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Narrative notes are often difficult for new nurses and students to master as they’re far more open ended than flowsheet documentation. In this lesson, we’ll review some key tips for writing narrative notes and review how to write a very common type of note, the DAR or PIE note.

What is a narrative note? 

A narrative note is a type of charting where the nurse types out their assessment findings, interventions and patient responses in paragraph format. For example, here is a narrative note for a patient with hypotension: 

At 0945, patient reported feeling dizzy upon standing and was assisted to sit back down safely. Vital signs at that time: BP 86/54 mmHg, HR 116 bpm. No signs of injury noted. Dr. Marlatt notified of hypotension and tachycardia; order received for 500 mL NS bolus IV. Bolus initiated at 0954 and completed at 1003. Post-bolus reassessment: BP 98/62 mmHg, HR 84 bpm. Patient denies dizziness and safely ambulated to bathroom.

As you can see from the above example, the note tells the story of a clinical situation. For this reason, notes are often used when you want to take a snapshot of a moment in time that summarizes information, conveys unusual events or gives an overview of the shift. This allows others to easily see what was occurring, rather than hunting all over the flowsheet to put together various pieces of data. 

Tips for writing a narrative note

  • Be objective in your documentation – In other words, document what you observe without adding your personal opinions or assumptions. For example, instead of writing “The patient was crying about her childcare issues” you would write “Patient was crying while speaking with social worker about childcare.”
  • Be specific – When possible, quantify your findings with specific numbers. For example, instead of writing, “Patient ambulated multiple times today” you would write “Patient ambulated a distance of 60 feet three times today.”
  • Use quotes – When documenting a patient statement, use their exact words when possible. For example, instead of writing. “Patient stated he would cause harm to anyone who approached him” you would write “When approaching patient to perform vital signs assessment, patient stated, ‘Get one step closer and I’ll punch you in the face.’ MD notified and assessments deferred at this time.”
  • Be concise – Include only the information that is necessary to convey the situation.
  • Use standard abbreviations – Be sure you are using the correct abbreviations white avoiding those on the Joint Commission’s “Do Not Use” list. If you are unsure about an abbreviation or it could have multiple meanings, err on the side of caution and spell out the word or phrase. 
  • Be timely – It’s important to write narrative notes (and complete all documentation) in a timely manner. This ensures that details are reflected accurately and allows others to see the patient’s status as close to real time as possible. 

First person or third person?

There are three general ways to write your narrative notes.

  • Option 1 using “I” statements: “I educated the patient on the signs and symptoms of hypoglycemia.”
  • Option 2: “Patient educated on signs and symptoms of hypoglycemia.”
  • Option 3 using “this nurse” or “writer” statements”: “This nurse educated patient on signs and symptoms of hypoglycemia.” 

All styles are correct and accurately reflect the situation. However, the second option is what is used most widely and is what I teach my clinical students and new nurses.

How to write a DAR/PIE note.

DAR and PIE notes are very similar and common types of nursing narrative notes. DAR stands for data, action, response while PIE stands for problem, intervention, evaluation. Both essentially reflect what’s going on with the patient, the interventions or actions you performed, and how the patient responded. 

  • Data/Problem – What is the situation that has you concerned about your patient? For example, your patient’s pain level is 7 on a 0-10 scale despite receiving the prescribed analgesic medication. This is a problem that you need to solve and it contains the data you need to support your concern.
  • Action/Intervention – This is where you describe what you did about the problem. In this scenario, you call the MD and receive an order for additional pain medication, which is administered. 
  • Response/Evaluation – Every time you perform a nursing intervention, you must evaluate its effectiveness. In this section of the note, you’ll describe how effective (or ineffective) the intervention was. 

Here’s how that note would look: 

Patient complaining of pain 7/10 one hour after receiving Norco. MD notified and orders received for 4 mg morphine IV. Morphine administered at 0925 and pain level in right shoulder currently 3/10.

See how this note is short, directly focused on one specific problem, and clearly paints a picture of this clinical scenario? That is how your DAR or PIE notes should look. 

In the next example, you administer albuterol to a patient who is having an asthma exacerbation: 

At 1055 patient stated increased shortness of breath and chest tightness with O2 saturation 91% on room air. Audible expiratory wheezes noted. Pt assisted into upright position and albuterol administered. Patient states relief of symptoms, O2 saturation level currently 95% on room air, wheezes diminished.

And one more for good measure. In this scenario, you treat your patient’s hypertension: 

Patient hypertensive with BP 184/95, no signs of acute distress noted. PRN IV metoprolol administered at 1225. BP currently 135/76.

In summary, narrative notes can be powerful tools that help you tell the patient’s story. As a student, they can feel intimidating, but like anything else, they get much easier with practice. To improve your ability to write narrative notes, spend time reading nursing notes in the EMR. This is an excellent way to see what types of situations warrant a note, and how clinical information is conveyed. And, if you’re not able to actually write notes in the chart, write them out for practice and ask your nurse preceptor to provide feedback.

Want more tips on documentation and being an amazing student nurse? These tips and more are inside my book, The Ultimate Nursing School Thrive Guide.

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