Jump to content

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

Emergency   (11,715 Views | 52 Replies)

KeeperMom has 10 years experience and specializes in ED.

9,115 Profile Views; 639 Posts

You are reading page 3 of Does your facility allow the floor/unit nurses write up other nurses?. If you want to start from the beginning Go to First Page.

4,266 Posts; 22,400 Profile Views

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.

Share this post


Link to post
Share on other sites

brillohead has 5 years experience as a ADN, RN and specializes in Cardio-Pulmonary; Med-Surg; Private Duty.

1,781 Posts; 22,981 Profile Views

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.

Share this post


Link to post
Share on other sites

MaleICURN has 46 years experience as a BSN and specializes in Critical Care, PICU, OR.

25 Posts; 3,699 Profile Views

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.

Share this post


Link to post
Share on other sites

maelstrom143 has 10 years experience and specializes in PCU.

397 Posts; 13,315 Profile Views

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.

Share this post


Link to post
Share on other sites

joanna73 is a BSN, RN and specializes in geriatrics.

1 Article; 4,767 Posts; 43,731 Profile Views

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.

Share this post


Link to post
Share on other sites

17 Posts; 978 Profile Views

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.

Share this post


Link to post
Share on other sites

FluffyNipper has 41 years experience and specializes in psychiatry, addictions.

14 Posts; 1,468 Profile Views

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.

Share this post


Link to post
Share on other sites

Altra is a BSN, RN and specializes in Emergency & Trauma/Adult ICU.

6,255 Posts; 40,651 Profile Views

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. ;)

Share this post


Link to post
Share on other sites

1 Post; 352 Profile Views

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.

Share this post


Link to post
Share on other sites

soapaddictOH has 10 years experience and specializes in BICU, ER, SICU.

33 Posts; 1,493 Profile Views

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.

Share this post


Link to post
Share on other sites

6 Posts; 3,520 Profile Views

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:

Share this post


Link to post
Share on other sites

gardengal1 has 25 years experience as a ASN, RN and specializes in ED only.

82 Posts; 2,552 Profile Views

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.

Share this post


Link to post
Share on other sites
×

This site uses cookies. By using this site, you consent to the placement of these cookies. Read our Privacy, Cookies, and Terms of Service Policies to learn more.