The Shift: One Nurse, Twelve Hours, Four Patients' Lives

by Theresa Brown

Nurses used to “chart by exception”; we would note anything going on with the patient that deviated from normal and assume the rest was OK. Fear of lawsuits, combined with electronic health systems loaded with regulatory bells and whistles, has made charting more and more about recording everything possible about the patient, whether abnormal or not. Do the lungs sound clear? That’s normal—chart it. Is the patient urinating? Normal—chart it. Having bowel movements? Chart that, but also specify the consistency, color, and frequency. Is the pulse steady and regular? That’s normal, too, so make sure to chart it. Is the patient in pain? Pain gets charted if it’s present or absent, even though lack of pain is also normal. My concern is that over time charting has become a simulacrum of good care, rather than a record of it. A simple example: hospitals worry tremendously