Advice please!!!!

[mzjones6]

This is a rather long so bear with me on this. I'm not sure what the do at this point, if I should file a grieveance or just suck it up, keep on moving and improve on my performance. I've been working at this hospital almost a year and love working with the patients, but my fellow co-workers seem to keep getting me into trouble and in the end it appears that you don't get written up for giving bad advice, but only if you take the bad advice.

The first warning I got was understandable and deserved. I had a patient coming in for questionable febrile seizures and she became febrile overnight!! I paged the resident at least twice waiting for an order for tylenol, but she must've been dead to the world because she took a very long time to call me back. While waiting for the resident to call, another nurse told me to hurry up and give the tylenol or my patient would begin to have a seizure. I waited and waited, still no call back. All I needed was a T.O.R.B and that would've been the end of it. So this other nurse proceeded to write out the telephone order before the resident called back, since she, and we, all assumed the doctor would just write the order anyway when she arrived. To make a long story short I ended up giving the child tylenol before the doctor arrived and was written up for working out of the scope of my practice. My manager counseled me on going with my gut and if it feels wrong don't do it. She understood that as one of the new kids I was under a lot of pressure from the more senior nurses, but that if it I feel it in my gut, don't do it. I don't know if the other nurse got reprimanded or not and I didn't ask.

This last written warning came from a combination of things that happened on just one night, with different patients. This is the discipline that I feel should be partly be grieved because I feel like I was the fall guy. My first patient was a newborn admitted for hypothermia but ended up having hyperbilirubinemia. Now I've only assisted in setting up bili lights one time, so I knew I would need help. I asked for help and was told to print out the protocol, but the blanket under the baby, put the googles on, and set up the lights so many inches away from him, with the temperature measured with the bili meter. To make a long story short I fumbled with the lights and the dad asked that someone else set up the equipment because he didn't feel I was capable of doing it. I didn't take offense to it, I just said that's your right and I understand. Again, I asked for help and was told to call the NICU. The NICU nurses did it, and felt themselves that the dad was a little uptight, but they were older first time parents so I didn't fault them for anything. Well apparently afterwards, the parents kept asking if the NICU nurses to do everything, but we're not a NICU floor, and the baby didn't need the NICU, so it became an issue. The parents even met with the director of our unit to discuss what was going on with their child and the bili lights and NICU, so even the director knew (this isn't unusual, the director from time to time does go and listen and talk with the families on the unit to see how things are going). Another issue with this patient was that the Admission Screening Tool was not completed, which is done on admission. I discovered this at 5am that morning and passed on to the next nurse that it hadn't been done. Mind you the patient had had two nurses before me and neither had done the AST. I wasn't going to wake up a breastfeeding mother who was already up every 2 hours feeding, to wake her up to ask her 30-35 questions about her child.

During that same shift, I got an admission, and was so busy with a rectal irrigation and a transfer that I missed my own AST!! So I passed on the next nurse that it wasn't done and they didn't seem to care. Also this new patient had an order for a pulse ox and no EKG leads, and I had the patient on EKG leads and no pulse ox. I also realize this was my boo-boo and I should've corrected it, but I have walked into countless patients rooms and patient isn't attached to anything and should be. I just told the nurse and thought she could take the two extra seconds and stick the kid on a pulse ox.

So my write up was for all these combination of things: I was basically blamed for not doing 2 ASTs, when in fact one AST went through two nurses before me. I was also written up for leads and pulse ox monitors being backwards, and written up for asking the NICU to set up the bili lights when I could've utilized my resources on the floor. If I asked for help initially before the set up and after the parents asked for someone else and I'm sent off both times, what was I suppose to do? I don't know what my next step would've been. Apparently the charge nurse that night was capable of setting them up, but she was either too busy or didn't want to bother, either way I was disciplined for it. IN FACT, the nurse who told me to call the NICU is the same nurse who told me to give the tylenol to my febrile patient above. The monitors and pulse ox issue was could've been corrected the the day nurse, it take two seconds to put a pulse ox on, but instead she thought she'd report it. I go through countless pulse ox and lead stickers in a night, and alot of times because the day nurse before me doesn't have them on right, or not at all, but I don't report it everytime. As for the ASTs, I don't understand why I'm being held responsible for something that went through two nurses before me and neither one of them could do it during the day shift? As uptight as these parents were, would it have been wise to wake them up and ask them to answer a bunch of questions for me at 5 in the morning? Why am I the fall person because the previous nurses slacked off?

Now don't get me wrong, I understand all this involves some self-reflection on my part and I need to look in myself and see where I need to improve on my performance. My manager told me herself that some of these issues were simple tattle tales, but I get in trouble nonetheless. Now I'm in danger of losing my job all because I did things that I've seen done all the time. I've had the reporting nurse tell me the AST is incomplete, or that they didn't bother to put the child on monitors because they look good, but there are doctor's orders for monitors. At one point, some nurses were worried that I wasn't asking enough questions during my orientation, but now I ask questions and ask for help all the time and when I do what I'm advised, I'm still at fault. Please help me understand what it is I'm doing wrong and what I need to do to correct it. I've considered finding another job due to my co-workers and their attitudes towards me at time ( I feel ostracized at times, and left out of the cohesion of the group, a whole separate thread), but I really like my kids and want to make the best of it. AT this point, I'm so on edge from the fear of losing my job that I'm afraid I won't be able to do my job.

[Liddle Noodnik]

There should be a place on that write- up where you are allowed to make comments. Find a way to consolidate the stuff you wrote here, without blaming or judging, just like an incident report. I do think it's appropriate to say on there that you did consult the senior nurse (or however that went down) re the Tylenol, and also say that you asked for help from coworkers re the bili lights, yes, ok to have you read the procedure ahead of time, but then do it WITH you. I'm sure NICU is busy TOO. And if they help you, you can turn around and help THEM with something.

As with the AST's, you realize they should have been done, it was an awful night, sometimes things don't get done. I agree the parents shouldn't be woken up at 5 am esp after the night they had had. That's good nursing judgment. Again on the comment section you can say, I agree it should have been done, 3 nurses were unable to complete it in a timely manner, I will try to do better. What else can you say? Most important thing with incidents and write ups is be honest, be humble, and own whatever IS yours, and don't be defensive or blaming if you can possibly help it. You are still fairly new; I don't think your job should be in jeopardy. Maybe too, re the bili lights, ask them, "How would you have handled it, if you asked for help and the floor staff was unavailable?" Put it directly, put it in THEIR brain, ask what THEY would do.

Not fun, it's not fun to be new, I am "old" and STILL pretty disorganized and easily overwhelmed; we do the best we can :)

[RNforLongTime]

First of all, don't listen to that senior nurse who told you to give the tylenol without the actual order. That IS practicing medicine without a license and you can get into deep doo-doo over it.

I would ask my manager if the previous two nurses who didn't complete the AST also got a write up. I try to do my admission assessments on my patients as I'm getting them settled, unless there is an absolute emergency that warrants my attention.

Maybe it's time for you to start reporting mistakes you find. Obviously, someone is tattling on you. Tit for tat, I say.

[ItsTheDude]

simply put, office politics can be more important than doing a great job. realize it, then either find a way to get along with your coworkers (they'll help you) or a way for them to just be indifferent towards you (they won't help or hurt you). if you can't do that, move on now or you're gonna get the axe.

i've seen some of the best workers get canned b/c they couldn't deal with office politics.

[jfosterrn]

Hi There! I really do feel bad for you, and I definitely can say that I know how you feel. Although I had never made a med error or been written up, I worked with a few "tattletale" nurses when I went from dayshift to nights. I had placed a critical labs sticker on the "orders page" in the patient's chart instead placing it on a page in the "progress notes". Mind you, the doctor was called per protocol and was given all the information and orders were received. BUT, I find out at my evaluation that one of the nurses made a copy of the page and brought it to my manager. Nice, huh? She could have just put the sticker where it belonged. I worked nights and when I did chart checks, if I found a small error, I would bring it to the attention of that nurse. Not everyone is like that, unfortunately.

This is my third job in one year so my self esteem is pretty fragile at this point. Read my first post on this website. I have come to find out that so much is based on whether the other nurses like you or not. Especially if you are the only newbie around. I took the advice I got, and sat down with my manager again and got a better understanding of what was expected of me. Maybe you can do that after a calming down period where you don't feel so hurt by this.

Things have been going better for me now, as I am really trying to talk less, listen more, and focus on my patient care But if they begin to go downhill, and I can honestly tell myself that it was not of my doing, I will not hesitate to change jobs again till I find my niche.

I wish you good luck and calm nerves! :)

[tigarlily25]

you sound like you are a new nurse in a specialty area. (peds). First of all you need to know that you are the newbie, and im sorry but everyone is going to start having to feel they need to prove themselves to you as the more seasoned experienced nurse then you. you will be the first to blame, when the blame game begins, and the one to be chastized is you. The more experienced nurses who have worked on this unit, have gained more respect and there word is valued more. First of all you may be a new grad, or new to the floor, but you need to start educating yourself. If bili lights are part of the knowledge you need to know for this unit, then i feel you should of prepared yourself before you walked into that room, before you asked another nurse, read the manual, look it up online, watch a you tube video, new parents, patients familys, are in a scary enviorment, and need to feel reasured and confident in there provider, if you seem uneasy, or appear you dont know what your doing, they will pick up on it very quickly, and they will uneasy as well. Make a list of things you feel you need to educate yourself more on for you unit, find time (break time) (after shift) to find a TRUSTWORTHY nurse to help you review these things and practice ..like setting up lights..seek a friend, preceptor, clinical instructor....make sure its not some backstabbing know it all who like to eat her own..who will seek brownie points..in letting the NM think you are not qualified...

secondly..i know you looking to the more nurses for answers...this is good to a certain degree, but you need to use your own nursing judgment as well, dont let anyone pressure you in to anything, you are the one responsible, and its your licence,..you are responsible for the "suggestions" you take. I think it was wrong for those nurses to even suggest that..they should know better ( be weary, its not like i think everyone is out to get you...but some nurses like to watch others fail...esp new grads). If i was there i would of told you not to give it, just to keep paging, and make sure to document, that the resident was paged and you are awaiting orders. document document document. as for doing the admission assessment, the nurses should have been held responsible as well...but forget them..be responsible for yourself...dont wait for others to do things..do them yourself..if you dont have time ..they stay until you get it done....some things can be delegated to an assistant..such as putting a pt. on leads and a pulse ox...dont overburdon yourself with things they can be delegated, thats what the aids are for..and even if sometimes they dont act like they want to work. .... i know they like to feel useful, and called upon other to wipe. Make friends on the floor, even find a way to make you enemies friends,..find out what they like, like to talk, about...ask the older more exp. nurses questions ( good questions) (when they are not busy!!!) make them feel like you respect them and there knowledge, and they will take you under the wing as a new baby nurse, and will want to help and Protect you...not eat you. But most importantly educate yourself. Make sure the NM knows you are taking intiative to learn, they know you are new and will make mistakes, they also know people will rat on you...you just need let them know you are progressing. Take it from as a new grad nurse in MICU if i dont know something i seek help from the people who i know have my back, and i read up all the time to keep learning, and to know what i need to know...dont let them get to you..show them im here and like it or not im not going anywhere....wants they figure that out, they wont target you, and you be an official member of club. stay strong and dont give...your friend.

[Liddle Noodnik]

I have to tell you a very sad story. I was working in an ICU probably in 84 or so. I had the old fashioned glass bottle chest tube system, rather than the newer plastic closed drainage system that I was used to. Well I don't even remember exactly what happened but I think it was that the drainage part was getting very close to full, so I asked the charge nurse what to do. She told me to go ahead and empty it, just disconnect it, dump it out, and reconnect it. Well of course when I interrupted the seal, the patient IMMEDIATELY went into respiratory distress and pain, and her HR went way up, I KNEW she was in trouble. So I screamed at the charge nurse to come over and she immediately knew what I had done wrong; She corrected the situation and the patient was all right immediately when she did. THANK GOD!

Yes, I was going by the charge nurse's instructions, but by rights since I had the patient, was unfamiliar w/ the equipment, and KNEW the principles of a closed system, I should have known better than to "just" disconnect it.

Well, bottom line is, SHE got disciplined, SHE got fired, SHE had to get unemployment, and I HAD TO TESTIFY at her unemployment hearing! She and her husband had a new baby! and she was my friend, to boot I felt SO HORRID.

I even tried to make it that I was fired too, or instead of her. Or at least that I would have a stricter punishment (like I said, having that equipment for the first time I SHOULD HAVE READ UP ON IT!). The powers that be wouldn't have it. How horrible. Of course I told my friend how terrible I felt, and that I had tried to defend her. Unfortunately our friendship went by the wayside. We corresponded a bit, she sent pictures of her, her husband, and the baby, but after a while we just had very little more to say

So - you're not just jeopardizing your self if you do things that you know "somewhere back there" are not right, you could ("you" being any of us) jeopardize someone ELSE's career. I don't even know if she ever worked again as a nurse. I know she stayed home w/ the baby for a long time, and wasn't working again for at least a year, before we went our separate ways.

[Liddle Noodnik]

you sound like you are a new nurse in a specialty area. (peds)....

I think that was excellent feedback you gave!

[Virgo_RN, BSN, RN]

The first year of nursing is ROUGH. You should post this to the First Year forum. I'm certain most new nurses can relate.

With the Tylenol incident, I think this points to a need for standing orders/protocols. In the absence of them, your hands are tied.

With the AST, I agree that you should not be held solely accountable.

With the Bili-Light Parents, I'm sorry you did not get adequate support from your team mates. I know what that's like, because I've been there. There are times when it's pretty much sink or swim. Chalk this up to a learning experience. I'll bet you know how to set up those bili lights now.

[mzjones6]

Thanks everyone for the advice, it was all good and constructive and I'm going to take everything you guys said to heart. I decided to file a grievance with HR about the write-up because I feel the situation wasn't looked into enough. The only issue I have now is that I have anxiety when I go to work, and at times I'm more concerned if I'm about to get fired as opposed to doing my job. I'm considering looking for a new job and just leaving, but I'll wait and see how the grievance process goes and weigh my options after that

Again, thanks everyone, you guys were a big help.

[Kooky Korky, BSN, RN]

Fight back on every point. Don't worry about fitting it into some cramped space on the write-up form. Write there "see attached" and attach your own typewritten, signed, and dated write out of all these things. Make sure you personally hand a copy to the Director of HR, one to your Manager, and you need to keep one. Type it on your home computer to automatically have it saved.

Own up to your own mistakes, like letting another nurse talk you into following HER Tylenol order. Also, you should have paged the next doc up the chain of command or gotten your Supervisor involved, paged the attending physician, or something if you were that worried about the child siezing and the 1st doctor would not answer her pages. Don't ever let a slow doctor/sleeping doctor/ or any other doctor hang you up again. You should have paged stat if you were that worried. If it was only going to take a couple of seconds to slap leads on or hook up a pulse ox, you should have just done it, I think. Never count on the next nurse to do it. I have learned this the hard way.

Include:

The doctor who didn't answer pages.

The nurse who wrote the Tylenol order.

The nurses who missed the 1 AST.

The coworkers who would not help you with the bili light, made the father nervous, and caused NICU to be involved.

You should be nervous when you go to work. You've got too many patients, you've got unhelpful and even dangerous coworkers, you've got doctors who won't answer their pages and nervous parents. Now this, too.

Just watch your back, trust no one, do your own work, learn bili light set-up on your own time if you have to, go totally 100% by the book. Do not fear paging the next doctor up the chain and/or the Supervisor. Let everybody know you are a force to be reckoned with, that you will not accept their slowness or unhelpfulness. Become a tattletale and inform your boss every time some nurse writes her own orders or a doctor doesn't answer a page within a very short time. Utilize stat paging.

The heck with feeling ostracized. Become strong yourself. Also, the next time the AST isn't done, wake up that parent. The heck with her sleep. She's not there to sleep. She's there to answer the AST questions if that's what is undone. Do it and do it now. Do it at your convenience, not hers. If she refuses, chart it. Then you at least have a leg to stand on. But tell her how sorry you are for waking her (if she brings it up - don't you apologize for waking her. you have a job to do, stop being sorry for doing it), tell her her answers will help you take care of Little Johnnie or Joanie, and do it. Git 'er done!

Stop feeling sorry for anybody, protect yourself. You see what happens when you don't. How dare some nurse decide not to follow an order for monitors because the child looks good! What!??????? How do you think that's going to sound to a jury? A prosecutor? A judge? Oh, well, the baby looked ok, so I ignored the doctor's order. NOooooooooooooo!!!!!!!!!!!!!!!!!!!!! Think and do always as

if you have a jury and lawyers and news reporters watching you, exposing you, judging you. give them nothing wrong to judge.

[Kooky Korky, BSN, RN]

I have to tell you a very sad story. I was working in an ICU probably in 84 or so. I had the old fashioned glass bottle chest tube system, rather than the newer plastic closed drainage system that I was used to. Well I don't even remember exactly what happened but I think it was that the drainage part was getting very close to full, so I asked the charge nurse what to do. She told me to go ahead and empty it, just disconnect it, dump it out, and reconnect it. Well of course when I interrupted the seal, the patient IMMEDIATELY went into respiratory distress and pain, and her HR went way up, I KNEW she was in trouble. So I screamed at the charge nurse to come over and she immediately knew what I had done wrong; She corrected the situation and the patient was all right immediately when she did. THANK GOD!

Yes, I was going by the charge nurse's instructions, but by rights since I had the patient, was unfamiliar w/ the equipment, and KNEW the principles of a closed system, I should have known better than to "just" disconnect it.

Well, bottom line is, SHE got disciplined, SHE got fired, SHE had to get unemployment, and I HAD TO TESTIFY at her unemployment hearing! She and her husband had a new baby! and she was my friend, to boot I felt SO HORRID.

I even tried to make it that I was fired too, or instead of her. Or at least that I would have a stricter punishment (like I said, having that equipment for the first time I SHOULD HAVE READ UP ON IT!). The powers that be wouldn't have it. How horrible. Of course I told my friend how terrible I felt, and that I had tried to defend her. Unfortunately our friendship went by the wayside. We corresponded a bit, she sent pictures of her, her husband, and the baby, but after a while we just had very little more to say

So - you're not just jeopardizing your self if you do things that you know "somewhere back there" are not right, you could ("you" being any of us) jeopardize someone ELSE's career. I don't even know if she ever worked again as a nurse. I know she stayed home w/ the baby for a long time, and wasn't working again for at least a year, before we went our separate ways.

Isn't it a crying shame that someone always has to be destroyed when a mistake happens? I don't know why anyone had to be fired. Yes, the patient suffered momentarily, but, I assume, recovered once the mistake was quickly corrected. Too bad that the bosses didn't just educate you guys. Educate, teach, instruct, rehabilitate.