Not too long ago, I quoted a patient using a swear word in his chief complaint. One of the older doctors read it and reported it to my charge nurse, who then in turn talked to me about it. She told me it was unacceptable and unprofessional and not to do it again. I told her I have every right to document a patient verbatim in the pt's record, even if it includes vulgar language. I then got a talking too by the Nursing Division Director about the same thing. I asked her to tell me where it said that I can't quote a pt. using fowl language. She couldn't produce anything for me. She told me that it sets the hospital up for liability. I told her I learned it in school, she replied with, "well I don't know what school you went to..." If the patient didn't say it, I wouldn't have quoted it.
I asked the division director what would happen if I did it again, she replied that she would give me a verbal warning.
I know I'm not in the wrong about this, but two charge nurses and the division director don't seem to get it.
Any comments?
If a patient is swearing at me, I'll chart it in quotes. Charting exactly what the patient says can protect you in the result of a law suit. Example: I once had a patient in the ER who was very intoxicated & needed to be restrained. He was continuously screaming out swear words, yelling racist remarks, making crude remarks about female body parts, etc. Now this pt was around 22-23 years old, and he kept yelling about how his daddy was a lawyer, he was going to sue, we'd be sorry, blah, blah, blah. Well, I can guarantee that if daddy ever decided to try to sue us & got a look at the medical record, he would be absolutely embarrassed by the things coming out of his precious son's mouth. If I hadn't charted exactly what the pt said, it would never be in the chart, and daddy might have been more likely to try to sue, but as it stood, I never heard another word about the case.... ;)
Charting vulgar language in quotes shows that the patient is beligerent, irrational, and verbally combative. It can demonstrate a patient's frame of mind at the time, and along with descriptions of physical behavior can provide rationale for certain interventions, such as medications (Ativan! Haldol!) or restraints. I am a traveler, and have worked at MANY ER's all over the country, and have never gotten in trouble for charting vulgar language in a chart. It might not "look pretty" in the chart, but then this isn't always a nice, pretty world we work in.....
I agree with Amanda. Patients do get "beligerent, irrational, and verbally combative." Notice how I quoted her. That is how I was told to chart in school, also. It covers your butt, and your license.
'Cat'
I also agree that quoting patients especially when they are using vulgar language is not only appropriate but a necessary and essential part of complete accurate charting. I work in Psych and our Risk Management will not let us use words like "Irrational, beligerant, abusive" in our charting because they are subjective terms open to interpretation. If you write in a chart "patient is angry and aggressive" it can mean anything but if you chart " pt pacing hallways screaming F--K you all - I'm going to beat the S--T out of you all" There's absolutly no ambiguity as to whats happening. I have two lawyers in my family and they always say to think like your sitting in a deposition. Psych nursing is letigious and there are many times when a lawsuit is dropped because accuarte complete charting saved your @ss.
Peace and Namaste
Hppy
I was just about to ask if we "have a psych nurse in the house?"
I bet psych nurses are like court reporters when it comes to verbal abuse...writing everything down word for word.
We were taught in nursing school to write a narrative of the situation, paint a picture of it, including patient language, good or bad-quotations of course.
Maybe the management was looking for something more like,
"I am gonna bleeeeppp, bleeep bleep you nurses and bleeeping bleep!"
:D
all in agreement "quote it"
What would be the legal necessity of quoting a patient's foul language especially if the patient is intoxicated or psychotic? Would precise wording change the meaning when charting "patient screaming obscenities" would suffice? I have had plenty of trench mouth hurled at me over the years but never felt the need to quote any of it in my written documentation. Doing so would seem unprofessional to me. The reader understands without vulgarity. I have however felt compelled for legal reasons, the need to explicitly record physical threats; "pt. states he will twist my head off if I take my hand off of his arm..." and attempts to injur, "I'm going to slit my wrists if I get out of here" or, "I'm going to punch that lady over there if I can get off of this bed..." because the response here is to physically restrain the patient. I see a difference in these situations of bad language versus risk of injury.
R
I work with several MI's, and the precise language/documentation often decides whather or not they get admitted to the local 'floor'.
Just "quote it" and if they threaten to reprimand you for it ask them if you can "quote" them as having said that.;)
Vulgar to some isn't vulgar to others. You know my mom is mad if she says darn it and if she adds a gosh darn it she's really mad. When I worked in a factory one girl I worked with used F...ing every other word as in "I have to bake F...ing cookies to take to my F...ing kids F...ing school picnic. I hate the F...ing place" It does depend on the situation but direct quotes should be used if a quote is needed
I understand that context and interpretation are individual. Cat, I think that if all I had to do to get a certain physician to transfer a nuisance patient out of my ICU was to accuse him of dropping the "F" bomb, I'd use that tool rather often. In general, I still believe that regular vulgarity use in casual conversation diminishes the speaker and doesn't fit well among professional people. Call me a snob.
R
THe policy should be set by the hospital, not your school. Each hospital is entitled to their own standard. I am assuming that this patient used more than one expletive, I probably would have made note that the patient was using inappropriate language without quoting him.
