written up already!

[janetrette]

By Dec. 27, it's going to my 6th month evaluation and already I had been written up!!! My patient had a bone marrow aspiration biopsy and needed to keep NPO after midnight and he was keep NPO. It wasn't until the day during shift report I realized that there was an order to administer IV fluids. I felt bad since i really didn't see that order. The next thing I know I am being written for that. The patient wasn't diabetic for fyi. I understand it's my fault but felt somewhat discouraged. I feel right now my manager is eyeing me all the time right. now. I had my 5th month evaluation and he said i'm doing so well. but this was all before this incident. I feel discouraged. I know my patient isn't harmed at least. I hate to put everything in an excuse but I got my shift report from not the greatest person to get report from. The person who wrote on me was a float nurse.

My manager discussed with issue with me and wanted me to sign the paper in another time. Should I sign it? There are so many things that I could written up on others but still debating about that since I'm still kinda new. Like for instance, that same nurse that report to me didn't give the 2 K ryders order at 930am. When I go into my shift, I asked her did you give it? She said no. I had to call pharmacy to get the Kryder which they didn't give it to me only gave me 1 of the 2 Kryder. After the 1st one finished I made the doc order a BMP for the K. That nurse said, it's not a big deal. The k is only 3.2

I feel like a mixture of feelings.

[tommycher]

Was it an order to begin IV fluids at 0600? Often that is an order for a cardiac cath or a procedure using conscious sedation. It would seem to me, that if you are giving report at 0700, and it is noticed the fluids have not been started, it would be no big deal to just go ahead and start them. I cannot see how a lack of 125ml or whatever the order was for, would cause such a problem. However, if the order was written on the previous shift for fluids, and they were not started all night, then certainly it was neglectful to not complete the 12 hr or 24 hr chart check and catch that yourself. But, no harm done, and we all learn from our mistakes, and trust me, there will be mistakes. Graduating from nursing school does not ensure infallability in a human being, so do not beat yourself up, this is how we learn to become more diligent. Good luck!

[danissa, LPN, LVN]

Bone Marrow aspiration/biopsy..yes I have had that done, no anaesthetic other than local.(which was agony scraping on the bone)

Thouroughly nightmare procedue, even sedated I would think! (even though I wasn't one bit)

[tommycher]

Most often lumbar punctures and bone aspirations/biopsies are done with local anethestics, yet we still have to make these pt.'s NPO, due to the possibility of nausea/vomiting, and we still have to do the same recovery/vitals once they return to the floor. And, most often, in the case of hypotension, the docs do like for them to have fluids infusing.

[ASSEDO]

you are free to write a rebuttal to the action. do you have too many patients assigned to you that day? could you read the physician handwriting? give your side of the story and make sure you keep a copy of your rebuttal for your records.

you agreed that it was a medical error on your part so consider the write up as a benchmark of the learning process, and keep your head up.

good thought coming your way!

[NJNursing, ASN, RN]

Try not to get overly worked up about it. It's just a written warning and it wasn't a detrimental error, it was just IV fluids. If right after I get report it's not crazy i'll take a quick peep through the charts looking for orders written during the day (especially if I'm working back to back days) just so I can have a quick idea of what went on during the day because I know that not every nurse is a good historian for report and some things get missed because they're in a hurry or distracted. If I don't do it right after report I'll at least do it within the first 4 hours of my shift because our secretaries leave at 11pm and then I'm on my own the rest of the night in terms of charts.

It's a learning experience and as long as you do learn from it, you're showing to be human.

[AprilRNhere]

You guys are giving her advice on a situation that happened in 2005. This is a very old thread.

[Sabby_NC]

Part of the Nursing Learning Curve you are going to go through. Learn from this mistake and be more vigilant in reading post procedure orders. You will do fine.

[lorabel]

I feel for you and know just how you feel....I've been a nurse for only 3 months! I graduated in may 2007 but didnt start work until sept. had 6 weeks orientation and 1 week classroom orientation. I havent been on my own for thatlong.....just 2 days ago I got a verbal warning for not pushing my med cart everywhere i went and for being accused of not signing right away for meds i agve...the part about the cart is true...signing for my meds is not! I had to meet with my director and new hire support nurse. When i was told about the med cart I was dumb founded. no one EVER told me I couldnt leave it parked and locked in front of the nurses station! what i did was...I was standing at the nurses station charting and left my cart to answer a call light.........There were other nurses there and my cart was locked so I didnt think anything of it. Ive seen other nurses do the same thing........my lesson...know policy and NEVER assume what other nurses do is ok. I was too upset at the time to tell them I didnt know i couldnt do that........I asked later and found that if you leave your cart it has to be locked and pushed inside the nurses station! Secondly, the reason I didnt sign for the meds as i was accused of is becoz another nurse asked if she could help and pass meds for one of my patients......I had just come out this patients room and given her po meds...she had just come back to the floor and i was catching her up on meds.........I had the cart with me so I gave the po meds and reassessed her since she was just back on the unit...she had been npo. Anyway, I planned to get her other meds which included an IV piggyback, b12 injection, lantus, and one other injection..which were not in my med drawer..........before I had to chance to say anything, this nurse starts grabbing my med sheets. I said wait a minute, I have to see what else she needs.....this is going on right outside the patients room at my med cart. she says i'll get it and off she went. I said wait, I have to sign off on the po meds. she came back and said, sign off so i know what i can give.....she went to the director.......ok...I admit i could have signed in the room as was pointed out to me....I was too upset in the meeting with the director to defen myself and tell her how it really happened......I just took my lumps and the attitude that it wasnt going to change anything.....would they believe a new nurse or a more experienced one? i had a lot going on at the time but thats no excuse......I should have stopped the nurse before she came in like a bull in a china shop and started pulling my med sheets out of my binder.....I was also told that I was unorganized...well, yeah.......I just came out my patients room and another nurse is talking and pulling my med sheets from me. i'm not an aggressive person in the least and avoid conflict at all costs...something that has to change. I need to learn how to stand up for myself along with many other lessons........I feel like I cant trust anyone......I feel completely alone and depressed. As a new nurse, I never hear words of encouragment or anything positive..never you are doing a good job, etc.....I know in my heart that I am. I work in oncology.....Many patients and family members have told me so.......I can make my patients laugh and laughter is sometimes the best medicine. It boosts their morale and makes them feel better. i'm never inappropriate and I can sense who I can be this way with and who just needs pampered or left alone in misery....My support nurse has told me that at least 5 different patients have told others how caring I am and what a difference I have made to them or the families...a couple told me i'm their favorite nurse (not necessarily a good thing) and theylook forward to me coming in and are disappointed when I'm not there. Our patients stay a week or more.some have been there for a month or longer........I feel so lost. I'm wondering if i should just quit and go somewhere else......would it be any different? I have to stay within the network for 2 years becoz i took the sign on bonus......I'm supposed to stay on my unit for 6 months but wonder if I could transfer??????? I and other new hires feel like we dont have any support from management.......the PNCCs are nasty and short with us when we ask what they consider dumb questions or ones we should already know the answer to...some I do know, but i ask just to be sure..thats what i was told to do. Some days i love my job and some days I hate it. right now, i'm hiding under a rock and trying not to beat myself to death.........contemplating LTC which I dont want....its less stress......but i love the hands on nursing.......dotn know what to do. I dont think I would get anywhere but on the bad side if I talked with my director and told her how i feel. She tells you one thing but does another.....

[Grayeagle]

Lorabel:

'Nursing eat their young' applies where you are.

There are better places to work.

I would start looking .. the added stress they are laying on you is just not required.

If you really enjoy where you are and the treatment you are getting is the only real issue, have a heart to heart with the DoN.

Tell her what is bugging you, point by point.

Write an outline, make an appointment and come in on a off day so you dont have shift work hanging over you and plan on hammering it out.

A good manager doesnt want to lose an employee.. they will work with you.

A bad manager isnt worth the time of day.

Writeups in general .. I got hammered for a procedural error in paperwork -shrug-

..new to the process so I wrote an outline for that particular process in my notebook and went from 'paperwork screw-up guy' to 'you did a great job on that'

..a wise man told me long ago 'a good pilot always evaluates the situation then applies corrective action' ..in Nursing it's been paraphrased but it remains true. Evaluate the situation, apply corrective action and move on :)

-Frank (just started pre-req's after bein an LPN for a year and a half)

[lorabel]

thanks. I've heard that expression before. After the fact..of accepting the position on my Unit...I heard from other nurses from different floors that its the hardest unit to work and that the nurses, a couple in particular are really nasty....yeah...I found them! I'm also told they cant get nurses to work there and they can't keep the ones that dont know any better, such as myself. I feel like my unit has very poor management. I NEVER hear a good word, such as you did a great job today, or your patients are very happy with your care...no...the only thing I hear from anyone is what I screwed up or should have done.......When you're a new nurse i think we lack confidence and we NEED to hear positive feedback, not just the negative. I can take constructive criticism and embrace it...if it's given in a nice way.......When the PNCC is nasty and annoyed, I feel like hiding under a rock and lose any confidence I may have had! I'm planning on calling the nurse recruiter on Monday to see if I can transfer...i'm supposed to stay in my position for 6 months before I transfer.......Problem is paying back the sign on if I leave the network, and secondly, I don't want to say anything to my director until I'm sure I have a place to go. Any advice in handling that? I honestly feel like it's abuse......My daughter works as an aide on another floor and was telling her director how i'm being treated and she knew who the nasty nurses were without my daughter telling her. She was actually mad about the way i'm treated and said its not supposed to be that way. i'm a brand new nurse and "the team" is supposed to support me and HELP me, not belittle me and beat me down! I already checked for a position there and they only need night nurses. I dont think i want that but it might be better than where i'm at!!!!! I feel so incompetent and depressed. I've lost 10 pounds since I started in Sept..thats a good thing..i'm taking off the nursing school weight! Its just not a healthy way to do it. I promised myself that i would never forget what its like to be a student or what its like to be a new nurse! Advice appreciated.........

[LydiaNN]

Where I work, if you get written up, all you're signing to is that you've been informed that a supervisor has discussed the issue with you, you understand the required corrective action plan, you know what the consequences will be if you don't follow that plan and this documentation is going into your file. It doesn't mean that we necessarily agree with the write up. If there is a disagreement about the corrective action plan, we go to HR before signing the document. Also, we are able to add whatever we wish to the write up. Therefore, we aren't given a choice about whether or not to sign.

Does it work differently at your facility?

[lorabel]

I'm not sure how it works! I was too upset and dumbfounded to think to even ask anything! I bawled the whole way home and kept thinking about the way it really happened. I was so worked up I was even wondering if it happened the way i rememberd! I have to work with the nurse that reported me to the director on monday......Each day I feel more and more like an outsider. i'm afraid that my nature is to be more quiet and keep to myself because I'm afraid of being hurt...or stabbed in the back again...so my self-portective nature is to withdraw.....so now i'm afraid they will tell me I'm not a team player or something...theyre all so nasty its hard to say ...........there are a few that seem nice but I'm afraid to trust anyone! I talked with a coworker tonight. Shes also new to the floor and has been an RN for 7 years. she tells me its not just me. shes treated badly also and feels like an outsider. she said this is the hardest floor she has worked. She feels its poor management as well..........no support! I dont know if I should just drop it or go to my director and ask about policy for warnings, etc..