What's with all this disciplinary action?????

Ruby Vee, BSN · Mar 11, 2012

it seems like the medical community just dumps on nurses who makes mistakes.
a common topic on these forums is "i got wrote up" and "i got fired/asked to resign".
i have never heard of anyone getting wrote up in the lab because of a mistake. if someone makes a mistake in the lab a swarm of people will jump in and correct it to insure the pt doesn't get false results and all is well. people are human and people make mistakes. we are never yelled at or wrote up. the only mistake i know the lab will fire you for is doing a type & cross on the wrong pt.
do nurse manangers get prizes for writing people up? not saying that lab manangers are soft or skilled in cover-ups..........but they look out for their people.

this may be a common topic on the forums, but we really don't know the whole story. all we know is what the poster has chosen to share with us, and often the posters don't understand themselves why they were fired or asked to resign when someone else wasn't. even if they do understand they may minimize their own culpability while exaggerating someone else's -- either purposefully or because that's the way it seems to them.

my husband is in a position to participate in disciplinary hearings/meetings between employees and management, etc. he tells me that what's changed is the forums that are available for folks to bemoan their fate on line -- allnurses,com, facebook, twitter, etc. and the culture has changed in that folks do take to the internet to complain about something that was once a fairly private matter.

i believe a lot of the reason for these "surprise" write-ups or terminations is that people really do not understand how to function in the adult workplace or how they're doing at functioning as adult employees. (see the "fired for no reason" thread.) a new grad who has been told over and over that "overall, you're doing really well but you need to improve your time management, and i'd also like you to be able to tell me why you're giving each of those meds and whether that dose is high, low or abut average" hears "you're doing really well." (that's a culture change as well. when i was a new grad -- and yes, i do remember that far back quite vividly -- i would have heard "you're too slow and you have to study your meds a lot more.") time goes on, and the new grad continues to hear that she's doing well and completely misses (or glosses over) the message about time managment and studying meds. nothing changes and suddenly she's shocked and betrayed by a meeting with management where she's told "we hear you have issues with time management and that you don't know your meds." it comes as a complete surprise even though the preceptor thinks she's made it clear. now suddenly there's a deadline. the new grad has to shape up immediately or she's out of a job.

at this point, it may be too late to fix the time managment and lack of knowledge base issues in the time frame allowed. the preceptor is frustrated because she's brought it up over and over . . . . always prefaced of course, by the "you're doing really well over all" because we were all taught that you have to lead with a postitive, or, better, at least three of them. for each negative. the orientee is frustrated because she heard that she was doing well . . . and the rest of the message didn't sink in. management is frustrated because they've invest so many weeks of orientation in an orientee who appears unlikely to succeed.

people are human and they do make mistakes. no one knows that better than a nurse. we've all made mistakes. but sometimes being written up -- or not -- has more to do with what you do after you make the mistake or with a pattern of mistakes than it does with any one single episode.

Long Term Care Columnist / Guide · Mar 11, 2012

As usual, Ruby nailed it. :yeah:

FWIW, as a manager I very, very seldom write people up. I prefer to assume that most adverse incidents are a training issue rather than deliberate misconduct......at least until proven otherwise. In the vast majority of cases, I've found that an educative approach is the best way to inform the employee that a) they need to do something differently, and b) there are resources for them to help them do their job well.

Yes, I keep dated notes whenever I discuss a problem with an employee, because it's never too early to start a paper trail if things don't go well; but I rarely use my company's forms for a verbal counseling because our written warnings go on the same form, and they all go in the personnel file. I think there should be a clear difference between "Hey, do you think you could start coming to work on time?" and a "You really blew it, so straighten up and fly right". I have received exactly one written warning in my career, and I'll never forget it.....it came from the VP of Operations at an assisted living community I worked for several years back, and it was for failing to report an inappropriate resident-to-resident contact to APS. I had reported it to my immediate supervisor, expecting him to take action. I'll never make that mistake again, you can be sure of that....but that's why I'm against writing people up for every little thing under the sun.

Generally, I'll issue a written notice only on a second offense, or in the case of a safety violation that is so serious that it could have harmed someone. Once I gave my own kid (a CNA) a formal warning for failing to ensure a resident was wearing shoes when he put her on the sit-to-stand lift and she slid out of it....but as I told him later, I would've written up the Lord God Himself if He'd done something that foolish!

In short: if you treat people like responsible adults, they will usually live up to that expectation, and if you treat 'em like third-graders they're very much apt to behave that way. JMHO.