written up already!

  1. By Dec. 27, it's going to my 6th month evaluation and already I had been written up!!! My patient had a bone marrow aspiration biopsy and needed to keep NPO after midnight and he was keep NPO. It wasn't until the day during shift report I realized that there was an order to administer IV fluids. I felt bad since i really didn't see that order. The next thing I know I am being written for that. The patient wasn't diabetic for fyi. I understand it's my fault but felt somewhat discouraged. I feel right now my manager is eyeing me all the time right. now. I had my 5th month evaluation and he said i'm doing so well. but this was all before this incident. I feel discouraged. I know my patient isn't harmed at least. I hate to put everything in an excuse but I got my shift report from not the greatest person to get report from. The person who wrote on me was a float nurse.

    My manager discussed with issue with me and wanted me to sign the paper in another time. Should I sign it? There are so many things that I could written up on others but still debating about that since I'm still kinda new. Like for instance, that same nurse that report to me didn't give the 2 K ryders order at 930am. When I go into my shift, I asked her did you give it? She said no. I had to call pharmacy to get the Kryder which they didn't give it to me only gave me 1 of the 2 Kryder. After the 1st one finished I made the doc order a BMP for the K. That nurse said, it's not a big deal. The k is only 3.2
    I feel like a mixture of feelings.
    Last edit by janetrette on Dec 12, '05
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  2. 31 Comments

  3. by   caroladybelle
    Why was the patient NPO for a bone marrow aspiration?
  4. by   janetrette
    bone marrow aspiration / biospy!
  5. by   caroladybelle
    Quote from janetrette
    bone marrow aspiration / biospy!
    Yes, I know.

    Again, why????

    I have assisted with this procedure for the last 12 years - at least one or two per week and at over 10 facilities. And as the patient is rarely given anything more than minimal sedation or analgesia, there is no reason generally for the patient to be NPO.

    I have had the procedure done and never was ordered NPO.

    Was there some other adjunct procedure being done?
  6. by   janetrette
    not that i know of...
  7. by   Jessy_RN
    Sorry about the write up. Best wishes to you and much success in the upcoming year
  8. by   Daytonite
    janetrette. . .Your emotional state over this incident is normal. To feel like your manager is constantly watching you is also a normal reaction. You obviously feel very badly about what happened. I assume the paper they want you to sign is the write up. Yes, you should sign it. Think of it like getting a speeding ticket from a cop. Signing the traffic ticket is merely confirming that you recieved it. The consequences of not signing a traffic ticket are much worse than if you sign it (like, you're going to get arrested and go to jail). It's the same with the write up. If you are disagreeing with the write up, there should be a place on the form for you to write your response. If not, you can always write in your own hand "see my attached response" and then sign the paper. Not signing makes you look like you are belligerant, uncooperative and difficult to get along with. It goes into your personnel file. It will come back to bite you if somewhere down the road you want to transfer to another unit or are looking for some kind of promotion within the hospital. Any manager within the hospital who has good reason can look at what is in your personnel file. What do you think they will conclude if they see you refused to sign a disciplinary action against you?

    May I just say that I understand you are angry, but it does no good to start pointing the finger at everyone else you know of who has made errors, particularly the one who reported your mistake. It really is a bit childish to my way of thinking and points the finger back to you again as to the kind of character you have. I suggest that you sit down and do some productive thinking on how to avoid this error from happening again. Can you think of one thing you should do in the future to keep this from happening? I can. Whenever you have someone going for any procedure you need to sit down with the chart and go back through all the doctors orders for any special preparation instructions. I've had several patients that went to OR for the procedure you talk about. A trip to the OR is always a reason to check the chart for pre-op orders. OR aside, it is never wise to just follow what someone has told you when you have a chart, an original source, that you can review. If you follow doctors written orders you are not going to be wrong. It only takes a few minutes to go backward through the physician's order sheets in the chart. I've had liver biopsies where the doctors wrote orders wanting a specific kind of needle, and in one case, a "liver biopsy cart" (which we had never heard of, but found really did exist!) ready and waiting for him on the unit.

    So, I'm suggesting that you spend your time figuring out strategies to make you a better nurse so you don't make this kind of mistake again and forget about what other people are doing. Worrying about and taking care of yourself is quite enough. Then, I would also suggest you go to your manager, sign the write up, and tell her you have been doing a lot of thinking about what happened and what you should have done and what you have learned from this incident. This is one way to redeem yourself in her eyes and help you feel better about the whole thing. (Psst...and forget about being a tattletale. It serves no useful purpose for you other than to give you a reputation for pointing out other people's mistakes. Is that really how you want to be known?)
  9. by   jen42
    The first year of nursing is when new nurses make mistakes, like everybody else starting out in a new profession. If you make a mistake, you usually get written up. If you're getting written up every week, you might want to consider changing your workplace. But once- don't beat yourself up. The less confidence you have, the worse you'll perform.
  10. by   Human nurse
    I would not dwell on the actual "write up" I would focus on the events that led to the situation. Ask myself why did this happen? what can I do to prevent it again? What I would not do...Concern myself with others behavior, or dwell on it. The fact is it happend, and it's over, so make a mental note and move on.

    Honestly, in 10 years are you going to be thinking, "wow, I still can't believe I missed that order my first year in nursing"
  11. by   GooeyRN
    Its part of nursing. Any mistake regardless of the reason results in a spanking.
  12. by   nursemike
    I've had one incident report about a patient under my care since becoming a nurse (about six months, now) and I wrote it. Patient fell out of bed, and pulled a Foley on the way. Ouch! I don't say I wrote myself up--only my manager or director can write me up, by putting a disciplinary letter in my file. Our written policy is that incident reports are not disciplinary--the purpose is to learn to avoid similar incidents in the future. The circumstances of the fall were such that no reasonable person could say I was at fault--in fact, there's a bit of gallows humor on my unit that we shouldn't really write up falls, since they aren't unusual occurences.

    I've also had a few mistakes that probably should have been written, but no one, including me, thought of it. In most cases, I was at fault, so I know how to avoid repeating them. In one case, I thought a patient's insulin coverage started at 150, because the last two lines of his sliding scale were on a seperate page. Actual coverage began at 120 (2units) but by the time I saw it, it was nearly time for the next fingerstick.

    I commend the OP for taking responsibility for the missed IV fluids, mostly because, like my insulin, she probably has the best chance of avoiding repeats. But, IMHO, there's probably an element of "systems error" there, too, in that orders should ideally be easy to read and follow. I usually come in half-an-hour or so before my shift so I can get my Kardexes and really study them, and check off my meds after each pass--so if I find one I missed, I can still give it on time or very close to it. But there really ought to be a better way to keep track of this stuff...
  13. by   AtlantaRN
    OH PLEASE!!! it's not like you missed 2 pages of orders, or sent a patient to surgery with LR hanging, and they are a dialysis patient!!!

    We are all HUMAN...we ALL make mistakes...

    I remember the first time I got written up, and it wasn't even patient related...my hubby had a PE after laminoplasty c3-c7...he was in one hospital in our town, and I work 20 miles away at another facility (on top of that he had c6 nerve root tethering, so he couldn't raise his arms or feed himself for 4 months postop)...they wrote me up for attendance (should have just taken a leave of absence...I was SO MAD...but that was several years ago.

    Now I look at things differently, If I make an error, did it hurt the patient in any way...did the preop nurse hang the LR, then no harm, no foul...

    Writing people up is just a documentation process, to track sentinel events, so they can look at the whole process...don't take it personal.

    linda
  14. by   tommycher
    Was it an order to begin IV fluids at 0600? Often that is an order for a cardiac cath or a procedure using conscious sedation. It would seem to me, that if you are giving report at 0700, and it is noticed the fluids have not been started, it would be no big deal to just go ahead and start them. I cannot see how a lack of 125ml or whatever the order was for, would cause such a problem. However, if the order was written on the previous shift for fluids, and they were not started all night, then certainly it was neglectful to not complete the 12 hr or 24 hr chart check and catch that yourself. But, no harm done, and we all learn from our mistakes, and trust me, there will be mistakes. Graduating from nursing school does not ensure infallability in a human being, so do not beat yourself up, this is how we learn to become more diligent. Good luck!

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