By Amy Niemas, RN-BC, BSN, MSW, Clinical Content Director · Psychiatric Registered Nurse

Last updated: October 13, 2026

What WDL Means in Nursing and When It Is Not Enough

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Why This Matters

Regulatory bodies: CMS Conditions of Participation (42 CFR 482.24), State Boards of Nursing

No federal rule requires WDL or charting by exception, and none forbids it. The Centers for Medicare & Medicaid Services (CMS) Conditions of Participation require hospital records to be "accurately written, promptly completed," and every entry to be "legible, complete, dated, timed, and authenticated." A WDL charting item meets that standard only when it is true for all items in each area, and it is only as clear as the facility definition behind it. Courts have looked at what charting by exception leaves out. In Lama v. Borras (1994), a patient developed a wound infection after back surgery that progressed to discitis, an infection of the space between the spinal discs. The hospital had told nurses to chart by exception, and a local health regulation required qualitative nurses' notes every shift. The federal appeals court wrote that "a more complete account of Romero's evolving condition is not available because the Hospital instructed nurses to engage in 'charting by exception,'" and upheld a $600,000 verdict. The case hinged on the chart lacking a record of the change over time, however, not necessarily on charting by exception itself. Licensing boards look at the other side of the same problem. Marking WDL for an item you did not assess documents care that was not given. The Texas Board of Nursing lists "incomplete or inaccurate documentation of patient care, failure to provide the care documented, or other acts of deception or omission" as serious concerns. CMS has also warned that templates and auto-fill "can create unintended documentation errors"; so if that is what your facility uses, make sure you double-check your charting. This guide covers documentation. It does not replace your facility's policy, and it is general information, not legal advice.
  1. 42 CFR 482.24, Condition of participation: Medical record services — Electronic Code of Federal Regulations (2026)
  2. Romero Lama v. Borras, 16 F.3d 473 (1st Cir. 1994) — Caselaw Access Project, Harvard Law School Library (1994)
  3. Behavior Involving Lying and Falsification (disciplinary sanction policy) — Texas Board of Nursing, amended 2015 (2015)
  4. Documentation Integrity in Electronic Health Records (fact sheet) — Centers for Medicare & Medicaid Services, 2016 (2016)
  5. Head to Toe Assessment: A Minimum Data Set Supplement for Reducing Documentation Burden — Adrian B, Boyd D, Hager C, Head to Toe Assessment Task Force. Nursing Knowledge Big Data Science Initiative, University of Minnesota, 2025 (2025)
  6. Stepdown Unit Standards of Care, policy 62.03.00 — Kadlec Regional Medical Center, in a Washington State Department of Health filing, 2021 (2021)
  7. Nursing Fundamentals, Chapter 2: Communication — Open Resources for Nursing (Open RN); Ernstmeyer K, Christman E, editors. NCBI Bookshelf, 2021 (2021)
  8. Charting by exception: the legal risks — Nurses Service Organization
  9. Back to Normal? — Brucker MC. Nursing for Women's Health. 2021 (2021)

What WDL Means in Nursing

WDL means within defined limits. It is a single entry that stands for a whole list of normal findings your facility has written for each body system.

WDL Except

When a system matches the definition except for one or two findings, most flowsheets use "WDL except" (some call it "WDL exception"). You select it, then chart each exception. One hospital policy puts it this way: findings outside the limits are entered "by documenting WDL Except. When this selection is chosen, all exceptions to normal limits will be documented." Charting example: Respiratory: WDL except diminished breath sounds right lower lobe. RR 18, unlabored. SpO2 94% on 2 L nasal cannula. Patient states, "I feel a little short of breath when I walk to the bathroom."

WDL vs WNL

WNL stands for within normal limits. You will still see it in older charts, handwritten notes, and some flowsheets. Some nurses joke that WNL means "we never looked," which is the point: a short entry says nothing about what was checked unless something defines it. WDL points to a written definition. WNL depends on what the reader assumes "normal" means, and historically was based off broad, generalized norms for healthy people. Facilities set their own lists of approved abbreviations. If your facility's list does not include WNL, or WDL, spell out what you found instead.

WDL and Charting by Exception

Charting by exception (CBE) works on the same idea. The nursing textbook Nursing Fundamentals describes it as a list of normal findings: "Nurses confirm normal findings on the list found on assessment and write only brief progress notes for abnormal findings." Charting by exception was designed to cut documentation time. The published reports of time saved are small, single-hospital studies from the 1990s, although it has been widely adopted in many charting systems, such as Epic. The legal risks in the next sections apply to both.

When WDL Is Enough

WDL is the right entry when three things are true: - You know your facility's definition for that system. - You assessed every item in it during this assessment. - Every item matched the facility's definitions. If all three are true, WDL is a complete and accurate entry. You do not need to write out every normal finding, and you should not feel you have to. The detail belongs to the findings that are not normal.

When WDL Is Not Enough: What to Chart Instead

Each of these situations needs more than a WDL click. Most need "WDL except" and a specific finding.

Any Finding Outside the Definition

Chart the finding itself, with a measurement or a description someone else could check. "Edema" is a start, but "2+ pitting edema bilateral ankles" is a finding the next nurse can compare against.

A Chronic Finding That Is Normal for This Patient

This is the question new nurses ask most. A patient with long-standing atrial fibrillation has an irregular rhythm every day. If your facility's cardiac definition includes a regular rhythm, that patient's cardiac system is not WDL, even though nothing has changed. Chart "WDL except" and the finding, and say whether it is the patient's known baseline and whether it has changed. Follow your facility's definition if it handles patients' baseline findings differently. Charting example: Cardiac: WDL except irregularly irregular rhythm, known atrial fibrillation. Apical HR 88. Denies chest pain or palpitations. Unchanged from 0800 assessment.

An Item You Could Not Assess

The University of Minnesota task force is direct about this: "If all elements of the WDL are NOT assessed, do not use the WDL or WDL Exception." Its example is a sedated, intubated patient who cannot answer whether they have chest pain. You can still chart the heart sounds and rhythm you heard. The chest pain item is charted as "not assessed," not as "normal." Marking WDL for an item you did not assess charts care that did not happen.

Something the Patient Tells You

Your exam can match the definition while the patient reports a symptom. Chart what they said in their words, next to what you found. The two together are more useful than either alone, and the difference between objective and subjective data is exactly what a reviewer looks for.

A Reassessment After an Intervention

After a PRN medication, a position change, oxygen titration, or any other intervention, chart the specific response, with a time. "Pain 3/10 at 1045, 45 minutes after PRN oxycodone; decreased from 7/10 at 1000" shows the reassessment happened. A WDL click does not.

A Finding That Continues From an Earlier Shift

Once a finding is charted as an exception, keep charting it at every assessment until it resolves, even when it has not changed. In Lama v. Borras, the chart showed a bloody dressing, then incision pain, then a soiled dressing, with gaps in documentation in between, and the patient was diagnosed with discitis days later. The court said the jury could infer that "intermittent charting failed to provide the sort of continuous danger signals that would be the most likely spur to early intervention by a physician." "Unchanged" plus a measurement shows someone looked. Silence does not.

Where WDL Fits With Vital Signs and Focused Assessments

WDL covers the body-system assessment. It does not replace the numbers. Chart vital signs as values, not as WDL, so the next nurse can see a trend. Focused assessments have their own specific findings too: an IV site is either free of redness, swelling, and tenderness or it is not, and the IV line charting guide shows how to chart the site. The exceptions you chart are also what you hand off, so they belong in the Assessment part of your SBAR handoff.

WDL in NurseChartingPro

In NurseChartingPro, the clinical Head to Toe Assessments category lists each body system with a WDL toggle. Each system starts marked WDL. Selecting any exception chip clears WDL for that system, and switching a system back to WDL clears the exceptions and notes you entered for it. When you generate a note, the app writes one line for the systems marked WDL ("All systems WDL except: ...") and then lists each system's exceptions. Because every system starts marked WDL, treat each toggle as a statement you are making, not as a default you are accepting. Go through the systems one by one against what you assessed before you generate the note. For how the head-to-toe assessment fits with the rest of a clinical chart, see the clinical nursing charting overview.

Common Mistakes

Marking WDL without knowing your facility's definition

Weak: Neuro: WDL. (The nurse did not know the definition included pupil response.)
Strong: Neuro: WDL. A&Ox4, PERRL 3 mm, speech clear, moves all extremities purposefully, sensation intact.

WDL means every item in the definition was assessed. If you do not know what the items are, you cannot know whether you assessed them. A few supporting findings after the WDL also show the next reader what you checked. Although the supporting findings are not essential if the findings are truly WDL, it is good practice to write out supporting details, especially for new nurses or nurses new to a facility.

Marking WDL for a known chronic finding

Weak: Cardiac: WDL. (The patient has known atrial fibrillation.)
Strong: Cardiac: WDL except irregularly irregular rhythm, known atrial fibrillation. Apical HR 88. Denies chest pain or palpitations. Unchanged from 0800.

A chronic finding that is normal for this patient is still outside a definition that includes a regular rhythm. Charting it as an exception, with "unchanged," tells the next nurse what to expect and makes a real change easy to spot.

Marking WDL when you could not assess every item

Weak: Cardiac: WDL. (The patient is sedated and intubated and cannot report chest pain.)
Strong: Cardiac: S1, S2 present, regular rhythm, HR 76. Chest pain: not assessed, patient sedated and intubated.

WDL covers every item in the definition. If you could not assess one, WDL charts a finding you do not have. Chart only what you assessed and name what you could not.

Copying WDL forward from the last assessment

Weak: GI: WDL. (Carried forward from the previous shift before the patient was assessed by oncoming nurse.)
Strong: GI: WDL except abdomen mildly distended, bowel sounds hypoactive all 4 quadrants. Last BM 2 days ago per patient. Provider notified at 1015.

A WDL copied from the last shift can hide a change. CMS has warned that copying and auto-fill in the health record can create documentation errors. Chart what you found on your assessment.

Charting an exception once and then going quiet

Weak: 0800: Skin: WDL except 3 cm area of redness on sacrum. (No further skin entries for the rest of the shift.)
Strong: 0800: Skin: WDL except 3 cm area of nonblanchable redness on sacrum. Repositioned, heels floated. 1200: Sacral redness unchanged, 3 cm, nonblanchable. 1600: Sacral redness unchanged, 3 cm. Wound care consult placed per protocol.

The pattern across entries is what a reviewer reads. An exception charted once and never again looks like no one checked it again. Chart it at every assessment, even when it is unchanged. Also remember to chart any interventions you did to address issues present.

Pro Tips

  • Read your facility's definitions once, system by system: Most flowsheets show the WDL definition when you hover over or tap the row. Read each one during orientation and write down anything that surprises you, such as whether pain or a patient's mood is part of a system's definition. After that, you will know what each click means, or which ones you need to look at again.
  • Add a few findings after WDL, if possible: A WDL followed by two or three specific findings ("WDL. Lungs clear bilaterally, RR 16, SpO2 97% on room air") takes only a few minutes and shows what you checked. It also helps a reader from another facility, whose definition may differ from yours.
  • Say "not assessed" when you did not assess it: This sounds like a no-brainer, but it is a common mistake. "Not assessed, patient asleep" or "not assessed, patient off unit for CT" is an honest, complete entry. It is better than a WDL that you cannot support, and it also tells the next nurse what still needs to be done.
  • Use unchanged with a number: "Unchanged" alone is easy to write without looking. "Unchanged, 2+ pitting edema bilateral ankles" shows you compared this assessment against the last one.
  • Hand off the exceptions, not the WDLs: At shift change, the oncoming nurse needs to know what was not normal and what is being watched. Lead with the exceptions and the trend. The WDL systems can be one sentence.

Step by Step

  1. Know the definition: Read your facility's WDL definition for each body system before you use it.
  2. Assess every item: Assess every item in the definition during this assessment. If you cannot assess one, do not mark WDL. If your facility uses it, you can chart "WDL Except" and chart the specifics about the outlying item.
  3. Mark WDL only when every item matches: If every item was assessed and normal, mark the system WDL. Adding two or three findings, if possible, shows what you checked.
  4. Chart each exception: For any finding outside the definition, including a chronic baseline finding, choose "WDL except" and chart the finding specifically.
  5. Chart what the patient reports: Chart symptoms the patient describes in their own words, even when your assessment matches the definition.
  6. Follow each exception until it resolves: Chart the exception at every later assessment, with a measurement, even when it is unchanged.

Frequently Asked Questions

What does WDL mean in nursing?
WDL stands for within defined limits. Marking a body system WDL means you assessed every item in your facility's written definition for that system and every item was normal.
What is the difference between WDL and WNL?
WDL points to a written facility definition for each body system and can change depending on the facility. WNL stands for within normal limits and is an older, more general term, used for healthy people. Check your facility's approved abbreviation list before using WNL.
What does "WDL except" mean?
WDL except means the system matches your facility's definition except for the findings you chart next. Chart each exception specifically, along with a measurement or description.
Can I chart WDL if an abnormal finding is the patient's baseline?
You cannot chart WDL for a baseline finding that is outside your facility's definition. Chart "WDL except" with the finding, note that it is the patient's known baseline, and say whether it has changed. Follow your facility's definition if it handles baseline findings differently.
Who decides what counts as within defined limits?
Your facility decides what counts as within defined limits. The definitions are written in facility policy and built into the health record flowsheet, and they vary between facilities.
Is charting by exception legal?
No federal rule requires or forbids charting by exception, and many facilities use it. The risk comes from a chart that does not show a change over time, or a WDL entry for something that was not assessed. A local rule or facility policy may also require narrative notes at set intervals.
Can I mark WDL if I did not assess only one item?
No, you cannot mark WDL if you did not assess every item. WDL covers every item in the definition. Chart what you assessed and note the item you could not assess and why.
Page 1 of the Nursing Charting Cheat Sheet

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  • All 16 charting categories, clinical and psych, with what to write for each
  • Morse, Braden, Glasgow Coma Scale and SBAR at a glance
  • The charting mistakes that cost nurses their licenses
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