Caught! - Charting Ahead
in Journal of Christian Nursing, Volume 20, Number 4 Fall 2003
by Kathleen Eaton

Discussion Questions

1. How common is “charting ahead” in your setting? How serious do you think it is?

2. What other frequently-used questionable practices have you encountered in your own work setting?

3. When nurses find themselves in a position that makes it impossible to complete all the tasks required of them, how could they handle it constructively/ethically?

4. According to the biblical principles outlined in the article, which of the options you have just discussed would be most appropriate? Why?

Response by Pat Emery
What a telling article! It took courage to be transparent about this situation. Unfortunately this probably happens more often than we care to admit. The circumstances in healthcare today have forced many nurses to consider compromising their integrity. Some nurses do make bad choices truly believing it is for the sake of patient care. As an industry we have asked staff to work harder and to do more with less, and this is an example of the consequences.

What this nurse did is wrong. By charting information before it happened she falsified documentation. As a manager, I would discipline her and would certainly have to consider her dismissal. Not knowing the whole situation, it is hard to say whether I would let her go or respond as her supervisor did. This situation creates another problem: Is she trustworthy? Certainly she would have to prove herself and she would have to understand that she would be watched closely.

It seems that in this situation where the care is routine and most everyone receives the same or very similar care, the documentation forms could have been streamlined to make it easier and less time consuming (check lists, for example). In these days of short staffing, managers and staff need to work together to find ways to streamline processes so that efficiencies in the work can be gained. We need to do a better job of teaching people to how to prioritize care and in those times when there isn’t enough time, give the staff permission to decide what things just don’t have to be done. Many nurses today still believe they have to be all things to all people and are not good team players and/or delegators. Coming out of the era of “Primary Care” as the preferred model of nursing care, we have become accustomed to “doing it all” and somehow believe that if we can’t do it all, we are less than good nurses. As an industry we have created these types of ethical dilemmas for nurses and it is our responsibility as administrators to bring about change by helping them to think through how to handle difficult situations when there is more work than there is time to get it all done.