How to Write a Nursing Narrative Note

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2 days ago
4 min read

Nursing narrative notes are one of the most fundamental components of patient documentation. Unlike structured formats like SOAP or DAR, a narrative note tells the story of a patient’s condition and the care they received in free-form text. Here’s how to master the nursing narrative note, so your documentation reflects the excellent care you provide.

What Is a Nursing Narrative Note?

A narrative note is a chronological, story-like record of a nurse’s observations, interventions, and interactions with a patient. Unlike structured formats such as SOAP or PIE, narrative notes allow for more flexibility and detail.

Narrative notes are often used to:

Document changes in a patient’s condition
Record incident reports or unusual events
Describe emotional or behavioral responses
Support legal or reimbursement-related requirements

According to a recent study, poor documentation contributes to up to 20% of malpractice cases. Writing a clear and comprehensive narrative note is essential for protecting yourself and your patient.

How to Write a Nursing Narrative Note

1. Understand the Purpose of a Narrative Note

A narrative note is meant to paint a clear and accurate picture of the patient’s experience. It should include what the nurse sees, hears, assesses, and does. Narrative notes are especially important in situations that don’t fit neatly into a checklist, like behavioral changes, unusual responses to treatment, or unexpected events during a shift.

2. Use Chronological, Objective Language

Your narrative note should use clear, objective language to describe what happened in order. Avoid vague terms like “seems fine” or “acted strange,” and instead describe observable facts and patient statements.

📝 Instead of: “Patient seemed upset.”

✅ Try: “Patient was tearful, with arms crossed and minimal eye contact. Stated, ‘I don’t want to be here anymore.’”

Keep your tone professional and stick to what you saw, heard, or did. Avoid assumptions or diagnosing unless you're qualified to do so.

3. Include Key Elements in Every Note

To ensure you’re covering everything needed in a narrative note, use this simple checklist:

Time and date
Reason for contact or visit
Your assessment (physical or emotional observations)
Actions you took (e.g., meds given, repositioning, education provided)
Patient response
Plan or follow-up needed

If you're documenting after the fact, indicate clearly: “Late entry for 6/2/25 at 10:00 AM.”

4. Be Thorough—But Concise

A narrative note isn’t meant to be a novel. It should give enough context to understand the situation without including unnecessary detail. Focus on clinically relevant information, and avoid repeating data in flow sheets or vitals logs unless it’s part of the narrative.

📝 Too much: “Patient watched TV while lying in bed. Later drank water. Talked to visitor.”

✅ Better: “Patient alert and oriented. Reported 4/10 pain in left knee. Ice pack applied at 10:20. Repositioned for comfort. Will reassess in 30 minutes.”

5. Document in Real Time Whenever Possible

Waiting until the end of your shift to chart increases the risk of forgetting important details. It also leaves you vulnerable to a sudden change in patient condition or legal inquiry.

If your shift is too busy to document everything in the moment, jot down quick notes on paper or in a secure app and finalize your narrative as soon as possible.

6. Don’t Skip Critical Thinking

A strong narrative note doesn't just record facts—it shows your clinical reasoning. If you suspected an infection and took action, include your rationale. If a patient’s behavior changed after medication, document that link.

This doesn’t mean editorializing, but showing why your care mattered and how you responded.

📝 Example: “At 14:00, the patient developed a productive cough and O2 saturation dropped from 95% to 89%. Lung sounds diminished in the left lower lobe. Notified the provider who ordered the chest X-ray. Patient placed on 2L nasal cannula.”

7. Use Tools to Save Time Without Sacrificing Accuracy

With high patient loads and limited time, many nurses use AI tools or documentation templates to speed up note-writing.

Apps like NurseMagic™ are HIPAA compliant and let you type or speak your situation, then generate a narrative note instantly. Notes can then be exported into your EMR with a simple copy-paste.

Narrative Notes in Action: Real-World Example

Here’s an example of a well-written nursing narrative note:

1430 – Patient noted to be sitting upright in bed, clutching abdomen and grimacing. States pain level is 7/10. Abdomen firm to palpation, hypoactive bowel sounds. Administered 4mg morphine IV as ordered. Patient reported relief within 15 minutes, pain level decreased to 3/10. Will continue to monitor. Notified charge nurse and documented in MAR.

This note provides a clear timeline, describes the patient’s condition, details the nurse’s actions, and shows the outcome.

Final Thoughts

According to the HIPAA Journal, clear and accurate documentation is essential to ensure safe, evidence-based nursing practice. Use these tips to ensure you write your notes well. Tools like NurseMagic™ can even help streamline the process by generating professional-quality narrative notes from your spoken or typed input, cutting documentation time dramatically.