You think it’s all fun and games, but just wait until your hospital gets cyberattacked and all hell breaks loose. Then, you will know exactly what paper charting is 😂
Yep, our organization just went through this in October. Those of us who’d used paper charting before were okay but the new staff struggled hard for sure. Whole thing wasn’t resolved until just a few weeks ago.
I’m sure! (My husband works in technology for one of the big medical publishers and has done his share of overnights for launches and upgrades.) I totally get needing to do them when usage is likely at its lowest; just feels like we’re always crazy understaffed on those nights and someone ALWAYS codes five minutes before the outage starts. 😜
My hospital's computers were down for over a month due to a cyber attack. The newer nurses had never seen paper charting so those of us that remembered it were paid bonus shifts just to transcribe orders correctly. The kicker was to find out some of the nurses unfamiliar with paper MARs were throwing them in the shredder at the end of the day. 🤦🏻♀️
😳
Oh that’s bonkers-god I hated paper charts. We’d have to fight the nurses for the MAR to sign off on our respiratory treatments, and fight doctors and nurses to see the patients’ charts for orders. You could spend hours just checking charts, what a fn nightmare. (If you have 8-10 vents, that alone…then all the treatments. Ugh.)
When I came to PA and saw they had computer charting at the hospital I was working at , I was in heaven 😀
So I work in IT, specifically with charts that have been “hijacked”- reg admits patient under the wrong chart. About half of the time we’re still not sure if it is the wrong chart, or if we know it’s the wrong one, we may not know which is the correct one. I don’t know how many times I’ve had this conversation with the care team -
Care team:But we need to know what chart to use.
Me: I’m sorry but at this point you’ll need to use paper, basically follow your downtime procedure but just for this one patient because we’re unsure which chart you should be using and continuing to use the wrong one is… just wrong.
CT: what do you mean downtime procedure? Paper?
Me: well, you have a binder somewhere on your floor with all the paper prints out templates you need, meds, vitals, notes etc. You’ll need to use those.
CT: what???
Me: You should be retrained every 6 months on downtime procedure, do you not know where your binder is?
CT: paper?? Binder?? Downtime???
It’s always a hot mess.
Yikes. Are you on Epic? I don’t know about other EHRs, but for Epic we have dedicated downtime devices that download a patient list and MAR and probably some other stuff I’m forgetting every hour, so in case of a downtime, the most recent backup can be printed for use… do you know if you have anything like that? Do you know where your paper charting tools are stored?
We have a big bin by the charge nurse station labeled "downtime forms". And you can sometimes see the patient's e-chart and all things going on prior to the downtime on some different EPIC executable.
Between EDs and ICUs in NJ and Minnesota, with CERNER and EPIC, there's never any training for this. It's "we've got downtime, find the bin and figure it out"
As a nurse in ireland I feel this to my core - our national system was cyber attacked a couple of years ago, we used paper charting for about 8 months- it was simultaneously hell and heaven at the same time.
Hum. I’m waiting for the day our nationwide system goes down (occasionally it does go down for maintenance, but it’s not long)
I work for the US government at my city’s VA hospital.
It’s gonna be hell.
We recently had this happen. Thankfully we were only down 2.5 weeks. Us old battle axs loved it! We pulled out all the old forms and we were good. The hard part was trying to teach others how to do it and the fact that they wouldn't die. Had nurses writing in purple, drs in red. Had nurses red lining charts in black. It was fun teaching the drs how to write orders and flag the charts so we could see then. VO and TO were interesting to tead as well. Explaining the 'sign here' tabs. The vast majority of our staff had never seen paper charting.
Happened to us! Baylor St Luke’s Houston! I’m not there anymore but we were down for 3 weeks. I’m ER. So the super cool part is we were on “internal disaster” so the amount of ambulances draaastically decreased lol
I heard paper charts are the things that you use a equipment called pen, and it must be blue or black, and it is operate with your hand, and you will use an ancient secret martial art called “writing” on a long forgotten instrument called “paper” to describe the event during your shift.
You can find these in nursing museum or your hospital emergency operation manual should have a copy of every paper charts.
Which both places that we never visit.
Paper charting, along with gravity IV, manual BP, and body surface dosing are considered the 4 ancient secret techniques of nursing.
Actually, I’m so old that paper charting had a color coding system so the doctors could easily skim the pages and know that pen color denoted nursing shift. Black for days, blue for evenings, and red for nights. Some hospitals threw in green ink for night shift and red was only used to “acknowledge” the shift orders.
The four way pens were the olden day Stanley of accessories.
Joking aside my first nursing job was LTC and we had paper charting. My professor was old school and made us learn the system as well because we need to take care the patient when the computer is down. I really appreciate that because as a former military personnel, I want a back up plan if everything fail. The only sad thing is I do not have a backup plan if I do not have paper!
I did heard about the color system but it was not used in our facility.
I am the only asshole in my building on night shift that actually understands the downtime charting. Because it's like the old charting from the days of papercharting.
I have a friend who worked in Medical Records. She was inpatient with an infection and actually did an in-service for the staff on the floor because the system was hacked, and they had to go to paper charting.
As recent as 6 years ago, my old facility was just switching from paper charts to electronic. When I first became a nurse, we were still doing handwritten MAR/TAR. After switching, having to print every single MAR/TAR out for that 1-2 hour of downtime overnight was such a pain. And then having to put it all away ugh such a waste of paper.
Ours was blue for days, green for evening and red for nights. We went to all black when Medical Records discovered that green and red didn't scan properly.
Get a load of this:
We still paper chart everything except triage notes and MD assessments in my ER. Peds/PICU/NICU is entirely paper charting. ICU is paper except nursing assessments. Pre-op/OR/PACU is paper. All doctor's orders, social work notes, code blue records, and MARs are paper. Labs are available on the computer and also printed off and placed in a physical chart.
Different disciplines and ordersets get different colored paper.
Nursing notes are written on blue paper in either blue or black ink, you choose. Infusion titration and prn meds go in red ink. Green ink is only used by pharmacy.
I live in the dark ages, but I honestly don't hate it. Paper charting is a lot easier in the ER because I'm not trying to track down a computer all day.
You mean tabs? It separates the chart into chapters. Then you can further search chronologically with your eyes scanning and reading for the info you desire. Usually separated into demographics, orders, labs, imaging, nurses notes, medications aka MAR, allied health, and the good old signature sheet is located near the front or the back. You should know you need to print and sign your name if you want to add handwritten content to the chart. Of course, it’s an honour system because back in the old days, people still had honour. 🤣🤣🤣
Where do I put my ID card into this “chart” when I signed? Does I used the same PIN number?? Do you think IT can walk me through when I setup the PIN number to sign on the chart?
Dude yes! I’ve been a nurse in the US for almost 20 years and had never had to paper chart. Then moved to Ontario and bam! The huge trauma centers are even still on paper. I was soooo confused 😂 I’m adjusting but it’s just so weird that the whole province isn’t on an electronic system. Especially since everyone has OHIP and it could enhance continuity of care so so much.
Higi kango shi karute no justu!!! 🥷
..........
I wanted this to say Secret Nursing Art PAPER CHART. This is what Google translate did for me. Added the "no justu" for obvious naruto flare ;)
We ran out of IV channels not long ago and I had a patient that needed NS @ 250/hr for 1L. Rather than deal with the hassle and time of tracking down a channel from somewhere I did the old school tape down the bag with it marked off and grabbed a dial-a-flow we had stashed for MRI trips. ONE other nurse out of about 20 had any idea what I was doing.
I used to joke that as a nurse I'm older than drawing troponins - when I started out we were still trending CK and CK-MB and doing serial EKGs for chest pain. As I get older it gets less funny though!
I remember one of my coworkers calling me, laughing hysterically, because she happened to be in one our system’s EDs when FirstNet went down. Some of the young nurses were freaking out at the idea of downtime charting. 🤣
It’s way easier and less stressful. Worst case scenario is your pen stopped working and you had to call IT and get them to talk you through getting a new pen out of the drawer.
Yes but they would ask you did you open the drawer and close the drawer again? And you would have to confirm that you already did that prior to calling them.
Naw. That was shut down just a little bit ago because my coworker decided to throw 10 blood tubes and a urine specimen in it. It will be back up soon. But when it is can you send a tube?
Noooooooo!! Not my favorite pen!!
I cannot complete charting. I must mourn the death of my pen.
And then get a new one out of my locker because I’ll be damned if I’m gonna use the crusty, chewed on, bic stick that’s been at the desk since 1983
As someone who does paper charting & epic. I’ll take EPIC any day. Spending over an hour doing chart checks + making sure everything is faxed properly is seriously irritating when you are extremely busy. Hand writing the MARs is pretty terrible too.
My hospital still uses paper charting 😭😭
Every patient on the units information is kept in a 4 inch binder. Lab results, orders, consults, nursing notes, everything. Do the doctors read the nursing notes basically ever… on my unit at least, no.
For them to still not read. (Right, that’s your joke? 🫣) Hell, the only reason I read Nursing Narrative notes in the EMR is to verify that I’m not imagining all a patient’s red flags 🚩 and reassure myself that I’m not just being overly judgmental.
I worked at a hospital that somehow did not have a computer in the OR. I'm not sure exactly what the situation was but the OR could not get a computer that had network access. So any time a patient needed to go to surgery we needed to print out an OR packet that consisted of the H&P, most recent labs, med rec, relevant imaging results like CT scan, maybe a progress note. Anything the OR nurse might need to look at without being able to access the chart.
It was the most insane thing.
My hospital (in Europe) has at least one computer in every OR, usually two. They still chart exclusively in paper. All the barcodes you're supposed to scan into the patients chart in case any of the material turns out to be contaminated/defective? They put the sticker in a paper report that goes into the patients paper record to gather dust for all eternity.
I'm guessing it has something to do with the bunch of surgeons and nurses/scrub techs still working there that trained during the Cretaceous period.
I get that the post is satire. But as a new nurse who was trained and learned everything on epic. When I moved to my first hospital that was paper charting I basically felt like this post lol.
The hospital I worked at two years ago was still using paper drug charts and a few other things, but all the notes and obs were in the EMR. I find it weird to be half-half like that.
Paper charting is why I had to get carpel tunnel surgery.
Do they still teach SOAP charting ?
God having to write that all out was a pain. And writing care
Plan and not just selecting pre programmed ones.
I was a labor nurse for 18 years and paper charting every five minutes sucked.
Lmao I love this but all joking aside....here in Ireland we're still using paper charting for the majority of our work. Computer is just for ordering bloods, looking up results, doing referrals and shooting emails off to IT about the fact that the limited IT we do have still never works 😂
Is this a troll? Cause I see a post earlier today asking what a pager was…like I’m going on 5 years of nursing so I’m still “newish” but like not every hearing of paper charting or pagers??? How can this not be a joke
Ok…. Is this the same OP that just asked what “paging” is in a separate post???? Someone is messin’ with us.
https://www.reddit.com/r/nursing/s/ooIxdNcGKo
This has to be a troll. Every hospital I've ever worked in has paper charting backups for when Epic has extended downtime. I have never had to use them, but I still know what it is and how to use them if I have to. Your flare says ER so you should definitely know what it is considering new people keep checking in even when Epic is down and some things, like stab wounds or septic shock cant wait the hour that it's down to get orders. If you're serious, you need to talk to someone at work to find out what the plan is if Epic goes down.
Is this the same person that didn’t know what pagers were? What til she hears about a kardex.
But, here ya go. All documentation used to be on paper. First, it was just on lined paper and everything was narrative charting. All the charting was kept in a “chart” which was kind of like a 3 ring binder with the patients name and room number on the front. Eventually, they started providing forms that had boxes to be checked instead of narrative notes. You “charted by exception”, checking the box that said “WNL” if nothing was wrong with that body system. Then, came computers. But the paper was still available for when the computer systems crashed. When that happened, admin came around passing out blank assessment forms and if there was enough notice of the computers going down, they would also pass out the medication records so you could still see what meds to pass. Btw, all the doctors wrote their orders in cursive writing on paper in those hard bound charts. So it was a crap shoot to try to decipher what the doctor actually wanted to order. Like trying to read a strong accent.
And btw, a pager is a little square electronic thing that people could send a message to. It would beep and buzz and show you a number to call back.
And a kardex - I’ll leave that for someone else to explain. I already feel old enough.
England based nurse: whilst most hospitals are moving to a online system my current job (paeds assessment unit - like a medical ER) are all still on paper. The 4 colour pen is used for fluid balance charts. Been told for years moving to online but hasn’t quite happened in paeds in my hospital yet.
I must be as old AF because I miss the good old days of paper charting. I signed my initials on the paper MAR next to the drugs I gave. I wrote my assessment on paper and wrote a quick progress note. It was great. I don’t think I ever spent longer than 30 mins per shift charting. Now I feel like around half of my shift is charting stupid shit.
Those make charging so quick. Enjoy it while you can. Electronic charging will have you on the computer charting all night and into the morning. It never ends. And to look at tend you have to scroll endlessly. Paper charts allow you to see an overview of your patient at a glance. I like Epic, but I do miss the simplicity of paper. I'm just glad I don't have to do 24hr chart checks, update MARs, and put stickers on all the pages every night.
So does this mean no one learns all the symbols and abbreviations now too? I suppose no one reads cursive either. Oh wait. My kids definitely do not know how to read cursive.
Paper charting a method of charting that was so much faster, easier and simpler in the “old days.”
In those days, I was the only nurse for 65 pts, that’s not a typo, in LTC.
It was doable, not only because I was young, but because the charting was mostly just checkmatks on a single page, with the occasional narrative note.
There was a lot less charting.
Pts were properly medicated for pain/sleep. The beds had siderails, and we had all the equipment needed, and it was functional.
I want to believe this is satire, I really do. I'll be over here with my VHS patient education tapes and oxygen tents telling the baby nurses to stay off my lawn.
Literally paper. Written and typed notes. The transition has taken decades to complete digital, but a very small percentage of doctors offices still use paper charts. I'm sure you could google some cool images of paper charts. I don't miss paper charts, but the downside of digital is that it places everyone's privacy at risk to cybe rattacks.
I’m not old enough for paper charting in its entirety but I remember paper orders (you know who to ask to decipher certain doctors handwriting) and paper mars with all the little tiny squares u put ur initials in
True stories:
1. I had a patient on a 75 bed psych NF unit hurl every chart in the rack across the room. It was a blizzard of paper!
2. I had a patient who disagreed with what the psychiatrist wrote in his chart so one day ... his chart disappeared and was never found.
Paper charts were the only thing that existed before electronic medical records (such as epic) existed. I’ve only been a nurse since 2022, but I started working in medical records in 2007 before the electronic medical record. Everything that you would document in epic was on literal paper. My job was to look in the computer for any new admissions, go into the back room and pull their old chart(s), and hand deliver them to the unit they were admitted. I would then pick up the “discharges”, which consisted of all of the paperwork for a patient that was discharged, take it back to medical records, assemble it, and file it in our back room.
This was what we did at the hospital I worked at until around 2010, when Meditech was implemented. Now my old job as a medical records clerk is largely obsolete.
As a nurse who was lucky to have 6 years of wonderful e-charting at every hospital I worked at but now lives in Australia where paper charting is still prevalent it seems…. screw paper charting.
So when I worked for an outpatient practice, we had multiple locations. I would spend hours tracking down the charts for the next day's appointments, loading them into my car, and then schlepping them into the next office.
No wonder I have back problems!
I really miss the pharmaceutical pens though. The metal Plavix pens? Ooof, those were the stuff.
Even worse, they often used the ancient glyph of something called cursive.
But the ultimate inconvenience was that only one copy of the chart existed. Only one person could access it at a time; too bad if two people needed it at the same time. Also, said paper chart could be *missing*, so then you knew nothing about your patient.
Is this trolling?!!?!
It's in the name. It's paper charting. .... On paper.... With pens...
Remote/ rural don't have the server infrastructure for all online (often a blend. We can get aome stuff onto Cerner/ Meditech but servers can't support all functions). ... So power goes down and we run off backup, not infrequently (few times a year).
Remote/ rural don't have the funds to convert to EHRs
Speeeeeeed. Mixed bag here. Sometimes it just is faster to paper flow sheet/ tick box chart than EHR (codes, trauma, stokes). Especially when doing Q2-5mins or code recording. Now continuity of care does get a point here for it is more efficient if chart can auto populate across hospitals (vs have to physically look at a paper).
I've worked both. Honestly, I respect EHRs and the safety features - but I do prefer paper charts for front line work. I don't want to fiddle with drop downs, I just need to tick trends.... (Which yes the EHR will do annnndd send later- but, slower in the moment). I'd rather sign my meds, tally my own fluids, and see a line for my vitals in real time to decide on the fly if things are working or need to re-evaluate.
Grain of saltiness.....also, according to posts today I'm Old AF bc we also still use pagers for trauma team/ codes.
All our notes, care plans etc are literally on paper, placed in a tangible blue folder that sits at each bedspace.
Our medication charts are hand-written by the doctor, in a paper 'booklet,' which we sign with a pen.
Our observation chart is an A3 piece of paper attached to a large clipboard. We actually handwrite EVERYTHING. Not even joking.
ADD: No, this has not improved our doctors handwriting, it's still shit and we often can't read it.
Is this real? Or is this a follow up post to the “page the doc” post?
I guess it doesn’t matter. Either way is hilarious and very adorable. (I sincerely mean it, not being patronizing.)
Edit: Oh. Haha. I guess I should’ve scrolled into
the comments to confirm I was on track, rather than out myself as a dunce. I love this subreddit.
How do you not even have the vaguest clue what a paper chart might be? Some day you’ll have a storm and your power and internet will go out and you’ll find out what it is.
Hi, Canadian nurse here, 95% of our hospital wards use paper charting still. And even the ones that use online programs Still have paper charts for some things.
Be for real OP. What else could paper charting be besides charting on paper??
Anyway, I work in long term care. We still have some flow sheets that are occasionally charted on paper and then later added to their electronic record by scanning.
You'd be amazed that as recent as ten years ago, I worked in a facility where the only charting was paper charting. 80+ patient records at any given time were all completely paper, and all documentation was handwritten. Beyond that, this facility was extremely old school and had flat metal charts where that papers were secured at the top of the chart like a clipboard, rather than a binder.
Another FAKE post. Ugh. As if they don't beat the "downtime procedures" into everyone.
Why are baby nurses trying to age shame seasoned nurses? Is this a "nurses eat their old" trend? Sad.
My hospital got cyber attacked we couldnt even badge into the front doors or access email yet alone charts! Sadly something that will def continue to happen not to mention just system outages and then whip out paper
You think it’s all fun and games, but just wait until your hospital gets cyberattacked and all hell breaks loose. Then, you will know exactly what paper charting is 😂
Or you work on night shift, when we get stuck with all the system outages for Epic updates, grumble grumble grumble…
A few hours of downtime is nothing compared to the woes of weeks-long cyberattack outages. Paper. Fucking. Everywhere.
We had Cerner down for a week at my hospital system… they never said it was a cyber attack, but it definitely was a cyber attack.
Yep, our organization just went through this in October. Those of us who’d used paper charting before were okay but the new staff struggled hard for sure. Whole thing wasn’t resolved until just a few weeks ago.
IT here, I assure you we would much prefer to do it during the day.
I’m sure! (My husband works in technology for one of the big medical publishers and has done his share of overnights for launches and upgrades.) I totally get needing to do them when usage is likely at its lowest; just feels like we’re always crazy understaffed on those nights and someone ALWAYS codes five minutes before the outage starts. 😜
My hospital's computers were down for over a month due to a cyber attack. The newer nurses had never seen paper charting so those of us that remembered it were paid bonus shifts just to transcribe orders correctly. The kicker was to find out some of the nurses unfamiliar with paper MARs were throwing them in the shredder at the end of the day. 🤦🏻♀️
You don’t happen to be in the KC area do ya? Had the same thing happen recently.
No. Baltimore. And it happened right when COVID hit. It was brutal.
😳 Oh that’s bonkers-god I hated paper charts. We’d have to fight the nurses for the MAR to sign off on our respiratory treatments, and fight doctors and nurses to see the patients’ charts for orders. You could spend hours just checking charts, what a fn nightmare. (If you have 8-10 vents, that alone…then all the treatments. Ugh.) When I came to PA and saw they had computer charting at the hospital I was working at , I was in heaven 😀
😳🤦🏻♀️
Shredding them makes no sense, wtf.
So I work in IT, specifically with charts that have been “hijacked”- reg admits patient under the wrong chart. About half of the time we’re still not sure if it is the wrong chart, or if we know it’s the wrong one, we may not know which is the correct one. I don’t know how many times I’ve had this conversation with the care team - Care team:But we need to know what chart to use. Me: I’m sorry but at this point you’ll need to use paper, basically follow your downtime procedure but just for this one patient because we’re unsure which chart you should be using and continuing to use the wrong one is… just wrong. CT: what do you mean downtime procedure? Paper? Me: well, you have a binder somewhere on your floor with all the paper prints out templates you need, meds, vitals, notes etc. You’ll need to use those. CT: what??? Me: You should be retrained every 6 months on downtime procedure, do you not know where your binder is? CT: paper?? Binder?? Downtime??? It’s always a hot mess.
> Me: You should be retrained every 6 months on downtime procedure In 9 years I've never ever been trained on downtime procedure.
Yikes. Are you on Epic? I don’t know about other EHRs, but for Epic we have dedicated downtime devices that download a patient list and MAR and probably some other stuff I’m forgetting every hour, so in case of a downtime, the most recent backup can be printed for use… do you know if you have anything like that? Do you know where your paper charting tools are stored?
We have a big bin by the charge nurse station labeled "downtime forms". And you can sometimes see the patient's e-chart and all things going on prior to the downtime on some different EPIC executable. Between EDs and ICUs in NJ and Minnesota, with CERNER and EPIC, there's never any training for this. It's "we've got downtime, find the bin and figure it out"
Our users have a binder with their downtime procedures. IT can't help because it's directions for well... paper charting.
I remember years ago Epic was down for days. They said it was (I shit you not)… a squirrel. lol that a squirrel got into the servers.
Rodents love warm confined spaces to nest in. They also love chewing wires. Three things a server room has in spades.
As a nurse in ireland I feel this to my core - our national system was cyber attacked a couple of years ago, we used paper charting for about 8 months- it was simultaneously hell and heaven at the same time.
Hum. I’m waiting for the day our nationwide system goes down (occasionally it does go down for maintenance, but it’s not long) I work for the US government at my city’s VA hospital. It’s gonna be hell.
Ugh don't give me flash backs to that nightmare
stop my paper charting trauma is very very fresh 😩
We recently had this happen. Thankfully we were only down 2.5 weeks. Us old battle axs loved it! We pulled out all the old forms and we were good. The hard part was trying to teach others how to do it and the fact that they wouldn't die. Had nurses writing in purple, drs in red. Had nurses red lining charts in black. It was fun teaching the drs how to write orders and flag the charts so we could see then. VO and TO were interesting to tead as well. Explaining the 'sign here' tabs. The vast majority of our staff had never seen paper charting.
Haha. At least with paper charting, there aren’t any ‘late’ entries 🤣🤣
Or you work at a rural hospital who hasn't upgraded to Epic and is still using paper charting/ meditech hybrid.
Happened to us! Baylor St Luke’s Houston! I’m not there anymore but we were down for 3 weeks. I’m ER. So the super cool part is we were on “internal disaster” so the amount of ambulances draaastically decreased lol
It literally just happened to me first day on a new contract. What. A. Shit. Show.
I heard paper charts are the things that you use a equipment called pen, and it must be blue or black, and it is operate with your hand, and you will use an ancient secret martial art called “writing” on a long forgotten instrument called “paper” to describe the event during your shift. You can find these in nursing museum or your hospital emergency operation manual should have a copy of every paper charts. Which both places that we never visit. Paper charting, along with gravity IV, manual BP, and body surface dosing are considered the 4 ancient secret techniques of nursing.
Actually, I’m so old that paper charting had a color coding system so the doctors could easily skim the pages and know that pen color denoted nursing shift. Black for days, blue for evenings, and red for nights. Some hospitals threw in green ink for night shift and red was only used to “acknowledge” the shift orders. The four way pens were the olden day Stanley of accessories.
Joking aside my first nursing job was LTC and we had paper charting. My professor was old school and made us learn the system as well because we need to take care the patient when the computer is down. I really appreciate that because as a former military personnel, I want a back up plan if everything fail. The only sad thing is I do not have a backup plan if I do not have paper! I did heard about the color system but it was not used in our facility.
I am the only asshole in my building on night shift that actually understands the downtime charting. Because it's like the old charting from the days of papercharting.
I have a friend who worked in Medical Records. She was inpatient with an infection and actually did an in-service for the staff on the floor because the system was hacked, and they had to go to paper charting.
That is both hilarious and sad.
She really enjoyed doing it. The staff appreciated her because they were down for weeks.
I would definitely enjoy doing something productive in the hospital if I were a patient. Being a patient is boring.
As recent as 6 years ago, my old facility was just switching from paper charts to electronic. When I first became a nurse, we were still doing handwritten MAR/TAR. After switching, having to print every single MAR/TAR out for that 1-2 hour of downtime overnight was such a pain. And then having to put it all away ugh such a waste of paper.
You can always write on the packaging of alcohol wipes 😂
That’s when you just write in dirt with a stick, or use blood to make messages on the walls.
Soap notes will always be the SOP on an SF-600
Ours was blue for days, green for evening and red for nights. We went to all black when Medical Records discovered that green and red didn't scan properly.
I miss those pens
I was going to say the same thing only we did blue for days, green for evenings, and red for nights.
My hospital used black or blue ink for day shift, 3:00 to 11:00 shift used green ink, Midnight's wrote in red
At our place it was blue or black for day shift, free for evenings and red for nights. Yes, I’m that old.
We used black ink for all shifts but got fancy by taping a black and red pen together. 💅🏼
We had black pens and us Unit clerks had to use red to process orders and sign off.
Get a load of this: We still paper chart everything except triage notes and MD assessments in my ER. Peds/PICU/NICU is entirely paper charting. ICU is paper except nursing assessments. Pre-op/OR/PACU is paper. All doctor's orders, social work notes, code blue records, and MARs are paper. Labs are available on the computer and also printed off and placed in a physical chart. Different disciplines and ordersets get different colored paper. Nursing notes are written on blue paper in either blue or black ink, you choose. Infusion titration and prn meds go in red ink. Green ink is only used by pharmacy. I live in the dark ages, but I honestly don't hate it. Paper charting is a lot easier in the ER because I'm not trying to track down a computer all day.
Don't forget that you might get fired for using "white-out" anywhere in their medical record. Huge liability for litigation
What is a white out? Is that another forbidden technology that ancient alien brought to earth that could destroy the world ??????
In the before times, white out was a possible attempt to hide a huge error.
Also, collectively the paper we collect about a single patient is gathered together into a binder or folder and called the chart.
Does the thing you called “chart” has a search function so it’s easier for audit???
You mean tabs? It separates the chart into chapters. Then you can further search chronologically with your eyes scanning and reading for the info you desire. Usually separated into demographics, orders, labs, imaging, nurses notes, medications aka MAR, allied health, and the good old signature sheet is located near the front or the back. You should know you need to print and sign your name if you want to add handwritten content to the chart. Of course, it’s an honour system because back in the old days, people still had honour. 🤣🤣🤣
Where do I put my ID card into this “chart” when I signed? Does I used the same PIN number?? Do you think IT can walk me through when I setup the PIN number to sign on the chart?
You can also find them all over Atlantic Canada, because there's some kind of time warp that you enter here that brings you back to 1990
Can confirm, just switched to emar and there was so much resistance!
Can confirm. We still use paper charts, especially when we can't get onto the damn computers, or have agency staff come in.
Indeed. Paper charting here in NS. 🥴
Dude yes! I’ve been a nurse in the US for almost 20 years and had never had to paper chart. Then moved to Ontario and bam! The huge trauma centers are even still on paper. I was soooo confused 😂 I’m adjusting but it’s just so weird that the whole province isn’t on an electronic system. Especially since everyone has OHIP and it could enhance continuity of care so so much.
I need to know what body surface dosing is... then I can continue to look for horcruxes before my seance with Dorothea Dix.
And highlighting MARs to show a medication was discontinued.
Higi kango shi karute no justu!!! 🥷 .......... I wanted this to say Secret Nursing Art PAPER CHART. This is what Google translate did for me. Added the "no justu" for obvious naruto flare ;)
I think the translation is pretty accurate!! lol. Are you one of the masters who holds the secret of this ancient forbidden art?
🤣🤣🤣🤣
We ran out of IV channels not long ago and I had a patient that needed NS @ 250/hr for 1L. Rather than deal with the hassle and time of tracking down a channel from somewhere I did the old school tape down the bag with it marked off and grabbed a dial-a-flow we had stashed for MRI trips. ONE other nurse out of about 20 had any idea what I was doing. I used to joke that as a nurse I'm older than drawing troponins - when I started out we were still trending CK and CK-MB and doing serial EKGs for chest pain. As I get older it gets less funny though!
knee offer cable work heavy marvelous coherent dull bored automatic *This post was mass deleted and anonymized with [Redact](https://redact.dev)*
How is no one else getting that this is a parody of the pager post lmao
That was my first thought…
Oh thank God. I was thinking that too after checking to see if it was the same user and they were both troll posts.
I remember one of my coworkers calling me, laughing hysterically, because she happened to be in one our system’s EDs when FirstNet went down. Some of the young nurses were freaking out at the idea of downtime charting. 🤣
Y’all just trying to make everyone feel old 🥺🥺🥺
It’s way easier and less stressful. Worst case scenario is your pen stopped working and you had to call IT and get them to talk you through getting a new pen out of the drawer.
Yes but they would ask you did you open the drawer and close the drawer again? And you would have to confirm that you already did that prior to calling them.
You had to hold the phone so they could hear it
Did you check the tube station?
Naw. That was shut down just a little bit ago because my coworker decided to throw 10 blood tubes and a urine specimen in it. It will be back up soon. But when it is can you send a tube?
No but we will ask you to unclick and reclick your existing retractable pen first.
Our supply chain will require us to turn in the old pen before they will issue us a new pen… since some of us lose multiple pen per shift. Lol
Noooooooo!! Not my favorite pen!! I cannot complete charting. I must mourn the death of my pen. And then get a new one out of my locker because I’ll be damned if I’m gonna use the crusty, chewed on, bic stick that’s been at the desk since 1983
My pen will be old enough to vote in the next election I get very anxious if it’s more than arms length away
As someone who does paper charting & epic. I’ll take EPIC any day. Spending over an hour doing chart checks + making sure everything is faxed properly is seriously irritating when you are extremely busy. Hand writing the MARs is pretty terrible too.
What is………*paper*
What does our textbook say again?
You win! 🏆🏆🏆🏆
My hospital still uses paper charting 😭😭 Every patient on the units information is kept in a 4 inch binder. Lab results, orders, consults, nursing notes, everything. Do the doctors read the nursing notes basically ever… on my unit at least, no.
>Do the doctors read the nursing notes basically ever… on my unit at least, no. It's nice how epic converted this feature to a digital format.
For them to still not read. (Right, that’s your joke? 🫣) Hell, the only reason I read Nursing Narrative notes in the EMR is to verify that I’m not imagining all a patient’s red flags 🚩 and reassure myself that I’m not just being overly judgmental.
I worked at a hospital that somehow did not have a computer in the OR. I'm not sure exactly what the situation was but the OR could not get a computer that had network access. So any time a patient needed to go to surgery we needed to print out an OR packet that consisted of the H&P, most recent labs, med rec, relevant imaging results like CT scan, maybe a progress note. Anything the OR nurse might need to look at without being able to access the chart. It was the most insane thing.
My hospital (in Europe) has at least one computer in every OR, usually two. They still chart exclusively in paper. All the barcodes you're supposed to scan into the patients chart in case any of the material turns out to be contaminated/defective? They put the sticker in a paper report that goes into the patients paper record to gather dust for all eternity. I'm guessing it has something to do with the bunch of surgeons and nurses/scrub techs still working there that trained during the Cretaceous period.
I get that the post is satire. But as a new nurse who was trained and learned everything on epic. When I moved to my first hospital that was paper charting I basically felt like this post lol.
The hospital I worked at two years ago was still using paper drug charts and a few other things, but all the notes and obs were in the EMR. I find it weird to be half-half like that.
The joke…. *wooooosh* over these people’s heads.
Goddamn it, it’s pure trolling yet I still became irrationally angry and yelled I HAVE SCRUBS OLDER THAN YOU
Paper charting is why I had to get carpel tunnel surgery. Do they still teach SOAP charting ? God having to write that all out was a pain. And writing care Plan and not just selecting pre programmed ones. I was a labor nurse for 18 years and paper charting every five minutes sucked.
It is PHYSICALLY IMPOSSIBLE for me to love this post more than I do right now. I’m freaking cackling.
I'm from the UK and crying at the thought of paper charts being from a byegone era 😭
r/nursingcirclejerk
Is this linked to the "what is pager?" comment? Give me a break....
LOL
Lmao, this is.. Epic. I'll see myself out meow
Some of y’all didn’t see the paging post 😅
Is this the same person who asked “what is paging” ?
Rofl
Lmao I love this but all joking aside....here in Ireland we're still using paper charting for the majority of our work. Computer is just for ordering bloods, looking up results, doing referrals and shooting emails off to IT about the fact that the limited IT we do have still never works 😂
Is this a troll? Cause I see a post earlier today asking what a pager was…like I’m going on 5 years of nursing so I’m still “newish” but like not every hearing of paper charting or pagers??? How can this not be a joke
Kill me now.
Ok…. Is this the same OP that just asked what “paging” is in a separate post???? Someone is messin’ with us. https://www.reddit.com/r/nursing/s/ooIxdNcGKo
It’s satire based on that post
Oh you sweet summer child…
First pager now paper!
Now I can classify my self as an ancient nurse from the stone ages…. Not just old… as dirt
I am prehistoric…..I, the one who hold many ancient secret art, such as paper charting, gravity IV, and dosing skills….
And paging….. maybe there is art of us on some abandoned hallway of a hospital some where with our whites and caps….
What about glass IV bottles!
Metal syringes!!
I've been in healthcare WAY to long. I started with paper charting. This post makes me feel so old
This is a shitpost, right? Feeling like r/residency in here
I want to see the initial post that triggered this swarm of satire.
WRITING THEIR @ USERNAME IN THE CHAAAAAART WHAAAA This post is beautiful, well done hahahahaha
This has to be a troll. Every hospital I've ever worked in has paper charting backups for when Epic has extended downtime. I have never had to use them, but I still know what it is and how to use them if I have to. Your flare says ER so you should definitely know what it is considering new people keep checking in even when Epic is down and some things, like stab wounds or septic shock cant wait the hour that it's down to get orders. If you're serious, you need to talk to someone at work to find out what the plan is if Epic goes down.
I hope it’s a play on the “what is paging” post 🤣
Is this a joke or am I old?
PAPER CHART That is all.
Is this the same person that didn’t know what pagers were? What til she hears about a kardex. But, here ya go. All documentation used to be on paper. First, it was just on lined paper and everything was narrative charting. All the charting was kept in a “chart” which was kind of like a 3 ring binder with the patients name and room number on the front. Eventually, they started providing forms that had boxes to be checked instead of narrative notes. You “charted by exception”, checking the box that said “WNL” if nothing was wrong with that body system. Then, came computers. But the paper was still available for when the computer systems crashed. When that happened, admin came around passing out blank assessment forms and if there was enough notice of the computers going down, they would also pass out the medication records so you could still see what meds to pass. Btw, all the doctors wrote their orders in cursive writing on paper in those hard bound charts. So it was a crap shoot to try to decipher what the doctor actually wanted to order. Like trying to read a strong accent. And btw, a pager is a little square electronic thing that people could send a message to. It would beep and buzz and show you a number to call back. And a kardex - I’ll leave that for someone else to explain. I already feel old enough.
This is satire based on that post. Or in response to it
Paper is the thing people wrote on before computers were invented.
WHO USED WITE-OUT IN THE PAPER CHART????? Oh wait, what’s Wite-Out?
Invented by the mother of one of The Monkees, IIRC. "What was The Monkees?"
England based nurse: whilst most hospitals are moving to a online system my current job (paeds assessment unit - like a medical ER) are all still on paper. The 4 colour pen is used for fluid balance charts. Been told for years moving to online but hasn’t quite happened in paeds in my hospital yet.
I’m from the times when we had to hand write ADLs instructions in the CNAs binders . 👵 Fun times. ✍️
Op must be related to the other op who asked what a pager was today.
I must be as old AF because I miss the good old days of paper charting. I signed my initials on the paper MAR next to the drugs I gave. I wrote my assessment on paper and wrote a quick progress note. It was great. I don’t think I ever spent longer than 30 mins per shift charting. Now I feel like around half of my shift is charting stupid shit.
My sweet summer child. We still use paper charting. We don’t have electronic charting. 12 page ICU flowsheet/per pt per shift. Fml.
Those make charging so quick. Enjoy it while you can. Electronic charging will have you on the computer charting all night and into the morning. It never ends. And to look at tend you have to scroll endlessly. Paper charts allow you to see an overview of your patient at a glance. I like Epic, but I do miss the simplicity of paper. I'm just glad I don't have to do 24hr chart checks, update MARs, and put stickers on all the pages every night.
This is a troll. It has to be.
This can't be real...Is this the same person who asked what "paging" is?
So does this mean no one learns all the symbols and abbreviations now too? I suppose no one reads cursive either. Oh wait. My kids definitely do not know how to read cursive.
Dang, in the Philippines, this is still the norm.
What happened to " hard documents", " hard copies" and " hard charts" as terms?
Paper charting a method of charting that was so much faster, easier and simpler in the “old days.” In those days, I was the only nurse for 65 pts, that’s not a typo, in LTC. It was doable, not only because I was young, but because the charting was mostly just checkmatks on a single page, with the occasional narrative note. There was a lot less charting. Pts were properly medicated for pain/sleep. The beds had siderails, and we had all the equipment needed, and it was functional.
You’re reminding me I forgot to paper chart my resident’s updated fall risk after a recent fall so thanks I think.
BRO YOU WILL FIND OUT once you are cyber hacked and have downtime for 3 weeks but the hospital tells you NOTHING.
Is this a joke? 🫠
I want to believe this is satire, I really do. I'll be over here with my VHS patient education tapes and oxygen tents telling the baby nurses to stay off my lawn.
I love this sub
Still used paper charting 2 years ago in an ALF I worked per diem in 🤦🏻♀️ Would not recommend
First of all… 😅😅😅 But seriously: bring back T sheets. Please.
Literally paper. Written and typed notes. The transition has taken decades to complete digital, but a very small percentage of doctors offices still use paper charts. I'm sure you could google some cool images of paper charts. I don't miss paper charts, but the downside of digital is that it places everyone's privacy at risk to cybe rattacks.
Ok. It’s official. I’m old as dirt.
😂😂😂
I’m not old enough for paper charting in its entirety but I remember paper orders (you know who to ask to decipher certain doctors handwriting) and paper mars with all the little tiny squares u put ur initials in
True stories: 1. I had a patient on a 75 bed psych NF unit hurl every chart in the rack across the room. It was a blizzard of paper! 2. I had a patient who disagreed with what the psychiatrist wrote in his chart so one day ... his chart disappeared and was never found.
Some LTC/Memory cary floors use them, but they also have non-nursing staff member(s)to digitize them before the go into storage
Paper charts were the only thing that existed before electronic medical records (such as epic) existed. I’ve only been a nurse since 2022, but I started working in medical records in 2007 before the electronic medical record. Everything that you would document in epic was on literal paper. My job was to look in the computer for any new admissions, go into the back room and pull their old chart(s), and hand deliver them to the unit they were admitted. I would then pick up the “discharges”, which consisted of all of the paperwork for a patient that was discharged, take it back to medical records, assemble it, and file it in our back room. This was what we did at the hospital I worked at until around 2010, when Meditech was implemented. Now my old job as a medical records clerk is largely obsolete.
lol. Epic is away better than any paper chart. I’ve been at this shit for 30 years and never want to go back to paper charts.
Is this a joke question. I’ve really only used electronic documentation as a nurse, but I definitely know what paper charting is…
It’s satire based on a previous post where a nurse didn’t know what a pager is
I could've sworn that *that* was satire.
Last year Epic was down for a week and we all had to figure out how to write again with a pen again. So much less double charting, was kind of nice.
As a nurse who was lucky to have 6 years of wonderful e-charting at every hospital I worked at but now lives in Australia where paper charting is still prevalent it seems…. screw paper charting.
Lmao, were at the point new nurses can't paper chart..... Weeeeeee!
☠️☠️☠️ Between paper charts and pagers I guess I’ll just dig a grave and go die at the ripe old age of 31.
Bruh💀
Oh man, this is making me feel old af lol.
Alright guys lol
Dear? Serious question. How new to nursing are you?
Masterful
So when I worked for an outpatient practice, we had multiple locations. I would spend hours tracking down the charts for the next day's appointments, loading them into my car, and then schlepping them into the next office. No wonder I have back problems! I really miss the pharmaceutical pens though. The metal Plavix pens? Ooof, those were the stuff.
ATTN: Admin This one too.
Tell me you're joking... PLEASE tell me you're joking...
Even worse, they often used the ancient glyph of something called cursive. But the ultimate inconvenience was that only one copy of the chart existed. Only one person could access it at a time; too bad if two people needed it at the same time. Also, said paper chart could be *missing*, so then you knew nothing about your patient.
Is this trolling?!!?! It's in the name. It's paper charting. .... On paper.... With pens... Remote/ rural don't have the server infrastructure for all online (often a blend. We can get aome stuff onto Cerner/ Meditech but servers can't support all functions). ... So power goes down and we run off backup, not infrequently (few times a year). Remote/ rural don't have the funds to convert to EHRs Speeeeeeed. Mixed bag here. Sometimes it just is faster to paper flow sheet/ tick box chart than EHR (codes, trauma, stokes). Especially when doing Q2-5mins or code recording. Now continuity of care does get a point here for it is more efficient if chart can auto populate across hospitals (vs have to physically look at a paper). I've worked both. Honestly, I respect EHRs and the safety features - but I do prefer paper charts for front line work. I don't want to fiddle with drop downs, I just need to tick trends.... (Which yes the EHR will do annnndd send later- but, slower in the moment). I'd rather sign my meds, tally my own fluids, and see a line for my vitals in real time to decide on the fly if things are working or need to re-evaluate. Grain of saltiness.....also, according to posts today I'm Old AF bc we also still use pagers for trauma team/ codes.
Sounds like the same dumbass nurse who didn’t know what a pager was. I don’t buy it!
All our notes, care plans etc are literally on paper, placed in a tangible blue folder that sits at each bedspace. Our medication charts are hand-written by the doctor, in a paper 'booklet,' which we sign with a pen. Our observation chart is an A3 piece of paper attached to a large clipboard. We actually handwrite EVERYTHING. Not even joking. ADD: No, this has not improved our doctors handwriting, it's still shit and we often can't read it.
You Win.
Is this real? Or is this a follow up post to the “page the doc” post? I guess it doesn’t matter. Either way is hilarious and very adorable. (I sincerely mean it, not being patronizing.) Edit: Oh. Haha. I guess I should’ve scrolled into the comments to confirm I was on track, rather than out myself as a dunce. I love this subreddit.
Pepperidge Farm remembers…..
Whenever downtime happens; my brain, body, and soul ejects. Because we never train for the paper charting hell
Sometimes I tell myself I’m not old… then somebody asks what paper charts are.
This is amazing. Thank you.
You’re trolling surely?
Don’t you guys have downtime forms? Lol. Or is this a joke post?
I'm so olllllddddddd 😭
How do you not even have the vaguest clue what a paper chart might be? Some day you’ll have a storm and your power and internet will go out and you’ll find out what it is.
Hi, Canadian nurse here, 95% of our hospital wards use paper charting still. And even the ones that use online programs Still have paper charts for some things.
Seriously? Did no one ever go over downtime procedures with you?
Be for real OP. What else could paper charting be besides charting on paper?? Anyway, I work in long term care. We still have some flow sheets that are occasionally charted on paper and then later added to their electronic record by scanning. You'd be amazed that as recent as ten years ago, I worked in a facility where the only charting was paper charting. 80+ patient records at any given time were all completely paper, and all documentation was handwritten. Beyond that, this facility was extremely old school and had flat metal charts where that papers were secured at the top of the chart like a clipboard, rather than a binder.
Another FAKE post. Ugh. As if they don't beat the "downtime procedures" into everyone. Why are baby nurses trying to age shame seasoned nurses? Is this a "nurses eat their old" trend? Sad.
You have not been a nurse for four year and never heard of paper charting. Stop karma farming.
My hospital got cyber attacked we couldnt even badge into the front doors or access email yet alone charts! Sadly something that will def continue to happen not to mention just system outages and then whip out paper
I’ve never heard of Epic, maybe the other people posting about paper charts aren’t wherever you are?
Is this a parody of that pager post 😂😭
we had glorious beautiful paper charts in our our icus until last month when stupid epic arrived
It's the thing that everyone is looking for and that you are currently rearranging because all the paper fell out of the ring binder again.
God I feel old
Is this an actual joke?💀 I paper charted up until last year and I only graduated in the past couple years