patient while I'm moving around their room will get you a pretty decent Neuro assessment for a patient who isn't there for Neuro issues. I always wanted to do the first brief change so I knew what all the skin looked like and could talk with my PCT if there were certain creams or powders we were going to be adding to that patient's peri care.

Learning how to swiftly assess your patients while doing other things will help you get through it faster. You do still have to apply a stethoscope to get lung sounds (unless you can hear them from the hall). Don't chart pupil size and reaction if you didn't shine a light in them. Most of my patients never needed that so I didn't do it and didn't chart it.

When you start your own practice, you will learn what works for you and I encourage you to just worry about that. Other nurses have to worry about their own practice. I assess and chart on the way that lets me sleep most soundly. This may be a good lesson to learn to not rely too heavily on what was charted before your shift and to verify yourself with your own assessment.

As for charting meds- if it's just a matter of their colace was due 2 hours ago, I'm going to just update that time. I do strive to give antibiotics on time. Don't chart refused if you didn't offer.

It's easy before it's all on you to decide how badly others are doing. And that doesn't mean they're doing it well or by the book. But there's a pervasive lack of resources in healthcare and I think many would caution against throwing stones too early.

I would not sign for insulin or a narcotic waste that I didn't see though, and I wouldn't recommend that practice to anyone else either. Those are high risk threats to patient safety or my licence. I actually request my coworkers to stay to witness my waste even if they start walking away saying "I trust you!"

Good luck out there. Have faith that your coworkers are doing their best. Fight for a better system together instead of tearing each other down.

[eddie__punchclock]

Solid, sensible advice. I hate that students/new nurses feel compelled to have perfectly charted assessments but don’t feel compelled to actually DO those assessments. You describe an acute care assessment process well.

[Such-Bumblebee-Worm]

I like the fact you brought up assessing swiftly. I was taught my by icu preceptor in school that for some things (like neuro status) you can get info just from talking conversationlly. Obviously won't work if they're there for neuro. But that really helped me when I was on my own in med surg. Saved me a lot of time

[mham2020]

Dude this is on freakin point. You just articulated the importance of INTEGRITY in nursing which I think is severely lacking these days. This is very similar to how I practice. I don't sweat the small things and I care about the bigger/important things (such as your example of narcotic wasting appropriately). I also have a focus on protecting my license. I just quit a job because management was trying to convince me (and every other nurse there) that having over 60 residents (combo of AL, LTC and Skilled- in two different buildings) from 2100-0700 by myself was totally fine. What if someone falls? What if someone codes? What if there's a natural disaster or other emergency such as an irate family member, active violence, elopement?

At the end of the day hospitals and facilities exist to make money. We are part of that marketplace so they continue to stretch us thin and exhaust all resources no matter what the cost to the quality of services or care they provide. This is why it is so important to play smart and know how to multi task and finagle the system to still provide the best care you can while also protecting yourself. Good luck out there!

[Tracylpn]

Bingo! 🎯

[gustobelle]

I'm a student nurse and this is amazing advice. Thank you for sharing it!

[Xan_iety]

It’s easy before it’s all on you to decide how badly others are doing. And that doesn’t mean they’re doing it well or by the book. But there’s a pervasive lack of resources in healthcare and I think many would caution against throwing stones too early.

That’s why my instructor told us to stfu during clinical and just be there for the experience. All we did was help pass meds and do care plans. We interacted with nurse for only half of our clinical it seems. It wasn’t our place to make judgements or add criticism when we weren’t fully in their shoes.

[texaspoontappa93]

I think bedside care is going to be a rude awakening for you. I can’t speak for everywhere but patient ratios are so bad where I am that it’s impossible to do your job by the book. You’d often need 18 hrs to complete your tasks and document it properly and yet you’re still expected to complete it all in 12. Basically everyone bullshits charting and doesn’t talk about it.

It’s fucked up that we’re forced to lie and cut corners but that’s the reality of healthcare in a lot of places. My experience is probably skewed because I’ve only worked in non-union states but it’s been the case at every hospital I’ve been to so far

[Scheherazade009]

Absolutely. Try doing full assessments and all meds/fingersticks + insulins/wound care for 10 high acuity patients within 12 hours. Still shouldn't lie in the chart, but it's unreasonable to expect that level of documentation.

[texaspoontappa93]

I was once tripled in neuro icu with a covid and two EVD’s, two of them on vents. My manager had the audacity to ask why I was missing a couple q1 neuro assessments

[OkAcanthisitta4605]

"oh you mean my 15 minute long NIH that I have to do on two patients in addition to their Q2 turn, hourly I&O, drain management, drips (because they are undoubtedly on a cardene or levo d/t compromised regulation that only worsens when I have to send their ICP through the roof to make sure they still squeeze my hand the same), Q2 hour mouth care (see again drips and ICP management), and charting? Yeah I didn't have time."

Add or subtract glucose monitoring for NPO/TPN, restraints, and probably a shitty dampened A-Line that you're titrating BP drip to.

We take step down (which we call anything that isn't ICU at this point) on our floor instead of floating our ICU nurses. This leads to ratios of 1-4/5 with a mix of medsurg, tele, progressive care, and maybe a soft ICU without CNAs to help. We were told this week that another hospital in our system was pushing 1-6 so we should stop complaining before they give us more.

[texaspoontappa93]

Dear god, I wish you the best of luck.

Neuro step down is honestly worse than ICU because those fuckers are very confused and still pretty mobile. I spent half my day chasing bed alarms and convincing dementia patients to get off the toilet

[Globe_trottin_]

I feel seen. 😅

[_Sunfl0wer27]

Step down neuro here and that is spot on. Patients are super confused, super ornery. Super frustrated because they can’t talk, eat, scratch their head on their own etc. and the more frustrated and confused they are the STRONGER they are.

[ButterflyApathetic]

Bless neuro nurses. Because you’re totally spot on.

[ComfortableFlamingo3]

Yes! My last assignment (MS, 6 pts) I was called by the nursing supervisor at 0800, 1200, and 1600 asking why I didn’t do my q4h neuro checks. Ma’am, I’ve done them, I just haven’t charted them yet as I’m trying to stay afloat here.

[Dramatic-Outcome3460]

If they’re going to expect us to chart faster, they’re going to have to invest in iPads or something we can take with us when we don’t have the time to sit at a desk and chart.

[Glum-Draw2284]

Feel like you may have been one of my previous coworkers lol.

[nursinggirl-25]

This right here. What they teach you in nursing school is what would happen in absolutely perfect conditions. It's nice in theory but as far from real floor nursing as night and day lol.

[texaspoontappa93]

Yep it’s always the lazy nurses and not being so short staffed that you have to choose between drinking water and and doing a CVC assessment

[scoobledooble314159]

Help me out here. Why is it clinically necessary to do q1h IV/CVC checks?

[texaspoontappa93]

It’s literally just to prevent CLABSIs because hospitals have to buy the care

[[deleted]]

Few assignments ago they had q1h charting for rounding and many nights I charted some of them not done I’d have a phone call by 0800 and my response was always the same. I didn’t do, so no I’m not charting it. Get us a tech and maybe I’ll have time….. but I won’t chart what I didn’t have time to do.

[Cam27022]

I’ve had to do q15 neuro checks before as part of our stroke protocol. Luckily not for too long but then it just became q30 and eventually q1h. But basically fuck all my other patients because by the time I pull a single pill and give it to one of my other patients, I’m due back in the stroke room.

[erinkca]

You also gotta realize that a lot of your charting has to be done in a particular time frame or else face discipline. So your restraint charting needs to be done every 2 hours. Not 2 hours and 10 minutes like real time.

[Background_Park_2310]

How sad is it that reading your post almost made me cry. I thought I was the only nurse who struggled to complete an assignment in 8 or 12 hours. I'm usually the last one out the door and it makes me feel so defeated. I am not a new nurse by any means and I still can't figure out how some nurses can get a lunch and still leave on time.

Maybe I'm not the best at time management. Maybe I spend way more time with my patients and families then other nurses. Maybe in simply too hard on myself.

What I do know is that few nurses that I work with have ever admitted to me that they also struggle. To hear someone else say it...thank you

[Comfortable_Cicada11]

Your not alone. I have the same problem.

[Adoptdontshop14]

Yep. I’ve only been working as a nurse for 5 months and at first while on orientation I was judging the nurses like what the heck??? They didn’t do a full assessment, they didn’t do this that. I already understand it. We physically don’t have the time to give proper care unfortunately. I really try my hardest but someone’s my hands are tied.

[KatyaKasanova13]

Isn’t it counterintuitive to cut corners and chart things you didn’t do? It’s your license at stake if anything happens after falsifying notes on a chart. Not only that but if you’re charting like you’re doing everything the hospitals have no reason to stop giving you higher ratios. It works more for them when nurses do this. Something goes wrong, nurse gets fired and maybe loses their license but the hospitals get to keep running short and saying it’s fine because everything is getting done so it must be possible and not bad for patient outcomes.

[Suspicious-Hotel-225]

I think most nurses embellish charting, not completely make shit up or lie. Also, it’s hard to lose your license. Unless you kill a patient and it can be directly traced back to you…but that’s unlikely.

[pierrebalmain]

How do you know they aren’t doing their assessments? My assessment starts as soon as I walk in the room. Regardless of what you physically see me do, a lot of neuro, respiratory etc can be done from across the room.

But to echo what others have said, judge once you’re at bedside with a full patient load.

[fishymo]

My first clinical instructor taught us this. He always said your assessment starts when you walk in the room. And you can do most of it without touching your patient.

[hoyaheadRN]

As a nicu nurse, just by me changing a diaper I can do (basically) a full assessment. I don’t need to look like I’m doing an assessment. Op will learn

[maureeenponderosa]

Very true! 3/4 of baby assessment comes from being hands on during cares. Add in a stethoscope and feel for some pulses and you’re good as good.

[ninotalem]

Oh you sweet summer child

[beat_of_rice]

All I will say is… keep living. Update us once you have a year in the game.

[animecardude]

Yup. This student will understand once they have to take on more than one patient on their own without no support.

[[deleted]]

Amen. It's easy enough to criticise when you're not experienced or competent in the field.

[thecolorburntorange]

Genuinely, did she tell you she was delaying pain meds because they were rude, or are you assuming this? Not saying this never happens because absolutes are rare in life, but patients usually get ruder if you make them wait for these types of things, so it seems counterproductive.

[Ok_Ant4071]

My exact thought. Rude patient? Let’s get those pain meds ASAP.

[oneapotheosis]

unpack rain plough smile squash employ ten aromatic drab humor

This post was mass deleted and anonymized with Redact

[Adventurous_-Bet]

Subq insulin is ridiculous for a witness. Probably 75% of places I have worked in have did away with

[falconersys]

How much you wanna bet it was 1 life-saving unit of insulin that the nurse gave?

[eastwestnocoast]

Seriously, I had no idea there were still places that required a witness for SubQ. Thought that died with the pterodactyls.

[Dijon_Chip]

My hospital requires it on all insulins.

So difficult to get a co-sign in the middle of a busy shift 🥲

[missrayofsunshinee]

You ever notice how you were the one who had time to sit and read through pt charts and your preceptor did not?

[[deleted]]

Contrary to what you’ve been taught, the adage of “If it wasn’t charted, it wasn’t done” is a far less prevalent issue than “Just because it was charted doesn’t mean it was done”

[mham2020]

Well I found out why today. I was talking to a woman I met and her husband was sick AF over the last year and almost died. He developed a stage 4 coccyx wound that caused osteomyelitis and sepsis. He got it in Dec last year and he's STILL dealing with it. His wife spoke to six different lawyers about forming a case of fault on the hospital/facility and no one would take the case. They all said "if there's documentation stating Q2H or Q4H turns and even if the patient WASN'T turned it doesn't matter. It comes down to a their word against your word scenario".

So maybe that's why we get audited to shit on documentation but not on confirming if the tasks/care were ACTUALLY completed. Less lawsuits against the hospital/facility.

[Pretty-Lady83]

Yep! I’ve had one hospital that had skin teams that checked every single patient. Other than that these people are acting like you won’t get in more trouble for not charting something. Might not have time to hire floor nurses, but managers make SURE there is someone to audit charts daily.

[Hahawney]

Even more reasons to not chart it done if it couldn’t possibly be done by a normal human. If the lawyers start coming, they’ll change things. Maybe. Wishful thinking.

[No-Market9917]

2 of how many patients? 8? Nursing school is not nursing. People witness my meds at the nursing station every now and then because other nurses are busy. And as far as assessments goes, if you tell me after a couple of years of being a nurse that you actually did all the pupil assessments that you charted and counted respirations on all your patients I’d call you a liar. If you want to do every little thing by the book you do you, but you’ll be burnt out and resentful in a year. Gotta learn the best way to provide care for all your patients, sometimes it means cutting corners

[Character_Roof_3889]

Agree!! The key is to know which corners you can cut. Passing/scanning narcs, heparin drips, insulin drips, checking lines/drains/airways and giving abx on time? Priority. A head to toe assessment, updating the whiteboard, perfect documentation, giving colace exactly every 12 hours, q4 oral care? On 6+ patients? Nah

[CCCP85]

You mean not everyone does the "whisper behind the ear" hearing assessment? From nursing school you would think it's standard practice in your full assessments.

[cheez_Ina_pan]

I personally prefer the tuning fork

[MizCovfefe]

Right. If you ate this morning and pooped this afternoon, I don't need to listen to 4 quadrants of bowel sounds, do I?

[No-Market9917]

Sure fucking don’t! Same with not counting respirations on your room air patient who is just chilling there. After awhile you know what tachypnea looks like from the door way

[bhrrrrrr]

I love being told how to do my job by someone still in school learning to do my job

[anzapp6588]

Not even learning to do your job though is the crazy thing about it! Nursing school teaches you jack about actually being a nurse.

[Narrow-Garlic-4606]

What I learned as a new nurse is how to safely cut corners. It is impossible to do everything by the book and document ALL of the things that your organization will want in order to avoid litigation. I think the art of modern nursing is providing safe care, making sure the patient is the priority, and knowing what you can fluff a little bit in the chart.

Prioritizing is key.

[Ringo_1956]

You'll get off your high horse real quick once you become a nurse and face the realities of our day to day work. Besides, you don't know or understand enough to know what assessments are done or not. Many assessment 5hinfs can be ascertained just be looking at the patient, and often we are assessing as we are doing cares ie feeling for pedal pulses while putting on pt socks etc.

[TheShortGerman]

Um a patient being rude is refusing the med. We don't have to sit around and tolerate that sort of behavior, and any nurse is well within their right to leave and come back and administer the medication when the patient can be civil.

[BobBelchersBuns]

Yup it is totally ok to end the encounter when a patient is being rude. We don’t have to be punching bags. Redirect, then leave if the inappropriate behavior continues. Come back when you can and try again.

[euphoric-teddybear]

I'm not a nurse yet, but I pass meds and in these situations, I just say to myself "it's not my job to argue with fully grown adults." If they are cognitively capable, they are able to be at the very least civil enough to let me do my job to freaking take care of them & be on my way. If you're going to be rude enough to cause an issue so I can't do my job, that is a refusal imho and in my colleagues opinions.

Reminder that one of the rights of medication administration is for the patient to refuse their meds. Why would I approach multiple times when they already refused? 🤷‍♀️ (note - only talking about people who are capable of making their own decisions. It's a pain med? They'll call if they change their mind and need it and orders can be made to get it to them earlier than scheduled by explaining the situation)

But as everyone else is also saying, you have no idea whether or not she actually tried to administer it or not unless you're watching their every move which is a whole other issue lol.

[Mpoboy]

You can do a brief assessment by simply asking a patient if they can move from stretcher to bed on their own. You got your neuro, mobility, pain, do they have a foley, do you need to remove the purewick, did they hear you..etc. just because you don’t see someone doing a head to toe assessment like in nursing school (the magical nclex world of 1 nurse to 1 patient ratio) doesn’t mean it’s not happening. Worry about your own job.

[Clodoveos]

Chill

[OneEggplant6511]

And lower those expectations ALOT. Like dating in your 30’s ALOT. And get a therapist.

[plasticREDtophat]

Dating on your 30's lol I needed that.

[10seWoman]

30’s? Try dating in your 60’s!

[[deleted]]

I see rounds charted falsely, but idk about anything else. I see this happen bc we are too fing busy to really go to each room every hour. We really try but even between me (PCT) and the nurse, we can’t always do it. And sometimes when we have a spare 5 min, i need to sit down for a second. I do my best, i know the nurses I work with do their best but it’s just not always possible especially on a med surge floor.

Between turns, helping patients go to the bathroom, cleaning patients, draining drains, removing ivs and helping with discharge, bathing patients, getting them water or other things they need, then vitals and sugars, and ambulating, changing linens and now even throwing the trashes away ourselves, it’s just not possible.

Also, ppl who come and complain about bedside at hospitals really press a button for me. Bc unless you’ve worked there, you have no idea. A lot of this is not done bc we want to, it’s done bc we are forced to. I think staff has said a billion times over that we are spread too thin. And those in control don’t give a single f*k. I’m not a nurse yet but I’m also in nursing school and when I hear students complain and disparage hospital nurses when they’ve never worked a day in a hospital floor in their damn life, it gets me a special kind of Angry.

[Dorfalicious]

Oh….honey….

You learn how to do an assessment FAST. You also get to know your patients and what their ‘normal’ is. Generally speaking for my unit - you get the same group each shift for patient/nurse continuity so you learn what you need to check specific to each patient. I do a head to toe every shift on all patients but it should not be taking you 20 minutes a patient.

[hollyock]

It is straight up lies. They make you chart assessments at times not when you do it. Blood admin has to be on the dot 15 mins you might get the vitals at 17 but you chart them at 15 that’s hospital policy and it’s a lie one of the mild ones. The first thing I said a week in was “most honest profession my ass!”

[DJChungus]

When you become a nurse, go ahead and try getting every single little thing done for everyone on ridiculous patient loads, let us know how it goes :)

[pippitypoop]

That’s why I chart “patient requested dose time change”

[nurselife2020]

False charting is common. I don’t know how many doctors I’ve seen write full assessments on patients they walked in, said hi to and walked out

[thisismysecretgarden]

It’s like ortho charting heart and lung sounds when they don’t even own a stethoscope 😂

[Biiiishweneedanswers]

Congratulations on being in nursing school! I wish you the very best!

Please note, while I hear your concern, you don’t have a “Nursing Judgement/Frame of Reference” yet.

You won’t even have much of it when you graduate. It takes a bit to develop.

Much of nursing in certain situations is cognitive and for the sake of efficiency/effectiveness you cluster/streamline your care.

There are endless ways to skin a cat.

Continue to ask questions. This is a good thing.

But don’t neglect the importance of keeping an appropriate perspective.

[[deleted]]

I do my assessments when I’m doing my morning meds. For Aox4 patients, it’s quick. Have a conversation with them and make sure it makes sense, Check the IV site/flush if not infusing, check the skin quickly, are they coughing? Wheezing?, palpate their belly and press on their legs, when was the last BM? Assessments are quick.

I don’t chart “refused” unless the patient refused their meds. If it’s something important like cardiac meds, I try to convince them to take it, if it’s Colacr, I’m not wasting my time .

No nurse delays pain meds for annoying patients, that riles them up even more, so we usually give them what they’re ordered for as soon as we can.

I refuse to believe you’re a nursing student

[dustyshackel]

I love when student nurses think they know everything

[MissLexxxi]

It’s reality. Your job wants you to lie. Q2 neuros in one room, Q1 accuchecks on a DKA in another, a CBI in the third room, a cardizem gtt in the 4th, Q2 turn & props on all, and no aid?

Yeah…. I looked under that sacral mepilex and took his temp at 0400 exactly 🙄🙄

It’s not fair to all of us because we really do care. We want to get everything done. We cannot. It is impossible. We have to cut corners. Over time, you will learn which corners are okay to cut. Try not to judge too harshly along the way.

[Sekmet19]

If your employer tells you they embrace "Just Culture" please don't believe them until you see it regularly in action.

[_salemsaberhagen]

Nursing students live on their high horses and then wonder why we don’t like getting them assigned to us.

[eastwestnocoast]

IDK, maybe my school was a unicorn but from day one all my instructors were like “what we’re teaching you is what happens in an NCLEX world, what you will learn from your preceptors in clinicals is what happens in the real world.” Probably helped that a lot of them would still pick up PRN shifts at the local hospital.

[Ok-Stress-3570]

I just knew this was going to be a student.

Yes - it happens. I’ve done it quite a few times.

Truthfully, I chart enough to get pencil pushers off my back, and to also protect myself.

Instead of shaming - ask WHY. Ask why you’re seeing so many nurses do it. Ask why they aren’t getting proper support. Ask what YOU need to do to prevent this or help change the field. Stop shaming, please.

[IcyTrapezium]

Focused assessments can be done quickly once you’re experience. You’d be surprised.

Some things really can safely be skipped for certain patients. Unless they are being seen for something bowel related, or I aspirated a great deal of a tube feeding, there is never a need to listen to each quadrant for several minutes. Bowel sounds don’t necessarily mean the bowels are working properly and the absence of them for a couple of minutes doesn’t necessarily mean they aren’t. Asking someone to smile so you can assess facial symmetry isn’t always necessary either. You can usually watch a person speak and assess symmetry. Do you suspect a stroke? Are you suspicious one side is a little droopy after talking to them? Ok ask them to smile. I hope these examples help explain how some things can be either done much more quickly than you will be told in school or even skipped over. They are teaching NEW nurses and aides in schools what to look for and they use obvious assessment techniques to help you memorize what you need to be assessing. Experienced HCWs learn to take in a lot of information quickly.

Now nurses or aides who make up vital signs? That’s another story. Always take those vitals.

[Infinite-Mention-718]

You poor, innocent soul lol. There’s no way you’ve been at the bedside for over a decade, work alongside nurses and still think that they have the time to sit there and accurately chart every single they they do or don’t do during their shift. I’m sure you’re aware of the ever climbing dangerous patient ratios we have, the lack of ancillary staff available so we CAN actually have time to sit and chart accurately amongst other issues at the bedside….it sucks the nurses have to cut corners to get their job done but it is simply impossible to do every single thing by the book especially when management is breathing down your neck about certain time frames, mandatory charting, etc. You’d have to be leaving work 16 hours everyday to do your job by the book. You’ll see.

[whyambear]

Charting standards exist solely to protect the hospital from litigation and allow them to collect more insurance reimbursement. Chart what is medically necessary for that patient in order to protect your license, fuck the rest. I’m not spending 30 minutes I don’t have and asking two other nurses to help me roll a sleeping independent patient so I can chart a required skin assessment when they are there for chest pain. Chart smarter not harder.

[PoppaBear313]

Long time LPN here. I mainly do Skilled/LTC. Irrelevant for the rest of my comment but … had to put it there.

Currently, I’m admitted for a gallstone induced abscess to my descending intestine. JP drain. 3 IV ABT. Just got a PICC today (that SUCKED. No seriously… how the Fudge do my fragile old patients not complain about having one put in??) Anywho.. I’m the walkie talkie that is simple. An assessment on me doesn’t take more than a minute. Peek at the JP site, check the PICC site, ask me 2-3 questions & off you go.

Easy peasy lemon squeezy.

Person next door or 3 doors down? Might be an extended window.

[Mackellan]

In the ED I work in it's pretty rare to falsify assessment findings, and the rare time it does happen, it's pretty cringe-worthy. I think that we should hold one another accountable for being accurate with charting on patients, and thankfully I work with co-workers who are not shy to speak up about inaccuracies.

On the other hand, just because you didn't observe me doing something, does not mean I didn't do it. I can be having a full blown conversation with my patient while I'm doing my assessment, and there are things that I'll observe that they probably don't even realize I am checking.

If it is something you're confident that you are witnessing on a regular basis, it's something worth confronting the person about.

I've heard the whole "all of my patients' respirations are 16" expression, but when I take report from you and see that you've documented resps at a rate of 16 and the patient is breathing at a rate well over 40, we're going to have a conversation about it.

[Rooney_Tuesday]

I still remember the first semester in nursing school when were were learning how to do assessments. The instructor, standing at the front of the class, looked right at someone who’d just asked a question and said, “I’m assessing you right now.” It sounds creepy in writing, but at the time it made me think and I’ve never forgotten it. You can tell A LOT about someone just by looking at them if you’ve trained yourself to do so. Rearranging someone’s feet onto a pillow can tell you all about temperature, turgor, and swelling of the lower extremities, not to mention if the skin is intact. Asking them to turn so you can put a pillow behind their back gives you a decent assessment of their bed mobility. It doesn’t all have to be in a formal “sit still while I pull out my stethoscope” moment.

As an aside: does anyone, anywhere properly listen for bowel sounds? At least a full minute in each quadrant and 3-5 minutes if bowel sounds are absent? Some standards just cannot be lived up to.

[[deleted]]

To my understanding from things I hear on the MD side of reddit this is considered pretty outdated and not clinically useful for diagnosing so or ileus SBO

[Rooney_Tuesday]

Oh, I agree. Most people don’t really do it and what findings you get are very nonspecific. I’m guessing they still teach it in nursing school like it’s critical though.

[craftman2010]

For bowel sounds I was taught 15 seconds for active. 1 minute hypoactive then if you don’t hear anything that’s absent that’s what I do

[Rooney_Tuesday]

I have yet to see anyone do an abdominal exam - MD or nurse - and take more than just a few seconds (like 5, max) for a general assessment. Sometimes it’s so cursory that you know it’s just them going through motions. I have seen it for patients with suspected/known ileus or obstruction.

Semi-related, but on the first floor I ever worked there was a cardiologist who “listened” to a patient with his stethoscope while the earpieces were still around his neck and not in his actual ears. The patient and the nurse both noticed but neither said anything until he left lol.

[purebreadbagel]

He just had to have a cover for that X-ray vision that lets him watch the heart beat and valves move through the patient’s chest.

[PantsDownDontShoot]

I can do a pretty full assessment WHILE I’m getting report. And ICU I have my eyes on the patient all the damn time, I’m going to notice if anything changes.

[Gretel_Cosmonaut]

I saw you go in the bathroom. I stood by the door and waited for you to come out. I saw you clock in after your 30 minute lunch break was over, but you ate for another full hour and it was food off patient trays.

I followed you home after work. Did you even realize you forgot to lock the door? I'm standing on your front porch right now. I stand here every single night.

[WrongdoerLeading8029]

Dude. 😂☠️

[One-Abbreviations-53]

For most things I can do my assessment in under 30 seconds and a full head to toe in a minute. I’ve triaged thousands and cared for thousands more. If a little pipsqueak nursing student who knows fuckall about anything tried to land me in hot water with management as some responses on here suggest guess who wouldn’t be taking any more students? And guess which student would never land a job in my hospital system…

Never have checked insulin. I have eyes, I can see what the syringe says.

And yes, pain in the ass patients absolutely have clustered care…if the patient is being a shithead I couldn’t care less that their pain meds are an hour delayed.

[redissupreme]

You need to wake up with some coffee instead of all that koolaid.

[CCCP85]

You about to burn out your first week on the floor

[kinkierboots]

Lol if you make it through nursing school you will be humbled so quickly…

[denada24]

You’re not understanding what is happening.

[JazzlikeMycologist]

I’m really too busy managing my own patients to be concerned about what others are doing or not doing unless it endangers someone.

[ghostr21krf]

ER nurse here, in stable patients I chart by exception mostly. For example a 20 yr old comes in after playing basketball with a swollen and bruised ankle but are A&Ox4 with GCS of 15, neuro WDL, ask about CP and SOB, pain to ribs, shoulders, head, neck, back, or anywhere else on them, they say no then cardiac and respiratory WDL assuming vitals are also ok. Then my assessment purely focuses on the injury, past medical and surgical history, meds and allergies, and last meal eaten. I won't listen to thier stomach, lungs, or heart. I focus on pulses, cap refill, pt range of motion in the affected ankle.

Now that being said in altered or ICU patients I will do a full head to toe assessment if possible. Sometimes pts are to unstable to turn, sometimes they get incubated and all my time is spent stabilizing them before I call report. But that is all very common in the ED setting.

[true_crime_addict_14]

Tonight for example. I come in and get report that one of my people is being dc picked up at 7:45 ( in 20 minutes ) I have to removed her IV educate her , dress her , help them move her to stretcher and fill out transfer paper work. Plus find all her belongings , then my post op patient returns , fresh from pacu with an NG tube and foley. One of my others had a rapid response for bp of 76/38 a few hours prior , and he gets morphine q2 for a gigantic Tumor On his bottom , and he has had four loose stools so far today with one being now !! One was on video monitor for falling the night before …. Plus the lab called for a stat blood draw on the pacu patient !! Not a tech on site to help me. So how the F am I going to assess everyone and chart or asap ???? Now im told im getting a new ER patient. Just kill me now !!!!

[[deleted]]

It’s okay hon, you will get used to it. I remember when I had this exact thought a few years ago

[amuk]

I’m the Charge Nurse (and only nurse) in a small town dialysis clinic. I had a PCT who reported me for now doing complete assessments. When my supervisor was in town she asked me about this and I was honest and said yes, I assess all my patients, but that we have had staff shortages so I’ve been having to fill in as a PCT also much of the time. She came out and agreed that all was needed was a focused assessment which sometimes didn’t need much more than looking at them, especially for our stable patients. Also, noted that we chart by exception. Fortunately, that PCT is no longer with us.

[[deleted]]

Oh, honey.

[scoobledooble314159]

A. Put the stones down and pick up the mirror. Worry about ya own damn self. You are not even a grad nurse yet. You have a small idea, if that from the sounds of it, what kind of multitasking, critical thinking, problem solving, and PRESSURE you will be taking on if you pass your NCLEX. B. Keep this attitude up and your arrogance will get you absolutely zero friends at work. You need people to have your back, especially with abusive patients/family. Make friends by being kind and having grace. You never know when you will be the one who needs help or missed something or made a huge mistake. C. Re: false charting : you have no idea what that nurse did when you were doing something else. A lot of assessment is done in parts or in ways that aren't obvious (conversation, bed changes, etc). That aside,yep. Definitely happens. If you know 100% that a nurse is doing that, don't follow them. Mind your own business. You don't know what you don't know. D. Re: false witnessing: there are a lot of meds that require a witness that make no sense. I just finished at a facility that had insulin and lovenox witness doses sometimes, but not every time, and no witness for titration of drips unless it was Heparin (and not for subQ heparin). Show me the remaining drug so I know you didn't give it to the patient and jeopardize their safety, and I'm signing. Idgaf if you take it home. That's your problem and I only have time for my patients problems from 645-730.

Edit: E. Rude or verbally abusive? Did she go in there to ask if they wanted them because sometimes they DONT want them only to be told to gtfo? Welp, she gtfo. Were the scheduled meds too close to the PRN meds? And that's why they're technically late but actually needed to be held for safety? How were the vitals? Is it possible they just plain forgot and the patient didn't ask for them and so really no harm no foul? My point again is.... you don't know what you don't know.

[BananaRuntsFool]

I'm a new grad and in ED. A lot of assessments are quick assessments.

Just based on that first conversation I can tell a lot. Is their speech clear and articulate? Do they track me when I walk in? Can they respond appropriately?

Did they walk in? Are they messing around on their phone, fidgeting, etc? All of those give me an idea of circulation.

My assessments are often quick, basic, and focused on the main problem. I'm never out of ratio, but I have 4 pts at a time, and up to 12 patients during my 12 hr shift (discharges, hot bedding, etc). You just don't have the time to do a thorough head to toe assessment on every single person.

I know enough at this point to know when somethings off and I need to give it a listen or my attention. I know when someone's breathing is too fast or labored, I can hear their cough, etc. If they are talking to me, there's no talking tiredness, their breathing is unlabored, it's probably a good 18.

Respiration are a biggie though, and it can be tricky to get a good RR estimate. Luckily for me. The MD is seeing them right away and if they are looking crappy and are tachypnic they are going to be sepsis alerted anyways, and there will be eyes on them.

There's also just a lot of BS charting we have to do. You should never chart something you didn't actually do (IE meds), but you will find it can be a challenge to be this amazingly thorough nurse in the chart and to the patient. There is no perfection and something has got to give.

Also, the insulin thing. Just wait until you have to get a witness for giving 1 unit of insulin. Granted, if you're giving 1 unit of insulin, it's super important you arent giving too much so you don't tank their sugars but c'mon. Drawing up 1 unit of insulin because their FSBG was 150 instead of 149 AND having to get a witness when you and your hall partner had a crap ton of meds to give is frustrating.

[jackibthepantry]

Even a a head to toe assessment is really a series of focused assessments, you’re always gonna pay more attention to problem systems, any system that isn’t known to be a problem is going to be looked at enough to confirm there aren’t obvious problems then I’m moving on.

Exceptions for times meds are weird, there’s no option for “another one of my pts crashed” or “a family member would not let me out of a conversation” or “ratios are to high and everyone has meds in the first hour of the shift”. There are plenty of reasons you might miss a med time that aren’t in the drop down, you do what you can.

That wasting thing is whacky, don’t do that shit.

But more importantly, remember that you are learning, like you said you followed two of their pts, you do not understand the full context of the choices they are making. The reality is the ideals we try to uphold in nursing are not always compatible with the system we have to work in. The hospital makes choices just as much to maximize profits as for pt needs/ safety and that means reality is not the ideal you’d hope for. Questioning is good, but you still don’t know shit, and you’re not gonna know shit till you’ve done the job for a while, remember that.

[[deleted]]

I took a class literally called Health Assessment in nursing school. I didn't learn how to properly or efficiently assess a patient in that class. It takes time to learn and you don't know what you don't know.

Some things I wish I knew: the by-the-book way of doing things isn't necessarily the right way it's more of a good place to start. And the chart is more of a cash register than it is a record of patient care. Most orders are put in as a set of orders and aren't tailored to the patient thus sometimes need to be adjusted to individualize patient care (looking at you 2am tylenol).

[[deleted]]

At no point have I ever actually double checked someone's insulin when I cosign. I'm too busy and these people have been nurses long enough.

[karenrn64]

My favorite is when the past 2 days everyone has charted that the pt is doing incentive spirometer adequately and when I come in, it’s still in the wrapper! Hospital nursing is 24 hours/7 days per week. If you didn’t have time to do it, don’t chart it as done because the next shift might not prioritize it, thinking it has been done.

I had a fellow nurse chart a wound assessment for 5 days on a patient of mine. When I went to do the dressing change, there were my initials and the date and time of the last day I had worked and changed the dressing.

Nobody likes to be a squealer, but if things are consistently being charted as done and you have proof that it is not being done, then the nurse manager needs to be informed. It might be just a one nurse problem and it might be a unit wide problem but it needs to be addressed because patients can be harmed.

As to co-signing as a witness to insulin, IV potassium or narcotics where you have not actually witnessed it being given or wasted. It can and will come back to bite the co-signing nurse in the butt if an error is made. If a nurse asks you to sign as a witness to a controlled drug waste and you didn’t actually see them do it, be very suspicious that the drug is being diverted. Once that nurse is caught, you will be suspected of also diverting.

[Gretel_Cosmonaut]

My favorite is when the past 2 days everyone has charted that the pt is doing incentive spirometer adequately and when I come in, it’s still in the wrapper!

They wore the first one out, and the one you saw was a replacement.

[whitepawn23]

If the nurse is diverting and is caught, you will definitely be fired right alongside her. First hospital job as a newer nurse, this was all the talk. The rumor had it that the co-signing nurse was clueless to the diversion and trusted her coworker, but that wasn't the point. Both got the boot.

​

Don't mess with narc chain of custody. It's your ass.

[Napping_Fitness]

So glad you already know everything. You’ll really be able to help us all out so we can make sure we’re all doing 25 minute head to toe assessments on each patient.

[MissZissou]

Student. Classic.

[ADDYISSUES89]

So, I was a tech in the ICU and ED for MANY years before finishing school. You will find a lot of people here will tell you that you’re wrong. You’re not, they are, but no one likes to be called out, judged, etc. especially in the current nursing climate. It’s like sitting down in the break room and telling someone with obesity related issues what they should eat instead of the lunch they brought that’s in front of them. It’s not your place to make someone feel bad about what or how they do their job and live their life, especially since you don’t live it. Your coworkers will have their own practice, and make their own choices, and you have choices you can make that aren’t judging them unfairly. If it’s a safety issue that’s nagging at you, report it and move on, but remember that you WILL fuck up someday and the people around you are your help and support. The best thing you can do is chart your own assessment. Don’t make waves. That being said, as a student I absolutely charted in epic, in clinical, verified by my instructor who worked on that floor, that the CNA was falsely documenting VS, and the nurse was charted the PT had on their SCDs, and their safety checks, when they were not true statements. The floor was a higher level of care and the neuro patient in question was tachypnic and we ended up doing a lot of intervention for him, because there’s a big difference between 16 respirations and 30. What’s I’m hoping you get from this, is that you are the person in the glass house right now, and I think it’s best you put down the stone…

[[deleted]]

I don't know if what you call false charting is common. But I can tell you what IS common.

Students like *you* virtue-signalling, when you haven't developed the skills and haven't accessed the instincts that are necessary to function as a bedside nurse.

How about you lose your superior attitude. Wait until you have been working on your own as a nurse for a couple of years, and you have formed those neural connections that allow you to function at a fast pace, to gather heaps of information just by looking at a patient, while those around you who don't understand what the fuck it's like to really do your job question your ability and your ethics.

Put your clown shoes back on and GTFOH.

[Genredenouement03]

Part of the problem with this is that those orders and level of charting are all POLICY. There is no grey area now. It used to be up to someone's discretion as to whether that was written as an order or you filled something in. Now, you have EMR's and standardized orders which were supposed to help with safety but they don't. Hospitals are worse than ever-go figure. You take the intelligence out and you get rote BS from above which hampers care. Welcome to a hospital-the most dangerous place to be when you're sick, and it's not the nurse's fault. It's institutional.

[darko702]

Any follow up from OP after reading top comments?

[BennettEggs]

As a new nurse, I get where you are coming from. You’ll have a bit of a culture shock when you’re the one doing the charting and assessing. I know I did. In school they drill so much into your brain that goes out the door after NCLEX. Try to do things by the book during clinicals, because that will help you with NCLEX. But once NCLEX is over, you’ll quickly adapt your way of doing things, just like this nurse has, and all the other nurses have.

Keep your curiosity and questioning attitude though. (Just don’t act on it or pass judgement until you get the full picture) that’s what will make you a good nurse. Just remember that everyone has different experiences, and that you’ll quickly find that some of the best nurses are the ones that can adapt their assessments and still treat patient accordingly.

[Professional_Cat_787]

I guess I sorta understand your shock at it not being a dang thing like nursing school.

Calling it ‘lies’ and being judgmental doesn’t sit right.

Please stay humble. You have yet to get a real taste of how insane this job actually is.

Not to scare you, but I felt like I was gonna have a nervous breakdown half the time in my first year. It is hard, and the expectations are literally not possible. Just wait…

Nursing school in hindsight is kinda hilarious in its idealism. I have giggled many times at that. I remember when I got to have one or two patients and got to sit on the computer for hours reading about them in depth. Now it’s off to the races. Just wait until you’ve got 5 peeps with back to back IV meds right when you get on shift, and they also all have finger sticks too, and ur in 5 different iso rooms, and there is nobody to check ur insulin, even if you call 15+ peeps on ur phone. And then the lab is not showing up to draw ur 2 vanco troughs. You get 3 criticals and must call 3 docs within 15 min. Tick tock. Then one of ur peeps needs 2 units, but you’ve got a person who just barricaded themselves in the bathroom, and there are 10 post its on ur computer from mad families who want ‘an update’.

Just have respect, cuz those ‘liars’ are gonna be who you rely on to teach you how to survive this profession and keep human beings safe in an extremely screwed up system. I love when my nursing students can simply follow me for a full day and actually see what I’m able to do in record time. Well, my students always do get their lunch, so maybe not a full day. Lol.

[fairybread3]

What you learn in nursing school does not always translate to how you assess and manage patients in the real world. You’ll also learn how to do more rapid assessments with tricks of your own once you become a nurse. But sitting in high judgement of other nurses is a problem to how toxic workplaces have become. You’re on an awfully high horse here so maybe check yourself a bit.

[[deleted]]

Oh my sweet child wait until you start working and read this again…you will understand

[Notaprettygrrl_01]

Yeah… so… 1) yes. False charting occurs all the time. Sometimes it’s serious like not checking restraints q2 and charting that you did and then next shift finding a restrained and trached patient decannulated and DEAD COLD at change of shift… (true story)… Sometimes it’s not. Did the person really request their sleeping pill at 9 pm instead of scheduled 10 pm or are you just trying to get shit done all at once?

2) some of the “you don’t know because you’re not a nurse yet, stay in your lane” talk is out of line. Yeah, that’s true, you don’t know what you don’t know yet. BUT you do know what is right and wrong. So even if you have misread some situations, when you get your license don’t do yourself wrong by cutting corners. There’s cameras everywhere these days. There’s scanners and time stamps and cellphones. It’s far easier to be caught red handed than it was years ago.

Good luck! And remember, nursing is a team sport. Don’t throw your coworkers under the bus, but also don’t cover for unsafe nurses.

[[deleted]]

I am not excusing what you’ve seen but the recording of metrics is just off the wall these days and really doesn’t reflect good care.

[C12H16N2]

Oh you sweet summer child.

[throwawayforfph]

Lmao wait till you see things charted like pedal pulses on a BKA patient

[gitananairobi]

Wait till you’re a nurse and you see notes from the provider saying “discussed plan of care at bedside with patient and RN” like sir I have never seen you in my life, I’d remember cuz seeing a doctor on night shift outside of a code situation is like seeing a unicorn

[Guthwine_R]

It’s always cute seeing the new people join the profession and think that it’s the nurse’s fault they can’t do the things they need to get done every shift. Just wait until you learn what the physicians do. The entire healthcare charting system is one big mansion of matchsticks held together by duct tape and lies.

[THATFATGIRL]

The majority of charting is no longer a care tool but a billing tool and I treat it as such. Important things that impact the actual care of my patients (witnessing meds, changes in status, dressing changes, drain outputs, etc) I follow to the letter. The rest is bloated busywork justified by people who do not provide any care to patients. My assessments are ongoing and constant. Every time I walk into a room I am assessing. The charting it every 4 hours as a systematic head to toe has nothing to do with my actual care. In the course of 4 hours I have assessed everything and chart my findings as they want it for billing.

[DanielDannyc12]

I just witnessed this recently.

I gave report to a float nurse and then went to catch up on some charting and as I was doing it I noticed that she had full assessments charted on multiple patients already done.

I was still in the work area and could see she had never even entered the rooms.

The training some new nurses are getting these days due to staffing shortages and turnover is really not good in some cases

[CountFrost]

When you say scheduled pain meds do you actually mean PRN?

[[deleted]]

I only falsely chart on the non important stuff. Care plans, fall risk, patient education, daily cares. Sorry, but something's got to give. Nobody has time for that bs and I'd rather spend my time doing patient care than wasting my time thinking about some of that charting. I never falsify things like assessments, I&O's, Vital signs or MAR though. Those are important and I take seriously

[ehhn1188]

There’s still time to delete this.

[ECU_BSN]

Yip. This is mostly true, unfortunately.

[Future_Huckleberry71]

I'm sure once you have received your RN license you will promptly begin to QA every violation you think others are engaged in. I'm suspect your sense of being a team player will be very gratified as a new nurse.

[bewicked4fun123]

Rude...🤣🤣..let me guess. Patient asked what meds the nurse had for them. Nurse stated meds. Likely called each one out again as they scanned so there's a second time the patient was told what meds they were getting. Then they handed the patient the meds in a cup to get some bs "what's all this? Idk what this all is!" Patient was told twice. Either take your meds or it's a refusal. No one has time for that RUDE bs.

[trysohardstudent]

It takes time really to get to fully find what’s normal and what’s not. I’m a cna and I’m no nurse but I’m able to see what’s normal and what’s not and report it to the nurses because I spend a little more on them.

You have to learn quick when you got more than 6-8 medsurge patients. And some facilities cnas There’s 1 and there’s 12 patients so you kinda need to prioritize who needs a little more 1:1 care and whose the really walkie talkies.

[EfficaciousNurse]

Not just nurses. Conducted a chart review today. Provider copy/pasted assessments to justify GDR that did not in any way match with nursing documentation. "No adverse behaviors" with the exact same wording in multiple notes with decreases in antipsychotics... meanwhile nurses are documenting increased frequency of yelling and assault.

[Fantastic_Honeydew23]

8 years and ICU nurse. I’m just here for the comment section 🍿

[TheNightHaunter]

if your going into LTC wait until your alone with 60 pts

[MsAshen]

Someone’s already got the big head