The “perfect” chart note: 5 steps for overcoming

Nurse practitioners are known for going above and beyond for patients, providing compassionate and individualized care. Nursing practitioners excel at paying attention to details and advocating for the patient. Nurse practitioners strive at seeing the patient as a whole and addressing every need. 

With all of these positive attributes also comes flaws of nurse practitioners. Because of APRNs attention to detail and striving to do an exceptional job, many nurse practitioners struggle with creating a “perfect chart note.” This type of perfectionism can create additional stress and challenges for nurse practitioners. 

Negative impact of the perfect chart note

There are several negative impacts of perfectionism and the effect on charting. Being aware of these results can help nurse practitioners better understand their own challenges of perfectionism. 

Note bloat

Many nurse practitioners fear legal implications such as a medical malpractice suit filed against them. Because of this fear, many nurse practitioners tend to overchart to “cover their butt.” This results in excessive charting, also known as “note bloat.” Nurse practitioners need to realize that creating long and detailed chart notes takes more time and energy. Not to mention, adding more information may actually hurt ourselves more than we realize. More on that within the Legal Issues with Charting Course. 

Write and rewrite notes

Nurse practitioners who struggle to create the perfect chart note spend too much time and energy completing chart notes. A lot of times nurse practitioners will write and rewrite the notes until it is perfect. While I do recommend nurse practitioners do a quick overview to ensure basic spelling and grammar is correct, completing rewriting documentation is a waste of time. 

Procrastinate the task

Creating the perfect chart note often results in procrastination. Nurse practitioners who struggle with perfectionism think it is impossible to write a perfect chart note. There is so much negative emotions and overwhelm associated with charting that oftentimes nurse practitioners try their best to avoid it altogether. This can cause procrastination, a backlog of open charts, and ultimately nurse practitioner burnout. 

Added overwhelm and stress

Creating a perfect chart note places so much unnecessary overwhelm and stress on nurse practitioners. These excessively high standards make it impossible to ever be content. Nurse practitioners may feel like they will never be good enough. They place so much pressure on themselves and get frustrated when things are not perfect. These unrealistic expectations can cause a lot of added overwhelm and stress. 

Feelings of failure

Nurse practitioners who struggle with perfectionism are often faced with feelings of failure. No matter how well they did caring for patients or documenting, it will never be good enough. Because of this, nurse practitioners can feel like a failure. This is where perfectionism can cause such a negative impact on nurse practitioners. 

A charting backlog

Nurse practitioners who have a large amount of open charts often struggle with perfectionism. They feel overwhelmed with the work that needs to be done and fear they cannot create a perfect chart note. Because of this, many nurse practitioners tend to procrastinate. As a result, the open chart notes pile up, creating a charting backlog. 

The more open charts there are, the more frustration there is. A charting backlog can create feelings of self-disgust, failure, fear, and unworthiness.  

***Be sure to check out these other articles for more information: The burden of charting backlogs and The charting backlog: 6 tips to tackle. 

Lack of work-life balance

Creating a perfect chart note takes more time and energy. Therefore, nurse practitioners end up staying late at the office or bring charts home, just trying to catch up. This can create a lack of work-life balance. Nurse practitioners spend more time working and less time for themselves, their friends, and their families. 

Nurse practitioner burnout

The negative effects listed above can compile and ultimately cause nurse practitioner burnout. A lot of nurse practitioners who strive to create the perfect chart note can be faced with unnecessary stress and overwhelm. The increase of time is a significant factor as well. Many nurse practitioners end up resenting their work and are often faced with nurse practitioner burnout. 

5 steps for overcoming perfectionism

Now that we have looked at the negative effects of perfectionism as a nurse practitioner, we will look at five steps to overcome perfectionism. 

• Define the perfectionist thought
• Identify the root cause
• Identify how negative thoughts impact you
• Replace negative thoughts with positive
• Keep working at perfectionism

Step 1: Define the perfectionist thought

Nurse practitioners working to address the “perfect” chart note first have to become aware of their negative thoughts. Take some time to reflect on any negative thoughts in your mind. Be cognizant of what words are coming out of your mouth. Becoming aware is the first step to improving the negative thoughts of creating a perfect chart note. 

Step 2: Identify root cause

The next step is to identify the root cause of perfectionism as a nurse practitioner. Where are these thoughts coming from? Are there experiences in your childhood or past nursing career that formed you into a perfectionist? Have there been disrespectful comments from other providers or coworkers? Have you been involved with a malpractice case or situation that created excessive fear in your practice?

Step 3: Identify how negative thoughts impact you

Take some time and reflect on how the thoughts of creating a perfect chart note are impacting your life. Think about how the negative thoughts make you feel. Think about the extra time you spend charting and redoing your work to complete a perfect chart note. Think about the added stress perfectionism can cause. Think about the decrease in time to actually do the self-care you know you need. Think about the energy perfectionism takes away from your family and loved ones. By identifying how a perfect chart note might affect you, the process can help bring motivation and fuel for overcoming perfectionism. 

Step 4: Replace negative thoughts with positive

When working to overcome perfectionism as a nurse practitioner, the most difficult step is to replace your negative thoughts with positive ones. This process will take time and energy to complete. It is our human nature to have these negative thoughts and it takes a while to retrain your brain to have more positive thoughts. 

What is most important is consistency. There will be times when you are tired and the perfectionist thoughts take over in your mind. It will be challenging to stop the negative thoughts and replace them with positive ones, but it is important to keep trying! Set out reminders such as motivational or positive quotes where you can see them daily!

Step 5: Keep working on perfectionism 

Overcoming perfectionism is an ongoing process. When nurse practitioners go to write a chart note, keep these steps in mind. Work on avoiding negative thoughts or actions. Try not to give in to the thoughts of creating a perfect chart note. Avoid the note bloat. Avoid the writing and rewriting chart notes. Avoid the negative self-talk. And ultimately keep working on the perfectionism. 

Remember that “Done is better than perfect.” As a nurse practitioner, you will end up writing thousands of chart notes. And not one of them will be perfect. 

If you are ever involved in a medical malpractice case, a malpractice lawyer is trained to pick apart any chart note. They will nitpick every detail to protect their own client. Even the best providers can have a malpractice case filed against them and will not have a perfect chart note. 

I encourage nurse practitioners to adopt a mindset where you are focused on ongoing growth instead of needing to be perfect. There is no sense in increasing the stress and overwhelm by striving to create a “perfect chart note.” Know that you are a human and will never be perfect! And that is just fine!

***To read more about the struggles of perfectionism as a nurse practitioner, read this article.