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So Much More Than Charting

Cox, Joy

Journal of Christian Nursing: April/June 2019 - Volume 36 - Issue 2 - p 127
doi: 10.1097/CNJ.0000000000000583
Department: Practicing

Joy Cox, BBA, BSN, RN, is a second-career nurse who worked in the neurosurgical ICU at UT Southwestern in Dallas, Texas. She currently works in a postanesthesia care unit (PACU) and seeks ways to support her fellow nurses.

The author declares no conflict of interest.



It was the worst CT scan I had ever seen. Although I had not been trained to read scans and had been a nurse for only 18 months, I had seen enough CT scans to know that this one would not lead to a happy ending.

The patient to whom that scan belonged lay in his hospital bed, resting. By his side was his bride of nearly 60 years. During my last neuro exam, I asked who she was. “High school,” he mumbled. His high-school sweetheart. That's how he had answered a few hours ago, when he could speak understandable answers. I didn't know, but feared, that this would be the last thing I would hear him say.

I tried to gently encourage his family to have their last talk with their husband/dad/papa. These brief interactions happened between my explaining monitor numbers and the surgeon's terms that tried to gently, yet clearly, explain why surgery was medically futile. These end-of-life, never-to-be-the-same-again conversations occurred amid administering medications, suctioning, and rounding with physicians to ensure we were all on the same page. Until that day, I had rarely understood the phrase, walking through the valley of the shadow of death, from Psalm 23. It wasn't my valley, and it wasn't my death that was overshadowing me, but there I was. I continued to draw labs and suction and turn and chart in the darkness of the shadow.

I wasn't present with this patient when he passed away. I walked in the next day, saw the empty room, and couldn't believe I had missed his passing. Yet, I was relieved it was over. I got two new patients and went on with the shift. I couldn't have guessed what would push me over the edge later that day.

The catalyst was an email. To be more specific, it was a kind, encouraging email that my manager found time to send. It read in part, “Thank you so much for all your hard work.” I should have been grateful to receive this note of appreciation. However, I became angry; I had been thanked specifically for the “excellent charting” I did on this patient after he received clot-busting tPA (tissue plasminogen activator) for his stroke. I felt incredulous. I was being thanked for appropriately charting blood pressure readings at the right times, charting medication administration, and charting physicians' orders. The email went on to mention details of charting, whether or not the patient could answer my questions, and for charting that the physician had been informed that the patient couldn't answer those questions. The message received was “Your charting is amazing; thank you for charting.”

I felt punched in the gut. You want to thank me for my charting? While I appreciated positive feedback, I had poured my heart and soul into that patient and his heartbroken family, and someone is commending my charting?

I asked that question internally, only to myself and not expecting an answer, but the Holy Spirit responded. It seemed he nudged my thoughts, ever so gently, You can't be mad at her for this. She hired you to chart. She hired you to give meds, then chart that you gave them. She hired you to assess, then chart. She hired you to talk to physicians, then chart about that. Check your job description–it's listed right there. Assess, administer, document. She hired you to do it, and now she's thanking you for doing so. All the rest–the crying with patients, the praying for them, the patience to explain over and over, the pouring out of your soul–I called you to do that. Let me worry about that part. Stop confusing what you were hired to do with what you are called to do.

That stopped me in my tracks. In the early days of my nursing career, I had been so quick to remember my calling and where it came from: “Only let each person lead the life that the Lord has assigned to him, and to which God has called him” (1 Corinthians 7:17, ESV). Now, I obviously needed a refresher. And I still do.

© 2019 by InterVarsity Christian Fellowship