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

Emergency   (11,769 Views | 52 Replies)

KeeperMom has 10 years experience and specializes in ED.

9,160 Profile Views; 639 Posts

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?

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289 Posts; 10,115 Profile Views

anyone can write up anyone for anything these days. but I don't know where the nurses found the time... Hang in there...

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prettymica specializes in hospice, HH, LTC, ER,OR.

776 Posts; 14,113 Profile Views

As they say... nurses eat their young.. why IDK, we all started from the same beginning... new, and inexperienced.. *****HUGS*****

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199 Posts; 6,544 Profile Views

If you didn't do anything wrong, I wouldn't worry about it. Anyone can write anyone else up, anytime. What did your manager/supervisor say about this? It doesn't surprise me to hear about the animosity between departments -- I think this is actually quite common in hospitals. You know the saying...Everything is always greener on the other side of the fence...

Good luck to you!

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msjellybean has 4 years experience and specializes in Emergency.

277 Posts; 5,201 Profile Views

Um, what were the circumstances surrounding the potassium? Was a K rider ordered or infusing?

And yes, you can treat an NPO pt with insulin.

In my facility, all incident reports go the the dept manager, because that's how the system is set-up. The nurse that wrote you up isn't seeking to gain anything for him/herself, nor to hurt you in anyway. They're completing an incident report because they saw a lapse in proper patient care/safety & they're obligated to report it. Edit to add: I'm only referring to the first incident you mentioned with this, not the cath example.

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brownbook has 35 years experience.

1 Follower; 3,383 Posts; 45,995 Profile Views

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.

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SilentfadesRPA has 14 years experience and specializes in ER/ MEDICAL ICU / CCU/OB-GYN /CORRECTION.

240 Posts; 6,921 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

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601 Posts; 10,047 Profile Views

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.

That's a typical med-surg pt for me :lol2:

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601 Posts; 10,047 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

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:

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ChristineN is a BSN, RN and specializes in Pediatric/Adolescent, Med-Surg.

3,464 Posts; 28,726 Profile Views

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.

Just curious as to why you think this pt would be inappropriate for a med-surg floor? Give the pt a few K riders, monitor the blood sugar, nothing really critical going on based on the information we were given.

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KeeperMom has 10 years experience and specializes in ED.

639 Posts; 9,160 Profile Views

Um, what were the circumstances surrounding the potassium? Was a K rider ordered or infusing?

And yes, you can treat an NPO pt with insulin.

I'm not going to treat a 212 BG for a patient that is NPO and headed to the floor. #1 - I don't know when the patient is going to be able to eat again and I have no control over when or if the receiving nurse is going to be able to address the hyPOglycemia and LOWER K+ I just created for the patient. #2 - I can't treat it w/o a doc's order which I told her THREE times I didn't have.

To further clarify, we were treating the 2.7 K+ which will naturally lower the BG in time. We just didn't have time to let the full K+ treatment infuse before she got the room assignment. If I treat the 212 BG and I "over treat" it w/o any food behind it, I'm going to further lower the K+ which is a far more critical situation in my opinion.

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ChristineN is a BSN, RN and specializes in Pediatric/Adolescent, Med-Surg.

3,464 Posts; 28,726 Profile Views

I'm not going to treat a 212 BG for a patient that is NPO and headed to the floor. #1 - I don't know when the patient is going to be able to eat again and I have no control over when or if the receiving nurse is going to be able to address the hyPOglycemia and LOWER K+ I just created for the patient. #2 - I can't treat it w/o a doc's order which I told her THREE times I didn't have.

To further clarify, we were treating the 2.7 K+ which will naturally lower the BG in time. We just didn't have time to let the full K+ treatment infuse before she got the room assignment. If I treat the 212 BG and I "over treat" it w/o any food behind it, I'm going to further lower the K+ which is a far more critical situation in my opinion.

You could have gotten an order for a K run, However, I get that is not your #1 priority in the ER. A K of 2.7 is not a critical value where I work, so it could wait until the floor to get treated. Now if it's a slow night, you could totally get a K order, but I certainly would not expect that.

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