AI SOAP Notes for Nursing

Automate your nursing documentation. Save hours every week with AI-powered clinical notes that understand patient assessments, vital signs, medications, and nursing interventions.

Try Free for 3 Days
  • Works with Epic, Cerner, Meditech, and any EHR
  • HIPAA compliant
  • $49/month
HIPAA Compliant
PHI Auto-Removed
Works With Any EHR
Cancel Anytime

Nursing Documentation Challenges

If you're a nurse, you know the reality: high patient loads, complex cases, shift handoffs, and documentation that never ends. You're caring for 6-8 patients per shift while trying to keep up with charting. After a 12-hour shift, the last thing you want is to spend another hour finishing notes. It doesn't have to be this way.

Without SOAP Note Buddy

  • Charting after long 12-hour shifts
  • Incomplete handoff documentation during shift changes
  • High patient ratios leaving no time for thorough notes
  • Copy-forwarding outdated information (risky for patient safety)

With SOAP Note Buddy

  • Generate complete notes in seconds between patients
  • Clear, comprehensive shift handoff documentation
  • Stay caught up even with heavy patient loads
  • Each note is fresh and personalized to current patient status

How It Works for Nursing

1

Add Your Patient

Enter the patient's admission summary, diagnosis, current medications, and nursing care plan. This is stored locally on your device (never on our servers).

2

Open Your EHR

Navigate to Epic, Cerner, Meditech, Allscripts, or any web-based nursing system. SOAP Note Buddy automatically detects the documentation fields.

3

Click Generate

One click generates personalized nursing notes based on your patient's current status, vital signs, assessments, interventions, and care plan.

4

Review & Submit

Review the AI-generated content, make any needed adjustments, and submit. Documentation that used to take 20+ minutes now takes 2-3.

Features for Nursing

Nursing-Specific Templates

Templates for admission assessments, progress notes, shift summaries, discharge planning, and SBAR handoffs. Understands nursing terminology and care plan structures.

Works With Epic, Cerner & More

Automatically detects and fills fields in Epic, Cerner, Meditech, Allscripts, and any other browser-based EHR system.

HIPAA Compliant

PHI is automatically removed before AI processing. Patient names, DOBs, and identifiers never leave your device.

Save 10+ Hours/Week

Nursing documentation that used to take hours now takes minutes. More time for patient care, less time charting after your shift.

Systems-Based Assessment

Understands head-to-toe assessments, body systems documentation, and nursing diagnosis. Writes comprehensive notes covering all relevant systems.

Understands Nursing Terminology

Vital signs, I&O, pain assessments, wound care, medication administration, patient education - the AI speaks your language.

Nursing SOAP Note Example

Progress Note: Post-Surgical Patient Assessment

Scenario: 54-year-old patient, post-op day 1 following laparoscopic cholecystectomy. Monitoring for pain management, ambulation, and discharge readiness.

S - Subjective

Patient reports "my incision sites are sore but much better than yesterday" and rates pain at 4/10, down from 7/10 post-op. States nausea has resolved and was able to tolerate clear liquids this morning without difficulty. Patient expresses desire to get up and walk. Denies shortness of breath, chest pain, or new concerns.

O - Objective

Vital Signs: BP 124/78, HR 76, RR 16, Temp 98.4F, SpO2 97% on RA.
Neuro: Alert and oriented x4, pupils equal and reactive.
Cardiac: Regular rate and rhythm, no murmurs, peripheral pulses palpable.
Respiratory: Lungs clear bilaterally, no adventitious sounds, using incentive spirometer appropriately.
GI: Abdomen soft, mild tenderness at incision sites, positive bowel sounds x4 quadrants, tolerating clear liquids.
Incision Sites: 4 laparoscopic ports with steri-strips intact, no erythema, edema, or drainage.
Activity: Ambulated 150 feet in hallway with steady gait, no dizziness reported.
I&O: Intake 480mL, Output 350mL, voiding without difficulty.

A - Assessment

Patient progressing well post-op day 1 following laparoscopic cholecystectomy. Pain well-controlled with current regimen. Tolerating diet advancement and ambulating without assistance. Incision sites healing appropriately with no signs of infection. Patient meeting discharge criteria for pain control, ambulation, and oral intake tolerance.

P - Plan

Continue current pain management with PO analgesics. Advance diet to regular as tolerated. Encourage ambulation every 4 hours while awake. Continue incentive spirometry q1h while awake. Discharge planning in progress - anticipate discharge this afternoon pending MD evaluation. Provide discharge instructions including incision care, activity restrictions, diet, medication reconciliation, and follow-up appointment in 1 week. Patient education completed on warning signs requiring immediate medical attention.

This example was generated by SOAP Note Buddy in under 10 seconds.

Works in Any Nursing Setting

Whether you work in acute care, home health, skilled nursing, or outpatient clinics, SOAP Note Buddy adapts to your documentation needs.

Hospital / Acute Care

High-acuity patients, multiple assessments per shift. Generate notes quickly to stay caught up with complex patient loads.

Home Health Nursing

Document visits efficiently in the field. Generate comprehensive home visit notes that meet OASIS and Medicare requirements.

Skilled Nursing Facility

SNF-specific requirements for Medicare documentation. AI understands MDS assessments and long-term care charting needs.

Outpatient Clinics

Quick notes for clinic visits, triage assessments, and patient education documentation. Stay on schedule with efficient charting.

School Nursing

Document student health visits, medication administration, and health screenings efficiently between seeing students.

Telehealth Nursing

Generate thorough documentation for telehealth triage calls and virtual patient assessments.

Simple, Affordable Pricing

No contracts. No setup fees. Cancel anytime.

Monthly Price $49/month
Free Trial 3 days
EHR Support Any web-based
Credit Card Required Yes, for trial
Compare Our Pricing

Most AI scribes charge $99-$299/month. SOAP Note Buddy is $49/month with no contracts. That's $600+/year in savings. Less than one hour of overtime pay saves you hours every week.

Ready to Save Hours on Nursing Documentation?

Join nurses who've reclaimed their time after shifts. Try free for 3 days.

Start Your Free Trial

Nursing FAQ

Does SOAP Note Buddy work with Epic?

Yes! SOAP Note Buddy works with Epic, Cerner, Meditech, Allscripts, and any other browser-based EHR. It automatically detects fields and fills them with AI-generated content.

Is the AI trained on nursing documentation?

Yes. SOAP Note Buddy understands nursing-specific terminology including vital signs, head-to-toe assessments, I&O documentation, medication administration, nursing diagnoses, and care planning. It generates clinically appropriate content based on your patient's information.

How does SOAP Note Buddy protect patient information?

PHI is automatically scrubbed before any data is sent to AI processing. Patient names, DOBs, addresses, and other identifiers are removed locally on your device. We're HIPAA compliant and offer a Business Associate Agreement (BAA).

How much time will I actually save?

Most nurses report saving 10-15 hours per week on documentation. Notes that took 15-20 minutes now take 2-3 minutes. That means finishing your charting before your shift ends.

Does it work for LPNs and nursing students?

Absolutely. SOAP Note Buddy is used by RNs, LPNs, nursing students, and nurse practitioners. The AI adapts to different documentation requirements and scope of practice.

Can I use it for shift handoff documentation?

Yes. SOAP Note Buddy can help generate SBAR handoff summaries and end-of-shift reports. Clear, comprehensive handoffs improve patient safety and save time.

Is there a free trial?

Yes! 3-day free trial. A credit card is required but you won't be charged if you cancel within 3 days. No pressure, no sales calls.