Too Much Charting?

A couple of weeks ago the department was absolutely swamped and really short staffed due to a particularly heinous strain of cold and gastro making its rounds with the staff. The staffing situation was dire enough that the manager changed her shirt into a scrub top and started helping out. It was quite a funny sight to see a woman in a pencil skirt, flats and a scrub top walking around the department carrying urinals full of hematuria. But I digress – that’s not the point. She eventually triaged a patient to fast track for back pain. Long story short, the woman was a drug seeker who’s very familiar to most of the staff. She didn’t let me examine her nor did she let the doctor do the same. Eventually, the doc told her to eff off (not quite like that, but her intention could not be mistaken) and that she could either get toradol or nothing before leaving. She then pretended to have a syncopal episode (seriously, how many times does a syncopal episode result in someone falling neatly onto the egg-crated mattress?). When she realized that the nurse was clearly ignoring her, she sat up and started to threaten her and swear at her using profanities that would offend a seasoned sailor’s sensibilities. Rightly so, my colleague didn’t put up with it for too long before she called security and had her ass dumped back out into the cold. Like any good nurse, she then documented. Then documented some more. She also included some direct quotes from her in her documentation because the patient was just that vile.

Lo and behold, this issue was brought up during our education day by the nurse clinician and our manager. Their position was that including some of her direct quotes was unprofessional and that now this charting would follow the patient around in her future encounters with the healthcare system.

I do see my manager’s point of view. Once something is written, there’s no taking it back. If she ever cleans up and has to access an ER again, this documentation is going to unfavourably affect how another nurse treats her. I can also see how in the midst of illness, one says things that they later regret and a person’s actions in one moment of time are not necessarily reflective of who they are. However, had I been in my colleague’s place, I probably would have documented in a similar style. Why? I’ve also dealt with this patient many times before and each encounter ends in almost the exact same way. A friend of mine who works in an ER across town also gets sworn at by her every time he invokes the fury of the triage gods. And yet, the only thing I’ve seen documented is that “patient is verbally abusive to staff”. I don’t think that this statement covers exactly how vile she is towards the staff. We regularly use quotes to capture what patients tell us so I don’t see why we can’t use direct quotes to document verbal abuse thrown our way. Moreover, in the unlikely scenario if she ever decided to sue my colleague, she would have documentation about the patient’s thoroughly reprehensible behaviour to back up her actions.

Obviously, I’m still not decided on where exactly I stand on the issue but I feel that I better pick a position soon because she’s not going to the only aggressive and abusive patient I’ll deal with.