Action plan for discipline?

Sour Lemon · Sep 28, 2016

I had some issues that were brought up at a meeting with me today with two HR people and my boss lady on my floor. I work in a relatively small hospital in NE Arkansas and this is my first hospital job since graduating nursing school last year. Anyway, a patient didn't get her IV put in and antibiotics hung in time, and I'm being held responsible for it even though the nurse that admit
Her shoukd have seen all hee orders before the 11-7 shift started..anyway I was told I have to write a 2 page action plan, to show them this will not occur again. I don't know where to start. Any help is appreciated. .thanks.

Well, what are your thoughts about why this happened and what you could have done differently to ensure a better outcome? Start by writing them out, then organize them.

Kyrshamarks, BSN, RN · Sep 28, 2016

You have got to be kidding me? They actually told you to write a 2 page action plan on how you wont do this again. What are we, back in elementary school? Are they going to send a note home to your parents to have signed if you screw up again? You are suppossd to be a professional and they are supposed to treat you like one. You screw up you get written up. end of story. I would not write anything.

joanna73, BSN, RN · Sep 28, 2016

You might want to review your code of ethics for some ideas if you're writing a reflection piece.

It sounds like they want a detailed action plan based on SMART goals. Start by reviewing your facility policies around standards of care and medication administration.

Many facilities will assign reflections and learning plans, including mine. It's not unheard of.

Ultimately, OP, your action plan should be meaningful for your practice.

nutella, MSN, RN · Sep 28, 2016

I had some issues that were brought up at a meeting with me today with two HR people and my boss lady on my floor. I work in a relatively small hospital in NE Arkansas and this is my first hospital job since graduating nursing school last year. Anyway, a patient didn't get her IV put in and antibiotics hung in time, and I'm being held responsible for it even though the nurse that admit
Her shoukd have seen all hee orders before the 11-7 shift started..anyway I was told I have to write a 2 page action plan, to show them this will not occur again. I don't know where to start. Any help is appreciated. .thanks.

I want to point out that it sounds like you are having more than this issue - because usually small or single incidents get addressed by the manager without HR (unless that is what they always do at your place). Usually, there are more serious concerns when HR is invited. Did they "write you up" aka corrective action and not just verbal warning?

I wonder if they are starting a paper trail and collecting evidence of performance issues and corrective action because you are showing more of a pattern or general performance problems. I could be wrong and this is just all normal for your place ...

Anyhow, it sounds that they want you to basically write something like a performance improvement plan in the form of an action plan.

They want to see that you have thought about the incident, that you understand what is going on and why it happened and they want to see a plan on how you will ensure a better practice. They will hold you accountable with it and I also think that they will audit your medication administration times and how closely you are following orders at least for a while or periodically.

There are different ways of writing such a plan but it is best to structure it. Perhaps something like:

- Identified problem and short root cause analysis as to why it happened

- the goal for the action plan (depends somewhat on why it happened but overall goal would probably be to realize orders for patients, prioritize orders, and ensure that they are carried out in a timely manner).

- the plan / what you are going to implement for yourself.

Obviously you have to reflect first on why it happened and I suggest you take a paper and brain storm. Do not stay on the surface but go deeper consider things like "was tired", "felt in a rush" , "was distracted" , " did not check orders", "did not reconcile" you get the idea. after that you think about how to address it.

Examples could be "will ensure that I get enough sleep before work", "take report in a quiet area to minimize distractions" , to "organize my workflow", " set timer alarm to check telemetry " and so on. I hope that it is not " I had no idea that IVs were that important" ...

After you outline all of that my best suggestion for a meaningful improvement would be to develop a flow sheet with a checklist that you can actually use at work.

Checklist are being used in healthcare in different areas to improve the quality of care. So you would be right on topic with that

here are some ideas of what checklist there are in general for quality improvement - you have to adapt something for your plan. It is more to give you an idea and some background:

http://www.hpoe.org/Reports-HPOE/CkLists_PatientSafety.pdf

Checklists | AHRQ Patient Safety Network

However, if your main problem is that you can not prioritize and you have several gaps in clinical practice a checklist may only address some concerns. Because even to create a checklist you need to understand how to prioritize and how to build your tasks around the important things that are basically scheduled already like medications.

You can also include that if something happens that requires immediate action and which means you would be late for medication administration that you will reach out to the charge nurse.

If you came with a plan and a nice checklist / grid in which you fill in the tasks and workflow it will probably help you. Make sure to avoid getting delayed in medications and tasks related to it.

And do not blame the other shift - that does not look good even though they probably should have said something to you.

Good luck

morte, LPN, LVN · Sep 28, 2016

did the off going nurse tell you the admission was complete? or did she tell you it was not complete? clarifying that would be an important thing to do. if that nurse is in the habit of leaving things undone, and not telling any one, she needs the write up.

HouTx, BSN, MSN, EdD · Sep 28, 2016

I would recommend that OP's action plan focus on the concept that quality care is a collaborative / team effort rather than the responsibility of any one individual. Rather than lapsing into a 'not my job' frame of mind, it would be more effective to outline steps that will be taken to avoid any gaps or missed care in the future... like making sure to personally review ALL admission orders for any new patients rather than only relying on report. Doing 24-hour chart checks, double-checking med recs, etc. This will most likely be seen as much more positive and constructive.