shift is wild

Any note: how it gets read

Charting a seizure you're not sure is real

Chart the shaking, not your theory about it: what to write when an event looks off, and which words come back to bite you later

8 min read built on 6 full opinions updated 2026-10-03

Written by a med-surg RN, ten years, day shift. Why there is no name on it

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A patient starts shaking or stops responding, and something about it doesn't look like the epileptic seizures you've seen. You might be right. You might not. Either way, deciding what it was is the provider's job, often with EEG. Your job is to write down what happened in enough detail that someone who wasn't in the room can picture it.

The short version

  • Chart what you saw, not what you think it means. Write down each movement, the time, what you said or did and how the patient responded. Leave out pseudoseizure, faking, behavioral and attention-seeking.
  • Use a clock. Note when it started and when it stopped. If you're guessing, say so: approx. 3 min, not timed from onset.
  • Cover all seven fields, every time: onset, movements, duration, responsiveness, eyes, incontinence or tongue injury, recovery. If you didn't see something, write that you didn't see it.
  • Chart stimulus and response together. Write what you did, then what the patient did. Don't make the reader guess.
  • Your clinical question goes to the provider, not into the chart. If the event didn't look typical to you, describe what was atypical and record that you reported it.

What to write instead

How it often gets charted How it reads better
Pt had pseudoseizure.0212 Pt found in bed with bilateral arm and leg shaking, side-to-side head movement. Eyes closed. Event timed 0212–0216 (4 min). SpO2 97% RA during event.
Faking seizure, responds when he wants to.During event, called pt's name x3, no verbal response. Touched shoulder, no response. Shaking stopped at 0216; pt answered questions at 0217, oriented x4.
Behavioral episode, attention-seeking.Shaking began after pt was told discharge is delayed (per pt's mother, at bedside). Movements decreased when staff left room, increased when staff re-entered x2. Provider notified of event and observations at 0225.
No real seizure activity, pt fine after.No incontinence. No tongue or cheek bite seen on inspection. Pt alert and speaking full sentences within 1 min of movements stopping. Pt states he remembers parts of the event.
Classic PNES, eyes squeezed shut.Eyes closed during event. Eyelids remained closed when RN attempted to open them to check pupils; pupils not assessed during event. Post-event pupils PERRL.
Seizure, ativan given.0305 Generalized stiffening then rhythmic jerking all extremities, eyes open, deviated to right. Unresponsive to voice and touch. Lorazepam 2 mg IV per order at 0307. Movements stopped 0308. Snoring respirations, responds to voice only at 0320. Urinary incontinence noted.

The last row is there on purpose. Chart every event the same way, whatever you think it was. Then nobody can say you described a seizure differently because of what you assumed.

Copy this

Nursing note: the event

``` [DATE] [TIME] Event note.

Before: Pt was [ACTIVITY / POSITION] at [TIME]. Pt reported [ANY WARNING SENSATION / NONE REPORTED]. Present in room: [WHO / NO ONE]. Preceding circumstances: [WHAT WAS HAPPENING / NONE IDENTIFIED].

Onset: [WITNESSED BY RN AT TIME / FOUND AT TIME, ONSET NOT WITNESSED]. Started with [FIRST MOVEMENT OR CHANGE SEEN].

Movements: [BODY PARTS INVOLVED]. [RHYTHMIC / IRREGULAR / STIFFENING]. [BOTH SIDES TOGETHER / ALTERNATING / ONE SIDE]. Head: [STILL / SIDE TO SIDE / TURNED TO RIGHT OR LEFT]. Changes during event: [WAXED AND WANED / STEADY / STOPPED AND RESTARTED x NUMBER].

Duration: [START TIME] to [END TIME], [TIMED BY CLOCK / ESTIMATED].

Responsiveness: Called name [x NUMBER], [RESPONSE]. Touched [WHERE], [RESPONSE]. [ANY SPEECH OR SOUNDS].

Eyes: [OPEN / CLOSED] during event. [GAZE DIRECTION IF OPEN]. Pupils [ASSESSED, FINDINGS / NOT ASSESSED DURING EVENT, REASON].

Vitals during/after: HR [ ], BP [ ], RR [ ], SpO2 [ ] on [RA / O2], glucose [ ] at [TIME] (if obtained per protocol).

Incontinence: [URINE / STOOL / NONE]. Mouth: [TONGUE OR CHEEK BITE SEEN / NONE SEEN ON INSPECTION / NOT INSPECTED]. Injury: [FINDINGS / NONE SEEN].

Recovery: At [TIME] pt [LOC, SPEECH, ORIENTATION]. At [TIME] pt [LOC, SPEECH, ORIENTATION]. Pt states [WHAT PT SAYS THEY REMEMBER, IN PT'S WORDS, NO QUOTATION MARKS].

Actions: [SAFETY MEASURES, e.g. side rails padded, positioned on side, O2 applied]. Meds given: [DRUG, DOSE, ROUTE, TIME, PER ORDER / NONE].

Notified: [PROVIDER NAME] at [TIME] via [PHONE / IN PERSON]. Reported [SUMMARY OF FINDINGS]. Orders received: [ORDERS / NONE]. [YOUR NAME, CREDENTIALS] ```

Message to the provider (page or SBAR)

`` [PATIENT NAME / ROOM]. Event at [TIME], [DURATION]. [MOVEMENTS IN ONE LINE]. Eyes [OPEN / CLOSED]. Responsiveness: [STIMULUS -> RESPONSE]. Incontinence [YES / NO]. Back to baseline at [TIME]: [LOC, ORIENTATION]. Vitals [NUMBERS]. Features I want to flag: [e.g. eyes closed throughout, movements stopped and restarted x2, alert within 1 min]. Request: [ASSESSMENT AT BEDSIDE / ORDERS FOR NEXT EVENT / EEG CONSIDERATION]. ``

Follow-up note when the provider has responded

`` [DATE] [TIME] [PROVIDER NAME] at bedside / by phone at [TIME]. Reviewed event of [TIME]. Orders: [ORDERS]. Plan per provider: [PLAN AS STATED BY PROVIDER]. Pt currently [LOC, VITALS]. Seizure precautions [IN PLACE / CONTINUED]. Will continue to monitor and notify provider for [PARAMETERS]. [YOUR NAME, CREDENTIALS] ``

Words that do the damage

Word or phrase Why it causes trouble Use instead
pseudoseizureIt's a diagnosis, and not yours to make. It's also an outdated termDescribe the event; write event or episode of shaking
faking, manipulativeClaims to know intent. Nobody can observe intentWhat the patient did and when
behavioralA conclusion with no dataThe behavior itself: pt yelling, pulling at IV
attention-seekingAssigns a motiveThe circumstances around the event: who was present, what had just happened
non-epileptic (on your own)Usually needs EEG to confirmProvider notified of atypical features: [list]
responds when he wants toSarcastic, and it doesn't record any actual responseCalled name x3, no response. Answered question at [TIME].
had a seizure (with nothing else)Doesn't say what happenedThe seven fields: onset, movements, duration, responsiveness, eyes, incontinence, recovery
postictal or not postictalAn interpretationOriented x4 at [TIME], drowsy, follows commands at [TIME]
WNL afterToo vague to show recoverySpecific LOC, speech, orientation, and the time

If you remember one thing

Write down what the patient did, what you did and when it happened. Leave the diagnosis to the provider.

What goes wrong

The usual mistake is a one-line label written where the description should be: Pt having pseudoseizure, no tx needed or Behavioral episode, pt faking.

That causes two problems.

First, a label throws away the data. Telling epileptic seizures from psychogenic nonepileptic seizures (PNES, the current term; pseudoseizure is outdated) is hard even for neurologists. They work from details. Were the eyes open or closed? Did the limbs move in phase or alternate? Was there side-to-side head movement? They also want to know how long it lasted, how fast the patient came back and whether there was a postictal period. If you chart pseudoseizure, the provider gets your conclusion with none of the evidence behind it. If you chart the details, the provider can reach their own conclusion. It might match yours.

Second, the label is the one line in your note that someone can argue with. Nobody can dispute Eyes closed throughout; called name x3, no verbal response; oriented x4 at 0214. They can dispute faking, and whoever reads it later will ask how you knew. A label also gives the next shift a reason to respond more slowly. And a patient who has PNES can also have a real seizure. When that happens, the note that says faking is the one that looks bad.

Your own doubt about the event still counts as clinical information. Write it in a form someone can check: Movements stopped and restarted x2 when staff entered room. Provider notified of atypical features. That records what you saw and shows you reported it.

What the guidance says

  • Put your nursing assessment of any seizure-like event in the nursing notes, with the details of what you observed. A note that just says an event occurred isn't enough. (SCDDSN.pdf), Relias)
  • If your note only says patient had a seizure, the provider can't classify the event. Write what you saw, how long it lasted, what you did and how the patient recovered. (Relias, ScienceInsights)
  • Record what came before the event, including any warning sensation or aura the patient reports. (Nurseslabs, NURSING.com)
  • Assess and record level of consciousness after the event. That way the recovery is documented and nobody has to assume it. (NURSING.com, Relias)

It is not hypothetical

What happened in 3 court cases — tap to read

None of the decisions in our set involves a suspected nonepileptic event. The three below show how charts get read later, sometimes years later. What was observed and written at the time carries weight. Opinions written into a record get treated differently from observations.

David Pitts Jr. and Kenyetta Gurley v. Louisiana Medical Mutual Insurance Company and Rhoda Renee Jones, M.D. — Supreme Court of Louisiana, 2017. A seven-month-old died after an ER visit and admission. The nursing notes recorded vital signs, intake and output, respirations and changes in condition, each at a specific time. They also charted, as an event, that the patient had seizure activity and stopped breathing. In a late entry, a nurse wrote that she had asked the physician several times about transferring the patient. The jury found for the physician. The trial judge overturned that verdict, and his written reasons leaned on the charted facts: "The medical records powerfully support that the child was very ill upon presentation". The Supreme Court did not let his override of the verdict stand, but it upheld his grant of a new trial. The court of appeal had reversed both. For a nurse, the point is how the case was argued. Everyone worked from the timed, observed entries.

Pophal v. Siverhus — Court of Appeals of Wisconsin, 1992. The trial court kept out diagnoses and opinions that treating physicians had written in the medical record and then didn't testify about. The appeals court approved. It applied a rule that such a record entry "may be excluded in the trial judge's discretion if the entry requires explanation". Those opinions came from physicians, not nurses. The general point still holds for any chart: a written conclusion may need its author to explain it, and a plain observation doesn't.

Martin v. Secretary of Health and Human Services — United States Court of Federal Claims, 2020. This was a vaccine-injury claim involving a child with a seizure disorder. The special master relied heavily on what the records showed at the time, finding that "the contemporaneous medical records fail to establish a proximate temporal reaction" after the vaccinations. In a later dispute, the entries written during the event usually get the closest look.

Read the decisions yourself

Every case below is a published decision on CourtListener. Open them. Nothing on this page asks you to take our word for what a court said — and where we only had the search result rather than the full opinion, it says so.

All the decisions behind this guide, in one page — searchable by court, year, or what happened.

What people say on the floor

Nurses talking to each other about this, quoted as they wrote it. This is opinion, not a source. It is here because it shows what the argument actually is — the rules above come from the decisions and the published guidance, not from these threads.

What everyone else says

Guidance from professional bodies, insurers and other people who write about this. Useful, but it is advice, not law — that part is above.

How would you chart it?

This is the part we cannot research. If you have a way of writing this that has held up — put it here. No account, no name needed. Nothing that could identify a patient: no room numbers, no dates of birth, no MRNs. Use placeholders, the example still works.

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