Excessive write-ups at work

[Little_Mouse]

I'm a new grad (have been working for 6mo. now) and the unit where I work is known for excessive write ups. This includes ANY med errors, but also forgetting to put a meal percentage or not completely filling out a graphics form, or even forgetting to sign a signature somewhere, like the bottom of the MAR. We have a union at work, but with talking to my fellow co-workers, no one (including myself) bothers to call them when they are written up for whatever reason (fear of rocking the boat?).

The write ups seem to get much worse now and the DON is insistent to my charge nurse that any incident should be written up quickly, so they are sent to HR as soon as possible. I'm on second shift, so we tend to get the brunt of the write ups...first shift doesn't seem to get as many since we're covering their butts and night shift that does the chart audits...well, who's to cover them? You can imagine they get written up a lot *sarcasm*.

This is really putting down the morale, especially during my shift. I'm thinking it's best to be looking for another job, a place friendlier to new grads...or finally bringing in a union rep during during a "conference" (aka write up)?

Sorry, just needed to vent. The work pays well and it's not nearly as stressful as other units (as I would imagine since I work), but I'd rather go for a place a little more stressful with a little less pay for a more supportive management and environment.

[Not_A_Hat_Person, RN]

Why not go to the union? Aren't you paying for workplace representation? If I were in your shoes, I would bring the union rep in for every single "conference."

[CNM 26.2]

What do you mean by "write up" are you referring to a disciplinary process or are you referring to something like an incident report? A lot of times incident reports get a bad rap but really they serve a good purpose. An incident report can instigate an investigation into a process that may be in need of changes. For example, you mentioned "ANY med errors." ANY med error SHOULD be brought to someone's attention-there is no med error that should go unreported. Sometimes med errors are the result of a poor process and not because the nurse that committed the error is incompetent. For example, I have seen situations where meds that look alike are stored next to each other in the med room and the wrong med was given when the nurse was in a hurry-in fact, it happened a few times-an incident report resulted in the simple fix of moving one of the meds to another area and the med errors stopped.

Now, if the "write ups" are petty and obviously one nurse trying to sabatoge another nurse that's another story. I was at work one day and got a call that my pregnant sister was in the ICU at another hospital in the same city in CHF and renal failure, unresponsive and one of her twins had died and they were inducing her for the second twin at 23 1/2 weeks. Luckily, we were a little overstaffed-I was the charge nurse but the manager was available so she acted as charge nurse, I told her that I had a little charting that I needed to finish but I would come back after I knew more about my sister and finish it. I KNOW this was not the best practice but at the moment I was very worried about my sister. I came back three hours later after things were stable and the nurse that took over had already written me up for not completeting my charting-she did it the second I left. Luckily my manager was understanding and disregarded the "write up." If these types of things are happening then it needs to be addressed, otherwise, learn from the observations of others-everything you mentioned is something that needs to be addressed-all charting DOES need to be signed, all med errors DO need to be reported.

[caliotter3]

If you would start bringing in your union reps, the write-ups might diminish in number. After all, that is what the union is for. Sounds to me like your employer has found an effective way to circumvent the union and they are taking full advantage of it.

[Music in My Heart]

Write-ups because you forgot to sign the MAR? Sounds pretty over-the-top to me.

Sounds like all the nurses need to be looking out for each other (we'll often pass a note along saying that something wasn't initialed, etc.)

[llg, PhD, RN]

What do you mean by "write up" are you referring to a disciplinary process or are you referring to something like an incident report? A lot of times incident reports get a bad rap but really they serve a good purpose. An incident report can instigate an investigation into a process that may be in need of changes. For example, you mentioned "ANY med errors." ANY med error SHOULD be brought to someone's attention-there is no med error that should go unreported.

...

Now, if the "write ups" are petty and obviously one nurse trying to sabatoge another nurse that's another story.

My question exactly. It is important for nurses to not confuse the legitimate and necessary documentation of actual errors and potentially dangerous "near misses" from petty nit-picking with each other. It sounds like that's what might be happening on the OP's unit. If that's the case, then education for everyone (including management) is in order -- education regarding the appropriate use of incident reporting, disciplinary processes, and teamwork.

Assuming there is no unit-level educator or manager that the OP can talk to about this, then perhaps the union is her best resource -- not to complain about "unfair treatment," but rather to ask for assistance in clearing up possible misunderstandings and overuse of the "write up" process.

It's funny... I hear people talk about "getting written up" on allnurses all the time. I have worked in 6 different hospitals in 6 different states during my career, and have never worked in a hospital where that term was used officially. Of course we've always had some sort of incident report for errors that needed to be investigated -- but it has never been a punative catty thing where nurses attacked each other as people describe here on allnurses. I've always wondered why that is.

[TickyRN]

So what is the union there for?

[Flying ICU RN]

This is a confrontational or totalitarian management style. This type of management is the usual choice for those who lack both the skill and finesse necessary to provide "leadership by example."

Where in the short-term the benefit may seem to be a decrease in perceived infractions, the long term cost to the employer will be turn-over costs, as the current surplus of Nursing Staff is not sustainable. Adversely effecting the bottom line, is not the way to win brownie points with the corporate office, and will eventually cost someone their job.

In the meantime, read both your union contract and in-house personnel policies in detail. Whenever they (unit Management) are in clear violation of a policy, submit a clear, concise, and professionally, "written" response (memo with copy to the union). Effectively turning the tables and "beating them over the head" with their own policies!

Do this only in fighting your own battles, don't become the unit Judas Goat.

[SoundofMusic]

This is exactly the reason I've left my current position -- petty write ups of the staff by our management. It's just gotten ridiculous and in these times when the staff is constantly short and being cut back, I wonder if they're doing to just get MORE nurses off their payrolls. Whatever the reason -- I'm not going to work under constant threat. Everyone makes errors at times, especially when short staffed and under supported w/ a heavy workload -- which is the constant norm nowadays.

[chloecatrn]

Okay. Now, I had a gorgeous reply to this post earlier, and it got eaten. So let's try again.

Forgetting to sign the MAR, or med errors are not excessive write ups. They are absolutely things that you should be written up for. And I know that a lot of people will put a post it on a MAR so that Suzie Q Nurse can sign when she comes in the next day. But I can't remember if I take my vitamin in the morning, so how am I going to remember if Michael Jackson in room 432 took his, or if he refused it? And if he refused it, and I document that he took it, it's a med error for false documentation. "But," you say, "it's just a multivitamin!"

And that's all well and good. It's just a multivitamin that you forgot to sign off. So we'll grant leniency on that. But if a whole page gets missed, because poor Suzie Q. Nurse flipped and two pages were stuck together, should we just assume that the pages were stuck together? Or should we write her up for that? Especially since tonight, that was the PRN page, and Michael Jackson asked for his propofol for sleeplessness, and there seems to have been an incident... (Okay, I'm trying to inject a little levity into the situation. )

As far as missing meal percentages, that seems a little more nit-picky. Again, though, if that's on someone with a gaping stage IV wound whose nutrition is crucial to their healing, and the amount of protein taken in is really crucial, I can see where that's a problem. Maybe a better place could be found to keep the nutrition sheets? Could they go with the MARs, so that when you go to double check your MAR at the end of your shift, you double check your meal percentages?

I don't mean to make light of these things, because I understand how serious they feel to you. Med error write ups should never be punitive, because they should be used as a learning tool. But you've got to understand that med errors, in the end, kill people. Signing off MARs is how we, as nurses, signify that we have double checked the MAR and they are correct, at least anywhere that I've ever had paper MARs.

If you're working evenings and you're covering daylight's behinds, STOP. It's not fair to anyone, including the patients who have been subjected to the errors that you're fixing and covering up. (Again, I am talking about poor Mr. Jackson and his propofol that may or may not have been signed off. Not Betty Boop, his next door neighbor, who might have eaten 65% of her meal, but we're not sure.) I second the PPs who have said that you should get your union reps involved. Not so much as a demand for the write ups to stop altogether, but as a request that what actually constitutes a write up be re-addressed with the staff.

Good luck.

[loriangel14, RN]

Getting written up for forgetting to sign the MAR is excessive.We use post it notes to remind whoever they need to sign for something.Where I work I have never even heard of someone being written up.We have incident reports but they are merely for record keeping of incidents, not used to punish.

You and your coworkers should NEVER attend any sort of meeting with management without your union rep present.That is asking for trouble.

[Blackheartednurse]

Heh,I know how you feel I get a lot of "verbal" writes up.I work as a home health nurse and they put a huge emphasis on the paperwork and sometimes I forgot to sign something or make some paperwork error.But today I almost had lost it when after having a very hard day yesterday with one of my patients who had a very critical blood pressure and refused to go to emergency (I stayed with him for couple of hours and came back home at midnight) my boss gonna tell me that I have been putting different heights in one of patient in progress notes!!! Really ok so the paperwork isnt perfect,but I just spend like literally 14 hours yesterday driving seeing patients and one patient had a blood pressure of 250/140 and I had to stay with him for like couple of hours (for free) but the first thing you going to say freaking papework instead of thank you.