Does your facility allow the floor/unit nurses write up other nurses?

Specialties Emergency

Published

I got a QRR / write up a few weeks ago from the floor nurse because I sent up a patient from the ER with a 212 blood glucose, a 2.7 K+, the pt was NPO and I did not have an MD order to treat the BG. What I should probably mention is that I called report 3 times to the nurse who never came to the phone and I had to clear the bed for a Level 1 coming in. I wound up taking the pt up and giving bedside report.

My charge nurses just rolled their eyes over this one and I wrote a lengthy reply about the K+/insulin connection, reminding the nurse that the pt WAS NPO nor did I have an order.

Got another write up yesterday from another unit nurse for, get this, "Not properly completing Heart Cath consent form" and "Not prepping (shaving) patient for Cath procedure." I sent the consent for up with the chart but the cardiologist had not been in to see the patient yet and her cath was delayed a few hours. When I got the pt to the room the nurse even asked me about the consent form and I told her that and she just rolled her eyes. Ummm HELLO? There is a spot to initial that plainly reads, "I have spoken with my physician about the risks and benefits of this procedure." Having a patient sign there would be FALSIFYING DOCUMENTS!!!!!

I'm still scratching my head over this one. I'm still a rookie but never have we ever had a patient sign a consent form w/o the patient talking to the MD first, nor do we ever, ever shave a patient for cath. If they go straight to cath, the cath staff does all the procedure prep.

I guess what gets me all butthurt about the whole situation is what did the other nurse hope to gain from the write up?

It is common across the board for floor/unit nurses to expect ER nurses to do everything for them or what? I have never been a floor nurse but I did work as a tech through school (1+ years) so I have a pretty good idea of how it works up there. While I am a new nurse, I have over 18 years of corporate-type experience and I have never seen so much animosity between departments! I also don't get how a BS write up manages to go all the way up the chain to that dept nurse manager. Especially the untreated BS one. Doesn't that NM know that you can't treat an NPO pt with insulin? SHEEESH!

Seriously, if you have time to write up another nurse for this kind of BS, then maybe YOU could complete the prep and paperwork.

Does your facility allow nurses in other departments to write up nurses? What's the process and how does your ED handle these types of write ups?

Specializes in Emergency, Critical Care (CEN, CCRN).

Echoing what others have said: in our system, a PSQI (Patient Safety/Quality Improvement report) can be written by anyone, at anytime, on any subject. That report automatically goes to the involved departments' managers/directors, and by policy must be addressed within 24 hours of filing. Even if that's to say "no cause for complaint found, case closed," the NM still has to review and sign off the case, and frequently that means they'll ask you for your side of the story. However, our PSQI system is completely non-punitive, and PSQIs can't be used against you in any kind of job action, nor are they admissible evidence in any kind of legal action. In that sense, no, you can't be "written up" by anyone other than your supervisor.

Hope this helps!

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Specializes in Hospice, ONC, Tele, Med Surg, Endo/Output.
Ahh, the good ol' "writing someone up" instead of questioning him/her face-to-face or over the telly . . . Some like the feeling (and power) they get in giving someone the American shaft behind their back.:twocents:

People are really sneaky. They want to write you up without confronting you and they want a manager to treat you like a child during the reprimand. Makes you feel all warm and fuzzy about your fellow human beings, doesn't it. Sigh.

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Specializes in Medical Surgical.

I don't think you did anything wrong. I think there was probably more going on with the floor nurse than we knew about. It may have been "one last straw" for the day. Nurses strike out because they are hurting and cannot strike out at the people who have really hurt them, so they turn on each other. It's a well-known sociological phenomenon---lateral violence by oppressed groups. I feel for you. I feel for our whole profession. We will never climb out of this crab bucket by attacking each other. Hugs to you!

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Exactly- where DID they find the time? Lol..if only we nurses could learn to work together better, instead of spending so much time picking each other apart!

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Specializes in Professional Development Specialist.
That's a typical med-surg pt for me :lol2:

Sounds like an easy sub acute patient to me too!

I really don't think you did anything wrong. Obviously I don't work in a hospital but the ER is to stabilize and send the floor for treatment, right? 200 or so is not a life threatening or dangerous blood sugar and 2.7 is treated with oral K+ and not even considered a critical level. This is non hospital setting.

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I know how you feel I also just started in ED. I had a floor send down the charge nurse to reprimand me the other day because I was "short" with them. I did not deny it and told her I was "Short" with them. Every time I have sent a patient to this floor they give you a run around. First its the room is not empty. Then call back almost an hour later the room is not clean yet. Call back almost another hour later and Oops they cleaned the wrong room that one is not ready. This patient had been in ED all day on a stretcher and had a blood clot in his leg. He needed to get upstairs and get settled. Never mind that I had three other patients all needing to go upstairs all needing regular pain medication. Of course I was "short" with them they were giving me the run around!

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Specializes in Urgent Care NP, Emergency Nursing, Camp Nursing.
I don't think you did anything wrong. I think there was probably more going on with the floor nurse than we knew about. It may have been "one last straw" for the day. Nurses strike out because they are hurting and cannot strike out at the people who have really hurt them, so they turn on each other. It's a well-known sociological phenomenon---lateral violence by oppressed groups. I feel for you. I feel for our whole profession. We will never climb out of this crab bucket by attacking each other. Hugs to you!

Maybe it's 'cos I'm a guy, maybe it's 'cos I'm fortunate in my work environment, and maybe it's 'cos I disagree with second-wave feminism, but I don't respond well to the pleas of victim-hood by nurses and using such pleas as excuses for poor behavior.

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Specializes in Medical Surgical.

To The Squire: and maybe it's because you are an ER nurse. I am not excusing behavior, nor being a feminist, second wave or first or whatever, nor excusing behavior. I am saying sometimes you just blow up and take it out on someone who can't fight back as effectively as the person or group you're really mad at. I'm all for stopping this. I don't think we ought to be content with pecking away at each other. Don't think this is feminism; this is advocating for the profession and the impossible tasks we set ourselves. Something's got to give; why is it always how we treat each other?

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You really have to pick your battles. Not treating a 212 BS is not earth-shattering. That was petty. On the other hand...you really should have addressed the K+ of 2.7. I'm not being mean by saying that. Especially because if someone does treat the 212 BS with insulin, it could cause the K+ to go even lower because insulin can "chase" the K+ into the body cells thereby lowering the available potassium. If you ever have a DOA because of hypokalemia, you will appreciate why this needs to be corrected. We usually give a bolus of D50 along with an amp of NaCO3 and 10 units of insulin which can greatly treat hyperkalemia. That's just food for thought for the next time. As far as not prepping for a cath..is this a policy to do so? Or is this just Cath Nurses who feel they should have a maid and a butler? As far as not geting consent, you were absolutely in the right. It is not like signing your voter's card. It is called INFORMED CONSENT meaning the MD informed the pt of the risks and benefits of having a heart cath. It is not within your scope of practice to legally give the skinny on a procedure and get the pt to sign. If something went wrong, you would be on the other side of a courtroom. That's all.:redbeathe

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Specializes in Psychiatry, ICU, ER.

I would not have done the consent in that situation, either. You were right not to do it, though there is always pressure for you to get it done by people who don't want to do it themselves. Stand your ground when you know the right thing to do.

Even if the cardiologist HAD spoken to the patient, if I get a room or they head to cath lab or wherever before I can get the consent, I put a blank consent on the chart and let the receiving nurse know it still needs to be done. Policy varies from facility to facility, but it ultimately comes down to the physicians, cath lab teams, and OR teams to do a time-out and to make sure consents are signed and on the chart, not mine. Consents are important but there are more critical things, and if I don't get to it because I have other more important things going on... like most other things in ER... pass it on.

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Specializes in CVICU, Obs/Gyn, Derm, NICU.
I don't think you did anything wrong. I think there was probably more going on with the floor nurse than we knew about. It may have been "one last straw" for the day. Nurses strike out because they are hurting and cannot strike out at the people who have really hurt them, so they turn on each other. It's a well-known sociological phenomenon---lateral violence by oppressed groups. I feel for you. I feel for our whole profession. We will never climb out of this crab bucket by attacking each other. Hugs to you!

I am totally tired of these women (and yes ...most of them are women).

Pathetic behaviour by women who have received so much advantage compared to women from many developing countries.

They need to get a life ....really do !!!

The issues caused by this sociological phenomenon are significant for our occupation.

Soul-sucking, demoralising, energy sapping effects which have significant impact on p't care, retention and work culture

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Specializes in ED.
You really have to pick your battles. Not treating a 212 BS is not earth-shattering. That was petty. On the other hand...you really should have addressed the K+ of 2.7. I'm not being mean by saying that. Especially because if someone does treat the 212 BS with insulin, it could cause the K+ to go even lower because insulin can "chase" the K+ into the body cells thereby lowering the available potassium. If you ever have a DOA because of hypokalemia, you will appreciate why this needs to be corrected. We usually give a bolus of D50 along with an amp of NaCO3 and 10 units of insulin which can greatly treat hyperkalemia. That's just food for thought for the next time. As far as not prepping for a cath..is this a policy to do so? Or is this just Cath Nurses who feel they should have a maid and a butler? As far as not geting consent, you were absolutely in the right. It is not like signing your voter's card. It is called INFORMED CONSENT meaning the MD informed the pt of the risks and benefits of having a heart cath. It is not within your scope of practice to legally give the skinny on a procedure and get the pt to sign. If something went wrong, you would be on the other side of a courtroom. That's all.:redbeathe

So let me get this straight. You think not treating the 212 BS is petty?

I think you also missed the two previous posts saying I WAS treating the 2.7 K+ nor did I have an MD order for any insulin.

As far as prepping for cath goes, we do not prep for cath unless we are CERTAIN the pt is going to the cath lab AND we have the consent and it is an emergency situation. In this case, it was neither of the two. It was not an emergency cath, nor had the patient's doc been in to see her. Even if we do have a pt going up for an emergency cath, we may only shave 50% of the time - depending on how much available time we have in the ER before the pt goes up for procedure.

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