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 CritCare, OutPt, Operational & Executive.
Hello - I've been an RN for over 32 years, civilian & military - HIGHLY recommend all the responders look up HEALTH WORK ENVIRONMENT.
"writing SOMEONE up" ? Focus on the issue & how it affects PATIENTS & SAFETY - don't take things personally. Instead of complaining - DO SOMETHING POSITIVE to correct processes along the way of patient care.
HIGHLY recommend your Managers look at TEAM STEPS & other team building programs. When you aren't busy in the ER (? I know that can be never) - but take time to get to know who takes care of the patients you deliver.
Ward RNs - Make friends with your ER co-workers - make it a 2-way street !
RNs: We are there because patients come to the hospital, via ER/planned admits/surgery, etc.
Please consider helping each other vice knocking each other down (LATERAL VIOLENCE)! It doesn't help.
I will never forget what it's like to be the new person ! HELP EACH OTHER & STOP COMPLAINING ! ! ! Pro-Active works better than Re-Active!
I am not a big fan of the eye roll or writing a colleague up. However, I do want to discuss the K+ of 2.7. That is critically low and could have resulted in ventricular tachycardia or Supraventricular tachycardia. If this happened on the way to the floor, could have resulted in death.
If you needed the ER bed, you could have gotten an order for iv potassium and placed the patient on a guerney with a portable monitor while the K+ bolus was infusing in over two hours. I am not concerned with the glucose of 209. That should have been just a recheck in two hours.
I am not trying to criticize but to educate. Good Luck.
I have done this for 5 years now...still don't have all the answers...lol.
I have only written up one incident...a patient who was on a Nitro drip was left unattended in a room, nurse was not notified that the patient had arrived. Patient was alone for 15-20 minutes before I went to the room, irritated that the patient had not yet arrived, to find the patient alone w/nitro drip unattended, w/bp 219/117, c/o chest pain. Otherwise, usually easy fix to deal w/issues once on the floor.
Specializes in CritCare, OutPt, Operational & Executive.
Maelsrm143 - I have lost count of how many times I have Self-Reported errors, many times noting a systemic problem (like in the old days having medications in alphabetic order - potential for errors goes down w/ single-dose administration.) can't recall how many times I've submitted "occurrence screens" , etc - whatever the name - the emotion has to come out * only the facts. It's not a game of tag, but a professional approach to solving issues that put patients at risk for harm.
The situation you described sounds dangerous & I hope the patient was ok. In person report/turnover is the safest way to manage, going over every order, med given, (to avoid missing a dose or giving it twice),IV lines, etc.
Keep the faith - I still love Nursing after all these years & am so glad that we are advancing the professional aspects across the board.
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.
Sending a patient to the floor without report regardless of reason is grounds for a write up. I can only guess that the nurse who wrote you up was busy (hence not able to come to phone for report) and then you sent up a patient who has elevated blood glucose levels (the DR could have used a sliding scale) and low potassium. You essentially tried to dump a patient and that's what bothers floor nurses. I'm sure you were busy in the ER and had the floor nurse tried to get a hold of you they wouldn't have been successful. How often does your department send patients up without giving report?
I am not a big fan of the eye roll or writing a colleague up. However, I do want to discuss the K+ of 2.7. That is critically low and could have resulted in ventricular tachycardia or Supraventricular tachycardia. If this happened on the way to the floor, could have resulted in death.
If you needed the ER bed, you could have gotten an order for iv potassium and placed the patient on a guerney with a portable monitor while the K+ bolus was infusing in over two hours. I am not concerned with the glucose of 209. That should have been just a recheck in two hours.
I am not trying to criticize but to educate. Good Luck.
Did you miss the part that I was giving a K+ infusion? I've mentioned it twice now in previous posts. I am fully aware of the low K+ and the insulin / K+ connection.
Sending a patient to the floor without report regardless of reason is grounds for a write up. I can only guess that the nurse who wrote you up was busy (hence not able to come to phone for report) and then you sent up a patient who has elevated blood glucose levels (the DR could have used a sliding scale) and low potassium. You essentially tried to dump a patient and that's what bothers floor nurses. I'm sure you were busy in the ER and had the floor nurse tried to get a hold of you they wouldn't have been successful. How often does your department send patients up without giving report?
Where did you get the notion that I didn't give report? Since you quoted my original post, I'm sure you saw that I did, in fact, give BEDSIDE report. After calling the nurse three times in 40 minutes to give report, I even tried to call the charge nurse to take report. So yes, if after 3 attempts, we take the patient up and give bedside report. In the two ERs I've worked in, that is pretty standard practice. It is hardly "dumping" a patient.
"Sending a patient to the floor without report regardless of reason is grounds for a write up."
Really, I have two thoughts on this. I normally work inpatient psych, but float to the Acute/crisis area, and we get perhaps 3-4 patients in 48 hours from the ED with no report. It's such a pattern its humerous (in a sick way) as if because they have psych issues, no physical/medical report will be needed. Though it's frustrating, I look at it as an oppotunity to educate, rather than a reason to complain (since I'm a crabby sort and I can always find a reason to complain :)
My other thought is that I see so many nurses quick to jump on the b*tchy bandwagon, and it never seems to occur to some of them to offer kudos to those that deserve it. And I'm talking about something equivalent, like a note to the charge or supervisor (we have a "service star" form at our facility).
I am the Team Leader of our shift. If any med errors/transcription errors/other errors are found I write them up, the others do not. It should come from a supervisor not a floor nurse. If management doesnt know about them HOW ON EARTH ARE THEY SUPPOSED TO BE CORRECTED? Everyone talks about the person being #itchy for writing someone up. But BE REAL people, we are only human, humans make mistakes. If we can learn from our mistakes and save someones life, lets do it. Heck, I have written myself up for med errors, even with others saying "dont write it up, they wont know, just fix the MAR" sorry, I was not brought up that way. I worked too hard for my license to lose it by falsifying records. Write ups are a TOOL to make us better.
Did you miss the part that I was giving a K+ infusion? I've mentioned it twice now in previous posts. I am fully aware of the low K+ and the insulin / K+ connection.
Where did you get the notion that I didn't give report? Since you quoted my original post, I'm sure you saw that I did, in fact, give BEDSIDE report. After calling the nurse three times in 40 minutes to give report, I even tried to call the charge nurse to take report. So yes, if after 3 attempts, we take the patient up and give bedside report. In the two ERs I've worked in, that is pretty standard practice. It is hardly "dumping" a patient.
Take it down a few notches, I'm not the one who wrote you up. At my place of employment we do not give bedside report.
everything's been pretty much covered previously, but just wanted to throw in that at my facility, unless it's for two very specific populations, the ED is not required to call report on any patient it sends up to inpatient units... (not sure if this is true for ICU, but definitely true for med/surg & stepdown)
when a patient is admitted to a busy floor sometimes they are not assessed by a rn for a while. a cna will get vitals and the patient may be left alone with a call light for some time. your patient with the high glucose and low potassium almost sounds like an icu admit? i think that is why the floor nurse was so frustrated. but writing people up solves nothing.
regardless of the who, what, why's, try to think of it as raising fellow nurses to your level. you are obviously an intelligent motivated nurse who really cares about these situations.
in the ideal world you would have a sit down with your manager the floor manager and some nurses from the floor. discuss what can be done, what is realistic to expect from each other. bring donuts, juice, and good coffee.
an icu admit? what kind of hospital do you work in?! that's a typical med surg admit, and no we don't always address those things right away. especially a sugar in the 200's, not that high for an er pt... we have bigger fish to fry
LaDFnDaUSNRN
4 Posts
Hello - I've been an RN for over 32 years, civilian & military - HIGHLY recommend all the responders look up HEALTH WORK ENVIRONMENT.
"writing SOMEONE up" ? Focus on the issue & how it affects PATIENTS & SAFETY - don't take things personally. Instead of complaining - DO SOMETHING POSITIVE to correct processes along the way of patient care.
HIGHLY recommend your Managers look at TEAM STEPS & other team building programs. When you aren't busy in the ER (? I know that can be never) - but take time to get to know who takes care of the patients you deliver.
Ward RNs - Make friends with your ER co-workers - make it a 2-way street !
RNs: We are there because patients come to the hospital, via ER/planned admits/surgery, etc.
Please consider helping each other vice knocking each other down (LATERAL VIOLENCE)! It doesn't help.
I will never forget what it's like to be the new person ! HELP EACH OTHER & STOP COMPLAINING ! ! ! Pro-Active works better than Re-Active!
Good luck & take care !