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.
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.
