Transcript of RNchat for December 29, 2009. RNchat is a Twitter chat for registered nurses who discuss a wide range of topics related to the nursing profession and health care and technology. Topics include: T1 - Robo-nurses T2 - Using software to deliver care using algorithms & decision-trees. T3 - Malpractice Litigation You can follow RNchat on Twitter: http://Twitter.com/RNchat Blog: http://Rnchat,org

1. philbaumann: Our good friend @EllenRichter will moderate tonight's #RNchat - 9p EST. She'll show ya
how to have fun with these chats.
12/29/2009 06:44
rnchat: Hello & welcome to the holiday edition of #RNchat, with me (@EllenRichter) barely filling
the shoes of our star moderator @philbaumann :)
12/29/2009 20:59
rnchat: #RNchat is a way for nurses (& all others in health care!) to meet, tweet & share feelings,
thoughts, ideas~ We welcome silent lurkers!
12/29/2009 21:01
rnchat: Lets begin the hour by seeing who is joining in. Introduce yourselves & tell us in 140 or
less what brings you to #RNchat tonight!
12/29/2009 21:02
rnchat: Dont forget to include the #RNchat hashtag with your tweets!
12/29/2009 21:02
marcobucci: Hello everyone. Hope you all had a great holiday #rnchat
12/29/2009 21:03
ocdgirl2000: #rnchat how are all of you this evening?
12/29/2009 21:03
TeriRN: I'm Teri, a hospice travel nurse. I'm here to have fun talking w/fellow nurses & glean from
their knowledge. =) #RNChat
12/29/2009 21:04
rnchat: Welcome all (and all lurkers) :) #RNchat
12/29/2009 21:05
tstitt: <--Tom Stitt, principal @aperial, open source web svcs for healthcare, sometimes
moderator of #hcmktg, silent listener tonight #rnchat
12/29/2009 21:05
eggy1024: hello, hello from cold, snowy madison, wisconsin! hospice nurse now, ER nurse in past.
looking forward to the chat. #RNchat
12/29/2009 21:05
rnchat: The topics will be labeled T1, T2, etc. Please remember to add topic label & hashtag
#RNchat to ea tweet so we can track your responses!
12/29/2009 21:06
nursingpins: Hi all - good to see ya- critical care New Orleans #rnchat
12/29/2009 21:06
marcobucci: I'm recently new to the profession and am currently working in the ER #rnchat
12/29/2009 21:06
rnchat: Some new faces....welcome!! #RNchat
12/29/2009 21:06
TeriRN: @eggy1024 Wow what a change from ER to Hospice. #RNChat
12/29/2009 21:07
ocdgirl2000: #rnchat let me know when the topics change from T1 to T2, I tend to be ADHD or

2. ocd..LMAO!!
12/29/2009 21:07
lorryschoenly: #RNChat Hi, Ellen, mostly lurking fron my cell tonight
12/29/2009 21:08
ePatientDave: Department of Redundancy department: RT @MeredithGould: Silently lurking! #RNchat
12/29/2009 21:08
TeriRN: @ocdgirl2000 Don't worry you'll know when it changes. #RNChat
12/29/2009 21:08
rnchat: T1 Bedside nursing shortages have led to development of Robo-nurses. What types of
nursing tasks can we SAFELY give up to a robot? #RNchat
12/29/2009 21:09
ocdgirl2000: @rnchat #rnchat or womanpower!!
12/29/2009 21:09
tstitt: T1-Example of nursing robot - like this? http://news.cnet.com/8301-17938_105-10320851-
1.html #rnchat
12/29/2009 21:11
TeriRN: T1 NONE! It bothers me 2C stats of bedside nurse shortage when I try 2get assignments
in hospital & can't d/t out of hosp 4 6yrs #RNChat
12/29/2009 21:11
rnchat: Think we could have a robot do turns every 2 hours with a staff member in a hospital?
#RNchat
12/29/2009 21:11
nursingpins: T1 Riobo-nurses would be another that we would be responsible for - will be another gen
or 2 before they will be any help. #rnchat
12/29/2009 21:12
rnchat: @tstitt Exactly....like that! http://news.cnet.com/8301-17938_105-10320851-1.html #rnchat
12/29/2009 21:12
TeriRN: @marcobucci T1 but even then if the pt has A-fib the electronic BP can be inaccurate.
#RNChat
12/29/2009 21:13
ocdgirl2000: #rnchat T1 um no..Robo nurses can't get in the face of an IV drug user & tell them they
can't get dosed until they get in the bathroom & pee
12/29/2009 21:13
rnchat: What if the doctor ordered medication, pharmacy filled robot & robot scanned &
dispensed to long-term pts? #RNchat
12/29/2009 21:14
ocdgirl2000: #rnchat T1 at least when it comes to dosing methadone..I don't think a robo nurse would
be as effective
12/29/2009 21:14
eggy1024: T1 #RNchat BP checks would be great, but we still are responsible for checking to see if
WNL, so wouldnt it just be easier to do ourselves?
12/29/2009 21:14

3. rnchat: Just thinking out of the box...we may not have the luxury of doing everything ourselves
with shortages! #RNchat
12/29/2009 21:15
nursingpins: T1 -ANY help we got would be appreciated - even a Robo-nurse. - would be as good as
some we have today - #rnchat
12/29/2009 21:16
TeriRN: @eggy1024 I agree. I've used electronic BP cuffs & manual on pts getting a wide diff.
major when pt is on bp meds & adjusting d/t BP #RNChat
12/29/2009 21:17
eggy1024: #RNchat T1 what about things like emptying foley catheters, making beds, or stocking
supplies?
12/29/2009 21:17
rnchat: I think we all know...its a given...that a robot could not replace a thinking human, but
there are possibilities! #RNchat
12/29/2009 21:17
eggy1024: T1 I would LOVE a robo nurse to clean poop/puke up! #RNchat
12/29/2009 21:18
rnchat: @eggy1024 T1 good tasks to delegate to a robot #RNchat
12/29/2009 21:19
marcobucci: Ultimately, pt. care is neglected. We are stuck workingn in inadequate environments
giving sub par care. #rnchat
12/29/2009 21:19
rnchat: @tstitt Thanks for that great link! Stroke/neuro robot-http://bit.ly/8QvZSr #RNchat
12/29/2009 21:21
rnchat: Almost time to move on to T2 #RNchat
12/29/2009 21:21
TeriRN: RT @eggy1024: T1 I would LOVE a robo nurse to clean poop/puke up!// that I'll let them
do gladly. #RNChat
12/29/2009 21:21
ocdgirl2000: #rnchat T1 the stuff they like to nag us for attention!
12/29/2009 21:23
rnchat: OK, along the same lines of thinking...T2 addresses dealing with patient care despite man
(and woman) power shortages #RNchat
12/29/2009 21:23
nursingpins: T1 -robo-nurses could never replace the human touch - one of the most important things
in nursing #rnchat
12/29/2009 21:24
rnchat: T2 Should we rely on apps/programs to prompt health care personnel to deliver care
using standardized algorithms & decision trees? #RNchat
12/29/2009 21:24
ocdgirl2000: #rnchat T2 that's a question for management!LOL!
12/29/2009 21:26

4. TeriRN: T2: I think nursing has been doing that for a while with clinical pathways. #RNChat
12/29/2009 21:26
rnchat: @ocdgirl2000 LOL T2 OK this is management asking!! ;) #RNchat
12/29/2009 21:28
ocdgirl2000: #rnchat T2 risk involved that more mistakes are made, who takes responsibilty?
12/29/2009 21:28
eggy1024: #RNchat T2 clinical pathways r everywhere, 4everything, but so often things arent 100%
black and white; can b hard 2just go down an algrthm.
12/29/2009 21:29
rnchat: T2 @ocdgirl2000 same responsibility as always, just following a standardized recipe
#RNchat
12/29/2009 21:29
nursingpins: T2 algorithams & ACLS has been the biggest infl in saving lives I've seen in 35y of
nursing - codes were a comp pandemonium pre #rnchat
12/29/2009 21:30
ocdgirl2000: #rnchat T2 unskilled personnel are now performing skilled tasks that they may not be
qualified to perform adequately,
12/29/2009 21:30
marcobucci: Algorithms are an excellent tool to help point in the rght direction. But they can only be
effective when used by the right person. #rnchat
12/29/2009 21:30
rnchat: T2 So if we are terribly short-staffed, can we give a less experienced RN an iPhone
w/app for postop chole pt care? #RNchat
12/29/2009 21:30
rnchat: T1 & T2 So robots & algorithms are only as good as the people using them #RNchat
12/29/2009 21:33
ocdgirl2000: @rnchat #rnchat T2"less experienced" or "no experienced?" out of school vs someone
who is agency..an unknown..
12/29/2009 21:33
LoryRN: @RNchat so then what is nursing the person or the app-no thanks i want a person who
can see outside the box #RNchat
12/29/2009 21:33
eggy1024: #RNchat T2 where do we draw the line? give a GN a fresh post-op CABG pt with an
algorithm to follow?
12/29/2009 21:34
TeriRN: RT @rnchat: T1 & T2 So robots & algorithms are only as good as the people using them
#RNChat
12/29/2009 21:34
marcobucci: Less xperienced RN should stay true to their knowledge base. Stepping beyond your
scope only puts people at risk. App or not. #rnchat
12/29/2009 21:34
rnchat: T2 Great points. We still have much to do if we are going to combat the nursing

5. shortages soon! #RNchat
12/29/2009 21:36
eggy1024: RT @terirn: RT @rnchat: T1 & T2 So robots & algorithms are only as good as the people
using them #RNChat
12/29/2009 21:36
rnchat: On to topic T3 folks :) And thanks for your patience with me! LOL~ #RNchat
12/29/2009 21:36
rnchat: T3 What are your fears as a health care professional regarding malpractice litigation?
How do U protect yourself against a lawsuit? #RNchat
12/29/2009 21:37
eggy1024: @rnchat #RNchat where are the nsg shortages? nsg jobs are next to impossible to find
around here and other parts of our state.
12/29/2009 21:37
TeriRN: T2 As a travel nurse, I think managers should look at years in nursing as well as
experience. I would love 2 go 2 a med/surg floor. #RNChat
12/29/2009 21:38
rnchat: So true! RT @ocdgirl2000 #rnchat T2 there will be times when all you have on your staff
will be new nurses and agency nurses!
12/29/2009 21:38
TeriRN: T2:managers won't look @ my profile d/t being in hospice for 6yrs. Still critical think & do
all the RN task just in homes not hosp. #RNChat
12/29/2009 21:39
rnchat: @eggy1024 When the baby boomer RNs retire, there wont be many left at the bedside!
#RNchat
12/29/2009 21:39
marcobucci: Nursing lawsuits are fairly uncommon in Canada. We do have union protection and
lawyers regarding that. #rnchat
12/29/2009 21:40
rnchat: Do those of you who use computerized charting feel that it protects your documentation
better from legal standpoint? #RNchat
12/29/2009 21:41
TeriRN: T3: I have my own coverage 4 malpractice I make sure I document everything I do Not
documented not done my nsg instructor taught me #RNChat
12/29/2009 21:42
rnchat: T3 I find it amazing how health care lawsuits are not prevalent in other countries like in
the USA #RNchat
12/29/2009 21:42
ShimCode: @tstitt User stories, checklists & algorithms – evolved by challenge, experience &
anecdote! Meaningful Use...I say! Oh My! #rnchat
12/29/2009 21:42
TeriRN: T3:Computerized documentation helps in that there is no error in not being able to read
the handwriting. #RNChat
12/29/2009 21:43

6. rnchat: @TeriRN T3 your instructor was correct...not documented = not done #RNchat
12/29/2009 21:44
MeredithGould: RT @LoryRN: @RNchat T3 Chart everything, get families permission in writing when
needed, and pray a lot #RNchat
12/29/2009 21:44
TeriRN: T3:If nurse is lousy documentor by hand they tend to be lousy documentors on comp.
Although comp helps with some assessment docum. #RNChat
12/29/2009 21:45
lrm4z: #RNchat Logan here sorry a bit late. T3 first few months on my own I was constantly
concerned that something i did would get me sued...
12/29/2009 21:45
rnchat: T3 Many EMR programs prompt you to document things you would normally never hand-
write ritually #RNchat
12/29/2009 21:46
ocdgirl2000: #rnchat I stay late, work off the clock, do documentation for others as well..which I should
NOT do..
12/29/2009 21:46
rnchat: Welcome @Irm4z T3 Yes, most of us fear getting sued all the time! Even when we do
things correctly~ #RNchat
12/29/2009 21:47
rnchat: @ocdgirl2000 T3 pssst....never document for others! :( #RNchat
12/29/2009 21:47
TeriRN: "cont. to rest quietly" one of my pet peeves. too ambiguous & can be interpreted in any
way by a lawyer. #RNChat
12/29/2009 21:47
lrm4z: #RNchat T3 only thing I've learned to do is be as diligent as poss and keep a positive
attitude, as well as work off the clock :(
12/29/2009 21:48
ocdgirl2000: #rnchat T3 we have # of clients assigned, each- it's only a few hrs to do it, for heavens
sakes! once a month you update their notes, and +
12/29/2009 21:48
TeriRN: RT @rnchat: @ocdgirl2000 T3 pssst....never document for others! :( // definitely a no no
protect your license. U worked 2 hard 4 it #RNChat
12/29/2009 21:49
lrm4z: #rnchat RE: documentation, no I don't feel protected, it's so easy to point and click and
not "really document"
12/29/2009 21:49
rnchat: T3 Litigation is real & can be frightening for a health care worker. We must always be
diligent when charting to cover ourselves #RNchat
12/29/2009 21:49
eggy1024: @TeriRN #RNchat i hate "will continue to monitor" and then never see charting reflecting
f/u.
12/29/2009 21:49

7. nursingpins: T3 the lit is full of evid. that many lawsuits could be avoided by est. relationships and
honesty etc before an event - have seen it #rnchat
12/29/2009 21:50
TeriRN: @eggy1024 I agree. monitor what? esp as final not of shift. You left so who monitored.
another pet peeve too. #RNChat
12/29/2009 21:51
rnchat: @TeriRN T3 Yes, I really hate redundant, empty charting statements like the one u
mentioned #RNchat
12/29/2009 21:51
rnchat: @nursingpins T3 Yes, big move toward openness & honesty with the pt from the get-go
can reduce frequency of litigation episodes #RNchat
12/29/2009 21:52
ocdgirl2000: @RNchat #rnchat T3 not FOR her, just do her patient's notes when she's not up to date
for the month! it has to get done! or, dr needs it
12/29/2009 21:52
lrm4z: T3 #RNchat someone explain the repercussions of documenting for others pls... I do it
too, and have even been asked to do so by others
12/29/2009 21:53
eggy1024: @ocdgirl2000 #RNchat r u documenting stuff you saw/did? how do you know what to
chart/can you trust the other nurse actually did it? risky!
12/29/2009 21:54
TeriRN: If U didn't do the assessment of the pt & document the assessment based on what UR
told UR name is on bottom line. #RNChat
12/29/2009 21:54
rnchat: T3 @Irm4z If you document for others, are you stating THEIR findings? If so, THEY
should be charting them, not you #RNchat
12/29/2009 21:55
TeriRN: If something goes wrong U R the one called in to court not the nurse who actually did
assessment. #RNChat
12/29/2009 21:55
ocdgirl2000: #rnchat T3 things have 2 get done, I do them.notes charting,pt's stating things,urinalysis
results,breathalizer results,Takehome schedules
12/29/2009 21:55
lrm4z: @rnchat no no, do the assessment myself, and chart for them, even if they did an
assessment too. #rnchat
12/29/2009 21:56
rnchat: T3 When reading medical records, its assumed that the writer is writing about THEIR
findings #RNchat
12/29/2009 21:56
rnchat: Well, sitting in the moderator seat, this hour flew like it was 15 minutes!! I enjoyed being
on the other end of the questions! :) #RNchat
12/29/2009 21:57
TeriRN: @ocdgirl2000 If U heard the pt say it saw the lab & test results then U can doc that but if

8. nurse told U it's UR word against theirs #RNChat
12/29/2009 21:58
nursingpins: T3 charting should be eth objective or subjective and listed as so - too many opinions get
charted as fact #rnchat
12/29/2009 21:58
marcobucci: U could be documenting things that were never done & be held liable for them. also
breaches privacy of pt. If you're not primary RN. #rnchat
12/29/2009 21:58
lrm4z: @rnchat Thanks sorry I was late :) I'll be more on time next time, scouts honor! #rnchat
12/29/2009 21:58
ocdgirl2000: @lrm4z #rnchat T3 they probably didn't even do that...LOL! I do what probably never got
done..if you know what I mean..
12/29/2009 21:58
eggy1024: @rnchat yes, what a great time! this was my first #RNchat. quite enjoyable. thanks to you
and others who were here too!
12/29/2009 21:58
rnchat: Thanks to everyone for participating so actively tonight! It was fun! Great responses to all
the topics! THANKS! :) #RNchat
12/29/2009 21:59
TeriRN: @rnchat I think U did great Ellen. Missed Phil but glad U could step in and help. Thanks.
Glad I was finally able to join in again. #RNChat
12/29/2009 21:59
TeriRN: @lrm4z Glad you were able to join in when you could. #RNChat
12/29/2009 21:59
rnchat: @philbaumann will decide the next chat so be on the lookout for further tweets! :)
#RNchat
12/29/2009 22:00
ocdgirl2000: #rnchat T3 we have computerized notes, schedules and dosing. 3/4 or more of the notes
are written by me. That's a fact. I only work 20 hrs.
12/29/2009 22:00
nursingpins: Thanks Ellen for taking over tonight - great job #rnchat
12/29/2009 22:00
rnchat: Transcripts of the chat will be provided by @philbaumann later on or tomorrow...hes great
about that! :) #RNchat
12/29/2009 22:01
lrm4z: @TeriRN thanks for the warm welcome! #rnchat
12/29/2009 22:01
rnchat: LOL guys....thanks for the cheers!! @tstitt @nursingpins @TeriRN @ocdgirl2000 #RNchat
12/29/2009 22:02
TeriRN: @JimRN You missed a great chat. =( Look for the transcript. We missed you. #RNChat
12/29/2009 22:02

9. marcobucci: Good stuff tonight. Take care all! #rnchat
12/29/2009 22:02
ocdgirl2000: #rnchat Thank you Ellen! it was fun and great to be back at Nurse chat! stim as usual!
clap clap clap!!
12/29/2009 22:02
eggy1024: @RNchat how often do you guys get together for this? #RNchat
12/29/2009 22:02
rnchat: You all are welcome to continue. I'm slipping back into my own Twitter account now!
Enjoy your nite & Happy New Year!! #RNchat
12/29/2009 22:03
rnchat: @Eggy1024 we do it weekly, trying to alternate hours & days Glad you came! :) #RNchat
12/29/2009 22:04
ocdgirl2000: @eggy1024 #rnchat whenever I get enough reminders!LOL! also I have to not be working
depends on hours they decide to have it~~
12/29/2009 22:04
TeriRN: @eggy1024 Usually once a week around this time and this day. @philbaumann post time
and day. Pls come back and join in #RNChat
12/29/2009 22:04
EllenRichter: THANKS for your help everyone!! I know I messed up a lot...forgot to type T2, T1, LOL~~
#RNchat
12/29/2009 22:06
TeriRN: @EllenRichter I think you did great. Hard to remember all of that. #RNChat
12/29/2009 22:06
EllenRichter: Boy, you guys that chart for others...thats wavy seas!! I wouldnt suggest doing that very
much! Even if its to save time! #RNchat
12/29/2009 22:07
MeredithGould: @EllenRichter No mess ups apparent! Totally great job. #RNchat
12/29/2009 22:07
EllenRichter: @TeriRN thanks :) Glad u made it home early! #RNchat
12/29/2009 22:08
eggy1024: no, it was fun! you did great. thanks! @EllenRichter #RNchat
12/29/2009 22:08
EllenRichter: @MeredithGould Yes...I got your DM but was afraid to respond on my account while
signed into @RNchat LOL ~TY though!! #RNchat
12/29/2009 22:09
TeriRN: @EllenRichter Me too. Left home of 2yrold actively dying. Needed this 2nite. Thanks
#RNChat
12/29/2009 22:09
EllenRichter: @eggy1024 I missed your intro...what type of nurse? #RNchat
12/29/2009 22:09
EllenRichter: @TeriRN I just love hospice nursing more each year. If I didnt love critical care, hospice

10. would be my next choice #RNchat
12/29/2009 22:10
eggy1024: @EllenRichter now hospice, have done mostly ER tho...still kind of miss it! #RNchat
12/29/2009 22:11
eggy1024: @EllenRichter @TeriRN i find there's more charting in hospice nsg than ER nsg. #RNchat
12/29/2009 22:12
EllenRichter: I work in geriatric critical care which means more than half of my pts end up hospice if
they make it...it really helps families #RNchat
12/29/2009 22:12
ocdgirl2000: @eggy1024 #rnchat charting is more for medicare reimbursement?
12/29/2009 22:14
EllenRichter: Well, in 2015, we will be directing our robo-nurses to follow algorithms that we will
electronically chart about from home #RNchat
12/29/2009 22:15
TeriRN: @EllenRichter That's a scary thought. I don't ever want to give up my face to face with
pts. #RNChat
12/29/2009 22:16
EllenRichter: Should be interesting to see how nursing care twists & turns with health care reform cost
cuts #RNchat
12/29/2009 22:16
ocdgirl2000: @EllenRichter #rnchat in 2015 I'm going to be retired!! that's the YEAR! then I can work
agency and get free bennies where I am now!
12/29/2009 22:17
DONNAinOHIO: RT @EllenRichter: Should be interesting to see how nursing care twists & turns with
health care reform cost cuts #RNchat
12/29/2009 22:17
EllenRichter: No, @TeriRN neither do I want to give up face-to-face patient contact! I love being a
bedside hospital nurse #RNchat
12/29/2009 22:19
EllenRichter: LOL @ocdgirl2000 I wish I could retire in 2015! Geez thats right around the corner! Lucky
YOU! #RNchat
12/29/2009 22:20
EllenRichter: Thanks for the RT @DONNAinOHIO :) #RNchat
12/29/2009 22:20
EllenRichter: OK people...my 2 dogs' eyes are yellow from holding it in!! I need to take them out! Have
a great nite~ :) #RNchat
12/29/2009 22:22
ocdgirl2000: #rnchat I like the idea of being "available" 2 some select places that I become "familiar"
with,comfortable with..just 2 help with patients
12/29/2009 22:22
ocdgirl2000: #rnchat I don't want to be a slave to a bullying boss and a scheduled lifetime of people
telling me what I can and cannot do..tired of it..
12/29/2009 22:23

11. JimRN: Don't hospice & critical care have opposite goals? #justaskin #rnchat
12/29/2009 22:33