Local Nurse and Intern Declare EMR Documentation War‏

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chart wars

COOPERSTOWN, NY – Citing a “clearly aggressive nursing note” which was felt to be “the absolute last straw,” medical intern Edward Costa formally declared a documentation war on nurse Catherine Ragaz at 12:03 this morning.

"Oh, she got me good"
“Oh, she got me good”

Costa reports that he was reviewing records from the previous evening when he first saw the overnight nursing note in question, which read, “Patient’s heart rate in mid 50s.  Dr. Costa promptly notified.  No orders given.”

“Can you believe that?  ‘No orders given?'” asked Costa, spreading out his hands in the universal gesture of futility.  “For a pulse of 55?  It’s not like I didn’t even assess the patient!  I did, and I told the nurse she was sleeping comfortably.”

“But I guess that doesn’t matter because it wasn’t an order, huh?” Dr. Costa continued, his eyes narrowing.  “Well, that’s the last time I let the record look like I did nothing.”

Sources report that the documentation on Ward 9 North intensified at approximately 1:27 AM local time, when Nurse Ragaz paged intern Costa to notify him of an SpO2 of 94. Documentation recorded in the EMR reveals a medical progress note stating, “Paged by Nurse Ragaz of low SpO2 reading.  Upon this extraordinary intern’s assessment, patient was incidentally noted to be on 0.49 liters Nasal Cannula, instead of the 0.5 liters previously charted in Ragaz’s spotty and inaccurate nursing note.”

“That was his crucial error,” reports another 9 North nurse, who wished to remain anonymous.  “You don’t try to out-chart an expert charter and Nurse Ragaz is an expert charter.  She’s known across the 8th, 9th, and even 10th floors for her efficient terseness.”

Indeed, the electronic record shows that at this point, Nurse Ragaz began paging intern Costa of each and every oxygenation setting, with frequent “updates” as she weaned patients up and down, each update followed tersely by, “Dr. Costa promptly notified.  No orders given.  Significant ‘tern attitude observed.”

Retaliatory notes were furiously documented by Costa.  At 4:03 AM, he attained his sole tactical success by ordering a series of venous blood gases (VBGs) after each page, forcing Nurse Ragaz out of the use of her “No orders given” phrase.

“It was a bloodbath,” reports a shell-shocked respiratory therapist.  “I can’t even believe she managed to make all those draws herself, every patient on the floor… it was nothing short of heroic.”

This morning the medical team arrived to find their ward in a state of electronic devastation, with charting debris scattered widely across the EMR.

“The sheer level of documentation was gut-wrenching,” reports one third-year medical student, who wished to remain anonymous.  “The attendings just scrolled and scrolled for minutes… I just kept hearing their stunned whispers, asking, ‘Where’s my last progress note?  Where’d it go?’  The progress notes were all crushed under dozens of overnight updates.”

As of 9 AM this morning, casualties are estimated to include the majority of the goodwill held by nursing staff, intern Costa passed out in a chair due to absolutely no sleep last night, seven charts that are now widely acknowledged to be “completely unreadable,” and ten actual patients.

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  • Avatar
    Kleptodepressive, MD

    As an intern, the words I hated on the chart were “MD aware.”
    By the time I was a chief resident, I realized that the only words I ever looked at on a chart were in the “assessment and discussion” section of a dictated office note.
    Now, all I care about is the button on the stupid EMR that allows me to “Attest” whatever was written “with the following additions and amendments.”

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    Cheryl Youne

    I too am a night nurse and can’t wait to share this with the gang.

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    Rachel Mary Norum

    Omg hilarious!!

  • Avatar
    Rachel Mary Norum

    Omg hilarious!!

  • Avatar
    Charlie Simms Dabbs

    Dad and I read the whole thing aloud to one another and just laughed!

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    Hugh Babineau

    Funny story. But Cooperstown? I did my residency there. There is no 8th, 9th or 10th floor. Only five. Four when I was a resident but they added a fifth; no joke.

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    Megan Petersen

    Fecal velocity is indeed needed in this case.

  • Avatar
    Kelsey Alyse

    Molly Katherine Natasha Khan

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    What help does a patient with asymptomatic bradycardia need?

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    Tara Bruce Naik

    Traci Miller Satterfield sound familiar? lol

  • Avatar
    Gloria Mitchell


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    Danner Thomas Hodgson

    At 4:03 AM, he attained his sole tactical success

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    Paula Clark McDearmont

    Lesson is, just order what the nurse needs to help your pt! Lol

  • Avatar

    Love it! Sounds like a secondary article

  • Avatar
    Kathleen Grint

    Patti Douglas Callaway, this is hilarious!

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    Chris McCracken

    HHH enemas, q15min neuro checks, q1hr I&O, rectal temps on all patients, manual blood pressures, manual disempaction… The choices are numerous, but the price paid in retaliation is certain.

  • Avatar
    Sarah Kohrmann

    Love the story, but I can never laugh about the ordering of a superfluous enema Joe Gonzalez. That’s just dirty… Then again, I’m sure not paging about an asymptomatic sinus HR in the 50s either lol

  • Avatar
    Bianca Buchholz

    Just hilarious

  • Avatar
    Victoria Morgan

    You know it was an intern because he actually thought he would out document the RN. ha ha.

  • Avatar
    Danielle Moffitt

    Anneliese Spearing

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    Mollie Lauren Kane

    I can’t stop laughing!

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    Tracy Creek

    As a night doc this made me crack up!

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    Anita Bonee Hopkins

    Gotta keep them wars alive Misty Scott Moore!!

  • Avatar
    Joe Gonzalez

    Enemas are much more fun to order than VBGs, but what can you expect from a ‘tern.

  • Avatar
    Misty Scott Moore

    Anita Bonee Hopkins HAHAHA!!!

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    Shannon Campbell Ward

    Lol efficient terseness

  • Avatar
    Thomas Thurlow

    Pretty much the way it works, don’t piss off the people that control your sleep and are on a first name basis with your staff.

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