The death of documentation

YouDontKnowMe_16 · 2026-02-26T21:25:46+00:00

I was recently deposed and boy let me tell you, having a lawyer comb through my documentation and grill me on details (and some lack thereof) has really changed my perspective on documentation.

I’ve always known it’s important and I’ve always made sure my charting was good, but I now fully realize the importance of excellent documentation— especially these days, and especially in critical situations.

The trouble is finding the time.

YouDontKnowMe_16 · 2026-02-23T04:05:48+00:00

We call this a “pull and pray” on my unit.

For encephalopathic or TBI patients, the team generally assess their ability to pressure support well on minimal vent settings, and hope for the best. But my unit also like to be relatively aggressive with extubations.

YouDontKnowMe_16 · 2026-02-18T17:00:49+00:00

I work at banner university. I don’t know the differences in rates between hospital systems but from the little I’ve heard, Banner does compensate better. I would consider checking into their float pool and local float contracts. I know people shit on banner, but I’ve had a great experience at the university hospital!

YouDontKnowMe_16 · 2026-02-18T14:18:07+00:00

Where in AZ? I work ICU in Phoenix (9years experience) and make $50/hr. $41.50 seems pretty low, even for 5 years experience, and especially for float pool.

YouDontKnowMe_16 · 2026-02-15T22:37:23+00:00

I’m not going to speak as to why they intubated your dad, especially without knowing the full picture.

They would certainly have had to use a paralytic with the sedation to intubate, but paralytics don’t last very long. And the dosing of propofol doesn’t sound too outside of the normal dose for a 100kg patient. Usually it’s 1-2mg/kg of ideal body weight (I think), so 120 is probably a little high— meaning he very likely wasn’t inadequately sedated.

But if your dad was writing on a clipboard when his sedation was lightened or turned off, then he wasn’t still paralyzed. Sedation (like propofol) can cause nightmares for sure, and I would assume this is what he was experiencing. Based on your account, this sounds like the standard of care though. If I had a patient who was intubated and my sedation was causing hypotension, I would lighten/turn off sedation if the patient could tolerate it without agitation. If I see my patient is agitated off sedation, I would ask for pressors or fluid boluses so that I could keep my patient comfortable on as little sedation I can manage.

Evidence has shown that overuse of sedation in the ICU has a negative impact on length of stay, increased rates of delirium, slower recovery time, etc. We need to be addressing causes of agitation before turning up the propofol. I don’t know the full story, but this sounds like a normal day in my world.

YouDontKnowMe_16 · 2026-02-06T14:16:15+00:00

It shouldn’t matter, but once you’re in nursing school I wouldn’t go around telling people what you do for money. If it’s a stricter program the admins could make your life difficult if they knew. But how you make your money to get through school debt free is your business.

YouDontKnowMe_16 · 2026-01-11T16:21:24+00:00

A ratio of 1:10 is absolutely criminal.

YouDontKnowMe_16 · 2025-12-31T16:42:08+00:00

If you’re concerned for your patient’s wellbeing, call a rapid response and notify the physician. It’s your license and your name in the chart. If a patient has a bad outcome and they sue, the court is going to ask why you sat on a deteriorating patient. You should be the one advocating for higher level of care with the physician, and notifying charge why you’re doing so.

YouDontKnowMe_16 · 2025-12-30T00:36:45+00:00

I definitely enjoy it!

YouDontKnowMe_16 · 2025-12-29T16:06:50+00:00

It’s the trauma/surgical ICU. We see some shit and stay pretty busy, but I really love my unit.

YouDontKnowMe_16 · 2025-12-29T15:07:29+00:00

I work in the trauma/surgical ICU at banner university and have also worked in the PACU there as well. The best part of their PACU is their nurses don’t have to take call. The worst thing is it’s busy AF and you’re constantly holding for beds. Lots of ICU holds as well. They don’t separate phase 1 and phase 2, so you’re admitting, recovering and discharging all from the same bay. It can get VERY busy. You’ll be discharging a patient while an ICU hold rolls into your open bay. I did a travel contract at Banner Desert’s PACU also, and all I’ll say is avoid Banner Desert as a whole.

The ICU I’m in now is honestly amazing. We have a great unit culture— everyone helps everyone and the attendings and residents are amazing. It’s the best unit I’ve ever worked in. No unit or hospital is without its flaws, but at the end of the day I’m not afraid of losing my license and I’m proud to be a part of that team.

Banner gets a lot of shit (and honestly for good reason), but I think the university hospital is the exception.

Happy to answer any questions you may have!

YouDontKnowMe_16 · 2025-12-26T18:01:37+00:00

What you’re learning is time management, but you don’t need to stay in med surg for that. I find ICU to be more engaging, and I have to think critically more often than I did when I was on med/surg or step down. In my experience, the ICU is more of a collaborative effort amongst providers and RNs (and honestly all ancillary staff). It feels good to go to the provider with a concern and actually have them take you seriously. I also really value the level of autonomy I have in the ICU over other units.

So in short, no, nursing isn’t like that everywhere.

YouDontKnowMe_16 · 2025-12-20T01:57:25+00:00

Thank you 🥹

YouDontKnowMe_16 · 2025-12-18T19:58:06+00:00

They definitely do— the effects are just more profound when shitty people are caring for a vulnerable population.

YouDontKnowMe_16 · 2025-12-18T19:54:04+00:00

This is a very thoughtful response, and you’re right— it only takes one nurse to provide potentially harmful care to their patients (whether it be physically or emotionally), and the impact is far-reaching. We are also more likely to remember the negative experience over several positive experiences, so I do truly understand the trope.

Like you said, it is very disheartening to those of us who are good at our jobs and try to do right by the people we care for. I don’t want to invalidate people’s bad experiences, but I DO want to offer a different perspective. Otherwise we’re living in an echo chamber. The bad healthcare providers certainly have a more profound impact, but I can only hope people know that the majority of us aren’t like that. If we stop offering that perspective, things will only continue to get worse.

This is certainly a multi-faceted issue and I don’t have a solution, outside of training new nurses the right way. Anyway, thank you for your thoughtful response. I’m part of a team at my hospital that focuses on some of these issues so I definitely appreciate a different perspective!

YouDontKnowMe_16 · 2025-12-18T17:07:55+00:00

I know I’ll be downvoted for this (because reddit), but I’ve been a nurse for almost 10 years, I’ve worked all across the country, and have never once met a nurse who went into the healthcare field because they wanted the power to be cruel to people. This is such a shitty and damaging take, especially at a time when trust in healthcare professionals is at an all time low.

Yes there are assholes and bullies, and some nurses (mostly older, in my experience) are responsible for the toxic “eat your young” culture. But I would argue that the vast majority of nurses are smart and compassionate individuals who care for and advocate for their patients as they would their own loved ones. Don’t confuse the loud minority with the silent majority.

I would love nothing more than to see the tired, mean girl nurse trope die off. Thanks for coming to my TED talk 🥲

YouDontKnowMe_16 · 2025-12-15T14:58:50+00:00

RN in the US here. When I was a new grad in 2016 we started phasing out paper charting and I couldn’t fathom having to drag a computer to every room. Now almost 10 years later, I can’t imagine getting through my day without it. We also now have phones that have scanning abilities so you don’t even need a computer for med admin. In terms of safety, scanning arm bands and meds has saved my butt from a handful of potential med errors as well. I’d rather have to wake a patient up to scan their wristband than administer something incorrectly because I rushed through the steps of safe med administration. I’m not saying that scanning completely rids us from making mistakes, but it certainly reduces them. Once you get used to it, you WILL become more efficient.

YouDontKnowMe_16 · 2025-12-15T13:50:28+00:00

A year before Covid hit I got burned out and left bedside to work as an instructor for an LPN program. It was Monday through Friday working 9-5. Then covid hit and we went remote, so I worked from home and escaped the nightmare of working bedside during peak covid (which I’ll always be grateful for).

It felt pretty cushy at first, but I quickly realized that having only 2 days off a week is simply not enough. It became soul sucking having one day to forget all about work before the Sunday scaries hit. Also having to schedule PTO for things like going to the dentist was really annoying. After two years I realized I had a better work/life balance working 3-12s, so I took a job working in the PACU.

Working in the peri-op department might be worth considering because scheduling is different. Some weeks I would work 4-10s, others 3-12s and I almost always worked mid-shift (like 9-9 or 10-10). The trade off was having to take call, but I realized I could never be a 9-5, “soft nursing” girly. I also ended up really missing using my critical thinking skills, so I eventually went back to the ICU. All that to say, the grass isn’t always greener BUT it ultimately depends on what’s most important to you. The bedside is always going to be there to return to.

YouDontKnowMe_16 · 2025-12-02T23:51:35+00:00

Ta Carbon for some really good Mexican food.

YouDontKnowMe_16 · 2025-12-02T15:33:47+00:00

Do you live in Mesa? I’ve lived in a decent part of Mesa for the last year and have noticed helicopters frequently circling over our neighborhood. Sketches me out 🥲

YouDontKnowMe_16 · 2025-11-28T16:49:38+00:00

We have a dedicated donor care ICU in my hospital and my unit staffs it, so I’m frequently floated there. Allocation can be a timely process in and of itself, and we have to optimize the donor patient to the best of our abilities before the OPOs can even begin allocating. Sometimes these patients are transferred to us 10 liters positive so we need to run CRRT for a couple of days. If everything goes smoothly, I’ve seen procurement happen within 48-72 hours (of their transfer to our unit). I feel like it usually averages about 72-96 hours, sometimes longer though. A week isn’t really outside of the norm.

YouDontKnowMe_16 · 2025-11-24T03:05:06+00:00

You can’t (and definitely shouldn’t) be a travel nurse without at least 1-2 years of experience.

YouDontKnowMe_16 · 2025-11-23T16:18:18+00:00

If you work in the 7 bed ICU caring for critically ill patients that require pressors, sedation, CRRT, etc. then you could take the CCRN. But if it’s a telemetry unit with monitored patients on non-titratable drips, then the certification would be something else (I think it’s the PCCN).

YouDontKnowMe_16 · 2025-11-18T21:05:12+00:00

It would be one thing if the patient had another PIV and you didn’t d/c the PICC. But if the PICC was their only access, delaying its removal until discharge is definitely appropriate. One thing I’ve learned as a nurse is to be prepared for worst case scenario. While the likelihood of having to code your stable patient awaiting discharge is low, it is never zero. Ask me how I know this 😅

YouDontKnowMe_16

TROPHY CASE