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?

Our floor nurses wrote up anything they found that was an "incident". I'd witness anything if needed. If I (charge) found it, I wrote it up.

Specializes in Cardio-Pulmonary; Med-Surg; Private Duty.
You really have to pick your battles. Not treating a 212 BS is not earth-shattering. That was petty.

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

I don't want to speak for anyone, but just give my perspective on what crabalot said. I read this as saying b/c the 212 BS wasn't a big deal, the other nurse's complaint about that aspect was petty.

Specializes in Critical Care, PICU, OR.

212 mg/dL BS is relatively OK, I don't know patient's big picture. Obviously doesn't look for a DKA.

But K+ 2.7 IS very LOW. Patient is significantly HYPOKALEMIC.

On my ICU even with patients on sliding scale KCl protocol, besides running K rider (40 mEq) we usually call the physician for (typically) back to back 40 mEq KCl.

Again, I don't know the big picture. Maybe the patient was renal? His/her BUN/Creat???? But if renal, nephrologist should be contacted. Anyway, the biggest mistake was to admit such patient to MED/SURG.

Specializes in PCU.

You have a valid point for not treating the FSBS of 212. It was not a critical high and could easily be corrected once on the floor. Furthermore, the K+ levels could have been adversely affected by lowering the blood sugar too quickly. As to the K+, you stated (later) that you had been infusing (as I assume that is what you meant when you said it had not had enough time to finish infusing). Therefore, you were treating the K+ level.

I think the biggest problem here might be that the floor nurse is not aware of the rationale behind your actions, or of the link between K+ levels and insulin levels and the charge failed to educate her as to what might happen to K+ levels when treating insulin levels. Often, floor nurses (I have covered ER and floor) do not think like ER nurses and their priorities are different and they erroneously assume that an ER nurse should think like a floor nurse. JMHO.

Specializes in geriatrics.

The only person who should have authority to write anyone up is the supervisor. Coworkers should never be allowed to write each other up. That hardly seems fair.

I work in a facility where perceived concerns regarding patient safety and workplace disruption are encouraged to be documented. Having said that...it is couched in a just culture where the focus is problem solving and process improvement. When there is perception that every issue brought to someone's attention is punitive, nothing is accomplished. This would be an ideal time for some education and team building between these departments. We all think we're the busiest and most overworked so we plant our feet and do nothing to move forward. A department shadowing and a shared leadership approach where the staff representatives form a team where professional and constructive dialogue is welcomed might lead to process improvement and a better understanding of each depts.unique needs. Just a thought.

Specializes in psychiatry, addictions.

Nurses writing up other nurses usually means that the "writing up nurse" doesn't have enough to do and his/her unit is overstaffed. It's also the reason that I will never work for another nursing unit again in my life.

Specializes in Emergency & Trauma/Adult ICU.
212 mg/dL BS is relatively OK, I don't know patient's big picture. Obviously doesn't look for a DKA.

But K+ 2.7 IS very LOW. Patient is significantly HYPOKALEMIC.

On my ICU even with patients on sliding scale KCl protocol, besides running K rider (40 mEq) we usually call the physician for (typically) back to back 40 mEq KCl.

Again, I don't know the big picture. Maybe the patient was renal? His/her BUN/Creat???? But if renal, nephrologist should be contacted. Anyway, the biggest mistake was to admit such patient to MED/SURG.

I agree we don't have the whole picture of the patient. But I'm curious about your comment that the patient was inappropriately admitted to a med-surg unit.

I do not feel this is necessarily inappropriate. OP has stated that a K+ infusion was begun in the ER, and a K+ of 2.7 is not in and of itself a critical situation without evidence of arrhythmias. A patient who has been vomiting or had diarrhea for 2-3 days can easily have a K+ of around 2.7 -- this does not necessarily make the patient critical care material. (and BTW -- ER patients who have indeed had diarrhea or been vomiting for a few days and who are hypokalemic in the range being discussed here ... often get some fluids, anti-emetics, p.o. K-Dur, and go home.

I know when you work in the critical care environment it's easy to get in the mindset that everyone should have textbook-perfect lab values. ;)

A coworker of mine was told by the manager to STOP writing up the other nurses. She is very condescending and it is amusing bc she will tell much more educated, experienced coworkers, doctors, ANYONE AND EVERYONE how to do everything. She is very young and has not been a nurse more than a few years, but she really truly believes she knows all. It is sad, really, bc I have wondered what she is missing in her personal life that she tries so desperately to fill in with insulting her coworkers.

Specializes in BICU, ER, SICU.

I left ER and went to SICU recently. I also don't think a glucose of 212 is something to freak out about. I am still stuck in the ER mindset of blood pressures. I hate calling the floors and giving report- God forbid the patient has a blood pressure of 179/85. "Was the blood pressure addressed?" No. "That patient needs to be medicated for his blood pressure before he comes to the floor." Really? The nurses/docs are like that in the unit too. I have written up other nurses a handful of times in 10 years. Sending a patient to surgery with a K+ drip on straight tubing running wide open was one of the write ups.

can you imagine if physicians did this kind of petty behaviors - maybe we should take along look and learn from them about professional relations

haha! one of our surgeons wanted a QA written up on our HUC because there weren't enough blank progress notes papers in a chart. :uhoh3:

Specializes in ED only.

People do this crap in our hospital all the time but fortunately, we never see them. At staff meetings, our boss will tell us we have had some write ups about ie: sending a pt for a MRI with a running IV rather than a saline lock; elderly demented female was wet when she arrived at X destination (she was dry when she left ER); there was a spot of blood on the siderail of the ER cart, ICU complains we did not do X, Y and Z before they got the patient, etc. Our boss mentions this stuff as a general learning situation and does not look at nor point out who might have been the offending nurse. Sometimes, she gives the other complaining department head an ear full (in a nice way - she never gets mad). We all let this stuff roll off our backs - we have to, otherwise, you begin to question your abilities.

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