Monday, January 18, 2010

Nurse Follies: THE Notebook

Not everyone can be well versed in medical jargon, so part of the nurse's job is to be to translate doctor-speak for patients. Why doesn't the doctor do it? Well, nine times out of ten, patients won't ask the doctor what certain words mean for fear of looking like an idiot. Some doctors like to use big words, and it annoys the patient, often leading them to wonder why they don't talk "like normal people". I explain that doctors frequently use the big words because they are still paying for them.

At any rate, it's not uncommon for patients and/or family members to write stuff down. This can be to either ask the nurse to translate it later, or to relay to family members and friends who call. (There's a big difference between lobotomy and lobectomy.) Sometimes, families will write stuff down so they can do their own research later. All of this is good and fine as having information is a good thing...as long as it's from a reputable source.

Oprah Winfrey's website is not a reputable source.

Then, there are those who come armed with THE Notebook. This innocuous little spiral-bound book is the biggest weapon in the family's arsenal...to them anyway. That notebook gets handled more than Lindsey Lohan at a coke party. Whenever anyone walks in the door, out comes the little notebook, and little ink pen. With beady eyes, the family member scribbles every little move you make. Every single word you say. It becomes a minute-by-minute transcript of the entire hospital stay, right down to the corn the patient ate for lunch, and subsequently deposited into the bedpan later that day.

You may wonder why someone would go to such lengths? Apparently, ambulance-chasing lawyers like that sort of thing when the family decides to sue you for their loved one getting pneumonia when you refused antibiotics and pulmonary treatments on their behalf. Or that their coffee was cold. Or that you gave your family member the Swine Flu because you didn't have the good sense to keep your ass at home. Or that they would like a big settlement so they don't have to go back to work at Taco Bell.

But what family members don't realize, is that nurses and doctors have their own little notebook, too. In the form of the patient chart, which becomes their permanent record. Nurses and Doctors should chart thoroughly anyway, but the appearance of THE Notebook, tends to make staff engage in hyper-vigilant, or as I like to call, defensive charting.

What Family Wrote
12:35 pm...Nurse Polly Perky came into room. Gave Mom medicine (lists off specific medicine). Nurse Perky listened to Mom's chest. Mom farted. Nurse then checked Mom to make sure she didn't shit the bed. The fart smelled really bad, and I requested tests to be done to find out why. The nurse refused.

What the Nurse Charted
1235 RN went to room to see pt, give scheduled meds. Family member at bedside eating large amount of pork and beans from local BBQ place. Pt reassessed, no changes from previous assessment. Denies pain/discomfort. Family member passed large amount of flatus, stated that the patient did it. Questioned pt, who refused passing gas. Flatus had bad smell, family member demanded further testing. RN explained that flatulence could not be tested as it was impossible to send specimen to lab. Family member upset that room now smells bad. RN offered room spray to family member, who accepted. Family demanding free cola from pt nutrition room. RN directed family member to the vending machines by the waiting room, stated that nutrition room contents were for patients only. Family member stood up from chair, noted brown stool-like substance running down leg. RN offered towels, and use of shower in pt bathroom. Family member accepted.

What the Family Member Wrote
745pm Nurse Sally Stern came into room. She ordered us to leave the room while we were visiting Dad, and called police to kick us out. She was rude to us because we are poor. Dad started to cry.

What the Nurse Wrote
1945 RN entered room and discovered family members drinking beer and smoking methamphetamine. Pt currently on 15L high flow oxygen. RN told family members this was unacceptable behavior, and asked them to leave the room. Family became belligerent, threatening staff by stating they had a gun and would come back and "shoot everyone". Security notified, immediately arrived et arrested family members. Dad became emotional, later told nurse that his family often does drugs around him, that they take his social security money and spends it on drugs and alcohol, and that he never gets his prescribed medicines at home because he has no money for the co-pays. Even said that the son beats him on occasion. Social Worker notified. Family barred from unit per pt request. Security notified.


Besides the obvious difference in the two, THE Notebook goes home with the family, subject to be amended at any time. Our charting stands once we hit the ENTER key. Oh sure, you can go back and edit, but the computer shows that too.

I hate THE Notebook. Most people do. It doesn't scare us. It pisses us off because we know that we have to now chart every single little minute detail, which takes us away from taking care of our other sick patients.

Assholes.

8 comments:

me said...

Ah yes ~ the evil, dreaded NOTEBOOK... I remember it well ~
Asshats

Faith said...

Well, from another POV, "the notebook" in our case was to chart all the different meds my dad was on, when he was scheduled to take them, what side effects they might have and what could be done to help, etc, etc...because when he went home, someone other than a doctor and a nurse needed to take care of him. He was on a LOT of meds. That notebook was the only way to keep track! It was also recommended by the doctor that we take those notes. Notes that likely saved my step-mother's sanity a bit throughout the 4 years she was taking care of dad while he was sick.

Not everyone is in it for the assholery, you know? Sometimes, they're just trying not to kill their family member when they have to take them home and care for them on their own.

GB, RN said...

I understand that, and I did mention that there are other reasons families keep notes that are not assholey.

But this post dealt specifically with assholey.

kate said...

Customer service has gotten me very used to the "cover your ass" approach to dealing with the public. I write EXTREMELY long and detailed notes whenever I have to deal with a particularly problem patient...which comes in handy when the patient calls my supervisor to claim that I "stole" her co-pay and refused to refund it because I was going to "spend it on a shopping spree". However, I had documentation from her visit where she actually she stormed out of her appointment because the doctor refused to diagnose her with a disease she read about online (and I had clearly stated that she was offered a refund, refused, told me to "go fuck myself" and ran out crying). Amazing.

RCH said...

I believe the phrase you're looking for, when referring to such patients ("how dare you throw me out for smoking meth??"), is assholier than thou.

me said...

Faith ~ I do understand that... and I meant no offense to those in that situation.

GB, RN said...

We actually like those who keep track of their meds. It's really helpful when there is a list rather than have the patient say, "I take one little while pill, and one little pink pill..."

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