Welcome back to another episode of Shift Happens! This week, Nurse Millie and Nurse Tara tackle a massive pain point for healthcare workers: charting. Our chief complaint today? "I spent more time charting than caring for my patients." From the dread of the "CYA" (Cover Your Ass) culture to the transition from paper to electronic charting, we break down why documenting takes up so much of a shift.

✨ LISTEN TO THE FULL SHOW:

Apple Podcasts: podcasts.apple.com/us/podcast/shift-happens-podcast/id1896920249

Spotify: open.spotify.com/show/033xje3slpmzfm9y1rarfb?si=57977de0ff9445fb

Captivate Site: https://shifthappenspodcast.captivate.fm

👋 CONNECT WITH THE SHOW:

Instagram: @shifthappenspodshow

TikTok: @shifthappenspodshow

Business Inquiries: [email protected]

🏥 ABOUT THE PODCAST: Welcome to the digital breakroom! Shift Happens is a raw, unfiltered look at healthcare, nursing, and the hilarious, heartbreaking, and chaotic realities of hospital life, hosted by Nurse Millie and Nurse Tara. New episodes drop every Friday!

⚖️ MEDICAL DISCLAIMER: The thoughts, stories, and opinions expressed on this podcast are solely those of the hosts and guests and do not reflect the views of any employing institution or hospital. This content is for entertainment and educational purposes only and should not be taken as medical advice.

You know what they say on TV.

2

Push one of epi, stat!

3

Yeah.

4

Nobody actually says that. Exactly.

5

Welcome to the real world of nursing.

6

I'm Millicent Alluaud, better

known as Nurse Millie, and I'm Nurse

7

Tara, and we're surviving

12 hour shifts, nonstop

8

car lights and pure

hospital chaos and each other.

9

This is shift Happens where we talk about

what really happens on and off the ship.

10

I'm Nurse Millie, and I'm Nurse Tara,

11

and we are here for y'all

to clocking with us and do a shift.

12

Now it's not going to be 12 hours,

but we can at least get a good

13

30 minutes out of you

and you can clock out and take a lunch.

14

Today we are going to be talking about

if it isn't charted.

15

It didn't happen.

16

Okay.

17

So we're going to start off

with our chief complaint today.

18

And the purpose of that is to introduce

the topic.

19

Explain why it matters and present

the central question to the episode

20

we will answer.

21

So our chief complaint today is I spent

22

more time

charting than caring for my patients.

23

So the reason we say that is because

documentation is extremely important.

24

It's an essential part of nursing,

but many nurses feel like there's

25

been more time proving they provided care

than actually providing it.

26

So today's question

is, has charting become more

27

about protecting ourselves

than caring for the patient?

28

So, Tara, what do you think about that?

29

I hate that phrase.

30

CYA, cover your ass when referring

to make sure you charted to CYA.

31

Cover your ass.

32

I think it just should be documented just

because it's so important to document.

33

Because like you said,

34

if it didn't, if you didn't charge,

if you didn't chart it, it didn't happen.

35

I'm really careful.

36

I'll say, when I'm doing a prone case

37

or the patient is on their stomach,

maybe for like a bad case.

38

And I'm charting that.

39

I've checked their eyes

because the number one

40

complication for a prone

patient is post-operative blindness.

41

And one thing is

they can have pressure on their eyes.

42

So let's say their problem,

they had something on their eye

43

that could cause blindness.

44

Let's say they're under general anesthesia

4 or 5 hours for this procedure.

45

They could wake up with mine.

46

This has never happened to me,

thank God, but I'm so diligent

47

about charting every 15 minutes, and I'm

checking their pressure in the eyes.

48

I'm down there, okay? You know, under the

49

drape, checking.

50

So I feel like it's very important

to do that.

51

I don't necessarily think, well,

I'm doing it just in case I'm sued.

52

I don't think that way.

53

I just want to make sure

that I'm just being documented,

54

that I'm actually

doing the task of checking.

55

Okay.

56

So I think to get away,

we should just get away from charting

57

just for what the lawyers would say.

58

A lot of times, that said, it just is very

important to document it and that way.

59

Well, I have several questions for you.

60

Now that you've stimulated

some thought for me.

61

Number one, for those of you not myself,

but for those of you that are thinking

62

about having 360 lipo and you're saying,

I'm sorry, we'll get back to the topic.

63

Let me write down my notes.

64

Okay.

65

Because the girls want to know.

66

I mean, I kind of do too, but

a friend told me to ask you right quick.

67

She texted me real quick.

68

So when you're doing 360 lipo

and you're on your stomach

69

to get the lipo in the front,

70

and then how do they flip you

over a dead weight when you're asleep?

71

And then that's my first question.

72

And then number two.

What about aspiration.

73

I mean I never even thought

about the eye pressure.

74

But I initially think aspiration

even though you're supposed to be NPO at

75

midnight.

76

The other question I have is

how do you keep if you're intubated.

77

How do you keep that tube stable.

78

So those are my three questions.

79

So you're never going to be at risk

for aspiration

80

if endotracheal tube is present. Okay.

81

So usually when you do a prone case

you start

82

whether supine you put him to sleep.

83

Then you flip them like a pancake.

84

It takes everybody in the room to flip

them.

85

Takes a few people. Okay.

86

And so you just. Of course

I just do with the head.

87

Lucky me.

88

So I just take the head and turn. Okay.

89

And there's a pillow.

90

What's called a prone pillow.

91

It looks like a square.

92

And it has an out cut out,

like in the space.

93

Okay.

94

And then the tube sticks out,

and you just connect the circuit

95

back to the trachea, too. Okay.

96

And that's the only way I would feel

comfortable putting someone to sleep.

97

If they're going to be prone,

they would have to have endotracheal tube.

98

Okay. Yeah.

99

So you do that and then take the fat out

and then put a prone and put in the fat.

100

So usually it's low risk when you're

switching from supine to prone.

101

Yeah. Okay. Okay. I was wondering.

102

Yeah. I feel like we do. It's a lot.

Oh, wow. Yeah. Okay.

103

I was wondering about that.

104

My second segment, back to the topic

is when you talk about charting.

105

Okay.

106

So I'm a newer nurse, but I know that

we've been charting electronically.

107

We have switched systems,

you know, throughout the past and present.

108

But so I'm sure actually,

right before I came into nursing,

109

when I was in nursing school,

they had paper charting,

110

and it was such a scramble for people

to transfer from paper to electronic.

111

So I feel like the electronic helped

112

because you're not scouring

through paperwork,

113

but also I feel like

because it's electronic,

114

there's more boxes to check

and more tasks to do.

115

So what is your perspective

from being a part of that transition

116

from paper charting to

electronic charting?

117

So I've been in a since 2001,

and I remember paper charting,

118

and I feel like charting wasn't essential.

119

We were just charting. Not as much. Okay.

120

So I've definitely feel like more charting

way more and checking way more boxes.

121

And in nursing school,

I don't know if you remember this,

122

you were taught don't chart

something in a million different places.

123

I feel we do that now because,

124

yeah, so repetitive.

125

And I just think that we were taught

not to do that.

126

So for me, the transition,

127

I guess you just adapt,

but it's just easier now.

128

I wouldn't ever

129

want to go back to your paper charting

because the vitals shift over everything.

130

You just click and it makes it a lot

easier than paper charting.

131

I wonder how we even did that,

because it's a lot of work to go and chart

132

everything and write everything out.

133

Now, I think another positive thing about

134

electronic charting

is that you don't lose.

135

It's not fragmented care.

136

So if you're seeing one physician

or you're at one facility

137

and then you go to another,

everything's on record.

138

But I have noticed

since we've had electronic charting,

139

like if I go to my primary care physician

or even when I was working

140

in the hospital, you lose that contact.

141

Yeah.

142

Okay,

143

so I'm telling him about my problems

and he's looking at me, but he's charting

144

and in primary care.

145

Obviously you have to see like a patient

every 15 minutes.

146

So I completely get it.

147

I recognize it, but I would think

for the non health care patients

148

they would be like okay

what's up with this.

149

And then the patient satisfaction scores

would be like, oh,

150

my physician wasn't listening

or my nurse wasn't listening.

151

They were just charting

charting, charting.

152

And so I feel like

that's like been a big thing.

153

Yeah I agree with you with that.

154

It just takes some of the intimacy. Yeah.

155

And being so personal,

when you're just charting

156

on your computer

instead of looking at the patient,

157

but you could just I think some people do

a good job, and you're saying I need to.

158

I'm still listening.

159

I just need to chart this in the computer.

160

And patients know

because they have my chart now,

161

but they can look up their own chart

in the computer.

162

I never set it up

because I don't like technology.

163

Sometime next shift report.

164

The purpose of this is to explore

the topic through personal stories,

165

experiences, humor,

and honest conversation.

166

Millie, what's the most ridiculous thing

you've ever been expected to chart?

167

I think how much poop a patient

168

let out in a diaper.

169

I'm like, are you?

170

I mean, are you wanting to know,

like the number of no.

171

Like about how much does that way.

172

And I'm like, am I supposed to?

173

Sometimes I feel like people

don't understand what they're asking.

174

Like, to make sure their bowels are good.

175

I'm not really sure.

176

So that definitely was a weird

one for me.

177

Tell me about the funniest charting

mistake that you've ever seen or made.

178

I think this every nurse everywhere

knows this one, and I just love it so much

179

because we always talk about it

when someone's like, oh,

180

that's.

181

Pussy.

182

What they'll say, oh it's pussy.

183

Oh, oh,

184

and you shouldn't say pussy

because I think people

185

I maybe would spell at pussy,

but most people spell pussy.

186

I would hussy.

187

So it's pussy. Oh. It's purulent.

188

That's the proper.

189

Can you explain to the audience

for those non healthcare providers

190

what purulent means? Well it's pussy

191

pussy pussy pussy

192

purulent.

193

It's the white.

194

Yeah, yeah.

195

Same thing.

196

Yeah. Gross.

197

So I feel like that's one

that if you see that

198

it just it

chuckles or I charting mistake.

199

There's a lot of you know they have

those things a bunch of charting mistakes.

200

Now I don't see it as much

because we're not writing.

201

Yeah.

202

You just click on a little box clicking

and then even assessment,

203

they tell you everything

like you're assessing.

204

When I say the eyes,

I'm checking the eyes.

205

I don't really do like a narrative anymore

where there's

206

a bunch of charting,

but I feel like that's like that's

207

I think everyone is going to agree,

like that's the number one.

208

But Millie, tell us about a time

when charting kept you at work

209

long after your shift into, gosh,

that's all the time.

210

That's all I'm saying.

211

Because again, we are,

you know, trying to perform the duties

212

of taking care of the patient.

213

And sometimes you get so caught into that

or you have so many things to do draw

214

blood, do consents, get patient

from surgery and back to surgery,

215

charting that charting list

and then you have to empty drains.

216

Monitor this look at the chest to

you know you obviously can't take a lunch

217

because you don't

want to get behind on charting.

218

But then there would be times

where I'd stay an hour,

219

hour and a half after work

because I have to catch up on charting.

220

Yeah.

221

Which if you have difficult patients,

you have a lot of discharges,

222

and with discharges come admissions.

223

And so, I mean, I would say at least

224

a fourth of my shifts that I would do,

I had to stay after to chart.

225

Yeah.

And this was you're working on the floor.

226

This was working on the floor. Definitely.

227

Or if the only.

228

Now let's talk about this

with electronic charting.

229

When the power goes out

230

or the program goes down

and you get stuck with a stack of papers.

231

Oh, yeah. Oh.

232

And then an hour before it's time for you

to go, all the computers come back on.

233

So now you have to put all the information

that you've been paper charting.

234

And we have seven in the morning.

235

Oh gosh. To put it back in the computer.

236

So you're scrambling. It's

so inconvenient. Yeah.

237

So I'd always think, you know,

I get the whole paper charting thing,

238

but it is a lot of paperwork

239

and things can get lost

or put in somebody else's chart.

240

But also you cannot fully rely

on computers,

241

on AI and on electronic devices

or programs.

242

Right.

243

And on the operating room,

if we do like a quick case.

244

Yeah, the nurses are like, I didn't chart

anything because it's so fast

245

and they're running around getting things

for everyone in the room and helping get

246

the patient on the bed and put to sleep

because they assist me with that.

247

They're like, I have no time for charting.

248

So they've done nothing

because the case was so fast.

249

So I know that for them

can be really frustrating.

250

And then you have to remember

everything that you did.

251

But if you do it enough, you can.

252

But if you have a high load of patients

in high acuity,

253

then you're like,

okay, now what happened with this?

254

What happened with that? Okay.

255

What do you think could be one thing

you could

256

permanently eliminate

in charting requirements tomorrow?

257

If I could hold on that in makes sense.

258

Richard, could you scratch that?

259

If if you could permanently eliminate

one charting requirement,

260

let's not say tomorrow. Okay?

261

If you could permanently eliminate one

charting requirement, what would that be?

262

I already know what that would be

because this is so annoying.

263

And one facility I work, we have to chart

separately the propofol,

264

the patient's name

and how much we gave and wasted.

265

That is so dumb because profile is not in

Arctic is not required.

266

I don't know why this facility

makes us do this, but it's so annoying

267

and it takes time to me

away from the patient

268

because I have the chart,

the profile as you're giving it.

269

Well, after I get like I put them

in, I'll say how much I gave

270

and I've already put in the chart

how much I gave, and it has to match up.

271

I don't know,

272

you think it has something to do

with people stealing it?

273

Like they want to make sure the amount

you discard matches the stealing it

274

girl, I don't know, you know, people

I don't want to name names, but people who

275

take propofol to go to sleep.

276

Well, it is he, right?

277

I gave you the thrill of those,

not the killer.

278

Exactly. So, I don't know.

279

I'm just thinking outside the box.

280

Well, it's I don't

I don't I'm sick of charting it.

281

It's not necessary.

This is the only place I charted now.

282

Fentanyl.

283

Deleted. Ephedrine.

284

I understand all that. Right.

285

But why am I charting propofol?

286

I don't know, maybe we can ask

chat? Amelie.

287

What's something nurses

do every shift that never gets documented

288

but takes a tremendous amount of time?

289

I think the emotional support, because,

290

you know, patients come into the hospital

or any facility

291

scared with a lot of questions,

then you have family members to address.

292

And then it's like the physician comes in

and explains everything to them.

293

And then as soon as they leave,

294

they're calling you like, hey,

what does this mean? What does that mean?

295

I remember, you know,

296

bathing the patient, cleaning them,

sitting there, taking the time to do that

297

or just explaining whatever questions

they have or talking them off a ledge

298

like also my husband will come home

and be like, I'm so talked out.

299

He's like 50% of my job today

300

was meetings

or seeing patients doing orders,

301

but a lot of it was counseling,

whether it be my colleagues,

302

whether it be a patient,

whether it be a patient's family,

303

whether, you know, especially in adult

or geriatric care, a lot of DNR,

304

when it's time to have that conversation

about end of life.

305

And so some families just aren't ready to,

306

you know, accept the position

that their family member may be in.

307

So that takes a lot of time.

308

And then once you've done

all that counseling

309

and you go home,

then you get a call from the facility

310

that's like, hey, more family

members showed up and they want to know.

311

So we're having like a sibling rivalry or,

312

you know, opposition about what

should be done with their parent.

313

Well, I feel can I answer that question?

314

Yes, you may please.

315

So I think that something that I do

the patient like, will you pray with me?

316

Will you give me a hug?

317

I'm not going to pray with the patient

or I gave him a hug.

318

Sometimes they just like,

Will you hug me or will you hold my hand?

319

I feel like that's something

I do a lot of times during my shift,

320

but it's not documented.

321

But if they are really stressed,

I do give that verse

322

it honey, if you put that asleep,

I want you to pray and hold me to.

323

Yes, I'm giving you a little margarita.

324

Okay.

325

Tara, what's your favorite charting

shortcut

326

or documentation tip.

327

My favorite documentation tip

because you can't be taking no shortcuts.

328

No, I was taking a shortcut.

I was going to get you up.

329

But my documentation

tip is just really what we've been pushed

330

and this be in us

if it is not documented, it didn't happen.

331

So anything that I do that

332

I feel like I,

you know, special thing I did

333

maybe not pray or give someone a hug, but

if the doctor tells me to do something,

334

I always make sure that per surgeon

that I charted that or patient refusal.

335

Yeah. Patient refusal.

336

So compliance I guess I cover myself,

337

but not really cover myself, but

just as important to chart those things.

338

So that's always my documentation.

339

I just feel like that's really important.

340

Like, how do you know you did it

if it's not documented

341

and even like to pass on the patient,

how do you know if I.

342

It's nowhere. Oh,

the patient got antibiotics.

343

Oh it's assumed that I gave

the antibiotics

344

is we have to give everyone antibiotics.

345

But if it's not charted,

then it's not done.

346

So it's really important to do that.

347

A little side note.

348

How do you know if if there's too much

charting versus just a traditional chart?

349

Because I feel like there was

I shouldn't say I feel like

350

there was this nurse that I worked with,

and you know how you have the boxes,

351

you can check for your assessment in the

like addendum box or comments box.

352

She would write everything out.

Patient was ambulatory.

353

Patient came in respirations.

354

Were those respirations that patient

as his patient was laid down at this time.

355

Patient took this patient was put to sleep

and it was like excessive.

356

And she's like, you know what?

357

If you read my stuff, it's a narration.

358

And I'm like, I think that's too much.

359

It was a lot.

360

What do they say? Kiss.

361

Keep it simple, stupid.

362

Am I calling her stupid or used to?

363

But but sometimes just keeping it

simple and charting the facts

364

are more important than charting a whole

bunch of mumbo jumbo, okay, I agree.

365

So we're going to head over to the nurse's

station.

366

It's time to take a break.

367

I need some water

and I got to get some charting done.

368

But while we're doing that,

369

the purpose of the nurse's station

is to engage the audience

370

through anonymous admissions,

listener questions, scenarios and advice.

371

So again, guys, if you want us to answer

some of your anonymous questions

372

or you just want to share a comment

with us or something

373

you'd like us to address,

please DM us or leave in the comments

374

at Shift Captains Podcast on Instagram,

YouTube, or Facebook.

375

And also you can follow us on Spotify,

376

Apple Podcast and TikTok.

377

So our anonymous admission for today

is sometimes I don't chart something

378

until an hour later because I was too busy

actually taking care of my patient,

379

and that's important.

380

You should not not take care

of your patient to document something.

381

It's like, oh,

you're coding your code blue or the heart.

382

Well, let me chart that real fast.

383

That's why I feel like on the,

electronic charting,

384

I think when you can mark an event

so you can just hit it

385

real fast, click and you can proceed

to take care of the patient.

386

So that's another good tip.

387

And sometimes you just have to chart

an hour later.

388

I think that's appropriate

because patient care is key.

389

That's essential.

390

It should not trump taking care of

documentation to take care of the patient.

391

So let me ask you this.

392

I'm going to piggyback, you know, I like

a piggyback off the anonymous question.

393

How do you find the balance between

charting and taking care of a patient?

394

Because what if you're like a new nurse

or it's a very critical patient

395

and you're not going to be

remembering everything to chart it later

396

because you're doing doing so much

intense care.

397

All right. Things down.

398

I would just write myself a little note

because I always keep little notes, and

399

I would just write myself a little note

as you just remember what to chart.

400

Now I just chart a few things

as I'm taking care of the patient

401

and I get everything done,

and then I'd go back to charting

402

just to to get it done quickly.

403

But as you do it more,

you get a lot faster in your charting.

404

I think that's an excellent tip.

405

Our listener

question is what's one charting,

406

habit, shortcut

or tip that have saved your sanity?

407

I said that about marking the event.

408

Or taking notes.

409

What do you think?

410

That's a tough one

411

because I just feel like charting

is just all over the place.

412

That is saved my sanity.

413

I also think

just not giving overwhelmed in the moment

414

and just saying, like, hey,

this will get done.

415

And you know what?

416

Some days I just have to come to terms

with the fact that I'll be staying late,

417

and that's okay,

because I'm still getting paid, right?

418

So just not getting overwhelmed

by having to mark everything down.

419

It's almost so for the newbies.

420

It's like when you're nursing school.

421

For me,

I wanted to read the all the chapters

422

and then once I was done,

I didn't retain any information.

423

So I would talk to my professors about it

424

and they're like,

you cannot remember everything.

425

What are the big takeaway points here?

426

And I'm like,

everything is a takeaway point. Yeah.

427

And so you just have to train yourself

to just say, hey, I can't remember it all.

428

I can't do it all, but I'll do my best.

429

And speaking of takeaway

points, let's go to our diagnosis.

430

Okay.

431

The purpose of that is to answer the chief

complaint

432

by sharing the biggest truth

or takeaway from the discussion.

433

So we've allowed documentation

to become the measure of nursing,

434

when it should

simply be the record of nursing.

435

Charting is the enemy.

436

Unsafe

workloads are definitely the key thing.

437

Yeah.

438

So let's talk about our treatment

plan of the day.

439

So the purpose of our treatment

plan is to leave listeners

440

with practical advice, encouragement

or actionable steps.

441

So I feel like document

accurately and objectively,

442

but never lose sight of the person

behind the chart.

443

Find documentation have.

444

Is that work for you? Ask for help.

445

And remember efficiency

comes with experience.

446

Yeah we said on that. Perfect.

447

So our discharge instructions

are going to be you want to end with one

448

memorable message listener

should carry with them and take home.

449

If listeners only remember one thing,

450

the best nursing care

doesn't happen on a computer screen.

451

It happens at the bedside.

452

Your chart should tell that story,

not become the story.

453

I feel like we've done a pretty good job

addressing all of these points.

454

So if you guys remember in nursing school,

we had our clinical pearls.

455

So the purpose of that is to finish

with a brief educational

456

tip, a nursing concept

or a medical takeaway.

457

So charting by exception.

458

Can you define that for me. Yeah.

459

Documentation

method were only abnormal findings

460

or significant changes are recorded

according to facility policy.

461

Okay that's a good one.

462

So basically that means focus on

what is different or clinically important

463

rather than documenting every normal

finding

464

when your facility permits it,

like the normal one chick.

465

Yes, she was starting to much. It's

too much.

466

Yes. Again guys,

thank you for tuning in to shift happens.

467

We hope you enjoyed our episode.

468

It's time to clock out now.

469

However, if you would like to leave us

some anonymous admissions or anything

470

you'd like us to address, please do

so in our TikTok DMs or comment area.

471

Facebook, Instagram or if you're shy and

472

you want to hide in the nurse's station,

you can go ahead and listen.

473

Or watch us on YouTube,

Apple Podcast or Spotify.

474

Thank you guys for tuning in.

475

Thank you.

476

I'm Nurse Millie and I'm sorry

I need to go finish some charting.

477

Yeah, we are charting to do

because it matters.

478

Maggie.

479

All right, that's our time.

480

The charge

nurse is already looking for us.

481

Thanks for working with us.

482

And if you enjoyed the episode, make sure

to hit subscribe on Apple, Spotify,

483

or wherever

you listen and follow us at Shift Happens

484

on Instagram, TikTok, Facebook

so you don't miss the chaos.

485

I'm Nurse Millie and I'm Nurse Tara.

486

Please don't hit the call button.

487

We are clocked out.