occurrence report=doctor hates me

  1. Well,
    This has been bugging me. I wrote an occurrence report for a rapid response and then patient died within a short time frame after a procedure. My manager told me that I was in the wrong for writing it and that MD doesn't want me to take care of his patients and also somehow another surgeon chimed in about "my conduct" during this review! Its a long story, but is that a JUST culture? Feels like retaliation to me for something our unit and MD could learn from? Does it make them look bad at higher up? A policy was changed to make me look bad too. I am trying to see if union can help me but doesn't look promising. PS our "manager" never been in this position before so she is trying to "make peace" for "my error" of reporting.UGH!
  2. Visit avado profile page

    About avado

    Joined: Sep '05; Posts: 30; Likes: 4

    32 Comments

  3. by   LovingLife123
    Without any details, I don't know if you were in the wrong. Your manager could be trying to keep the peace or you could really be wrong. What policy did they change? That kind of says a lot.

    You have to be careful when writing up doctors. You need to have documentation and evidence.

    If you were completely justified I would maybe look for a new job. Your manager should support you if you are right and a patient died directly from this.
  4. by   avado
    Pt was an observation from a minor surgery that needed rapid response and later died from possible sepsis within three days. No medical doctor following? It was simple occurrence report complication from a surgery that needed to make facility aware. Are facilities not to report a complication? This is a small hospital where I work with not even a compliance line set up. There is more to it because something was used for the surgery that was not normal, an "off label use" which they changed a policy to okay for off label use. It was set up for failure due to that! Manager said that device was normal...not in my 18 years..
  5. by   cleback
    Yeah, that seems fishy. An occurrence report is to review an event for safety and institutional learning. It's not for "writing someone up" for poor behavior.

    I hope, though, you stuck with just reporting objective events and not opinions on appropriate/inappropriate actions taken by the doc. That would be outside your scope and outside the intent of an occurrence report. If you were pointing fingers of poor care at a single provider, I could see how the doc would be annoyed.

    Anyway, it's hard to say why they deemed your report inappropriate without more details. If it was just an objective report of the events, yes, I'd say they're being unjust. Look for another job with a manager that supports people speaking up for safety.
  6. by   avado
    Yes, it is a fine line. I appreciate your thoughts.
  7. by   Been there,done that
    Please explain "an occurrence report for a rapid response ".
  8. by   Wuzzie
    Quote from Been there,done that
    Please explain "an occurrence report for a rapid response ".
    Yeah, I'm confused too. I've never once written an occurrence report for a patient decompensating.
  9. by   Daisy4RN
    Without all the details it is hard to say. If you didn't do anything wrong then I don't see why the union cannot help you. Be careful what you say from now on about this and other occurrences (I guess this is the same as an incident report?). Maybe I don't understand what you mean but what is wrong with your manager helping to keep the peace. Either way be careful how you proceed, pushing things too far doesn't usually end well for the nurse (can you say...throw you under the bus!).
  10. by   cleback
    Quote from avado
    Pt was an observation from a minor surgery that needed rapid response and later died from possible sepsis within three days. No medical doctor following? It was simple occurrence report complication from a surgery that needed to make facility aware. Are facilities not to report a complication? This is a small hospital where I work with not even a compliance line set up. There is more to it because something was used for the surgery that was not normal, an "off label use" which they changed a policy to okay for off label use. It was set up for failure due to that! Manager said that device was normal...not in my 18 years..
    Yeah, next time you fill out an occurrence report, just stick to the events. The people in safety reviewing those reports will perform a root cause analysis for the causes. It seems you were using the report to voice your opinion on a device being used, which is not appropriate for the report.
  11. by   cleback
    Quote from Wuzzie
    Yeah, I'm confused too. I've never once written an occurrence report for a patient decompensating.
    I think it's more like a failure to rescue situation.
  12. by   Daisy4RN
    Quote from cleback
    I think it's more like a failure to rescue situation.
    Yes, a facility I worked at required one for all RRT and codes.
  13. by   KatieMI
    "Occurence report for RR" can be, for example, about making several calls to covering provider in escalating clinical situation which were either not answered, or response was clearly outside of "common practice" (like not ordering "septic set" for patient with crushing BP, fever and tachycardia/tachypnea, ignoring deteriorating viral signs, not ordering ICU transfer when it was clearly indicated, etc).

    I do not understand the second part. Things, including drugs, devices, monitors and everything else, are used "off label" all the time simply because it is not possible to push every single thing through the multiple steps of EBM. If one "never saw using this thing like that" in X+1 years, it doesn't mean doing so is unsafe or illegal. Policies also cannot encompass everything, and they are changed all the time. Unless you are a specialist, making conclusions of some devise being used in a certain way may easily cross scope of practice line.

    And, yeah, hospitals are not required to "report complications". With "compliance line" or without it.

    I understand that you probably were just thinking along the line of "iamjustdoingmyjob, iamjustsoooomuchconcernedaboutsafety", but at least with the second part you hit where it hurts most. This "guardian angel" nursing behavior is what irritates physicians beyond means because it affects their function, their decision making and their sense of power. They are picked on by insurance companies, sales, contracts, etc., etc., WAY beyond normal human tolerance level, and "report" of some bedside RN voicing her "concerns" just because she never saw something done can be that last straw.

    If I were you, I would run out of there ASAP unless you agree to become a walking target. It may not be "just" but it is what it is. Physicians, and especially surgeons, bring $$$$$ in hospital, nurses bring little to nothing. Fact of life, love it or hate it.
    Last edit by KatieMI on Nov 12
  14. by   LovingLife123
    Quote from avado
    Pt was an observation from a minor surgery that needed rapid response and later died from possible sepsis within three days. No medical doctor following? It was simple occurrence report complication from a surgery that needed to make facility aware. Are facilities not to report a complication? This is a small hospital where I work with not even a compliance line set up. There is more to it because something was used for the surgery that was not normal, an "off label use" which they changed a policy to okay for off label use. It was set up for failure due to that! Manager said that device was normal...not in my 18 years..
    So the patient was on your unit with no doctor following, just the surgeon? Am I understanding correctly? That happens all the time, you don't have to have an internal med doc following. You should have had orders from the surgeon though and a way to get a hold of the surgeon the same way you get ahold of a hospitalist.

    I work in a surgical icu and sometimes, we don't have icu following, just the surgeon. But they give us our orders and numbers to page.

    And just because you haven't seen something used off label in your practice doesn't mean it doesn't happen.

    Does this hospital not have a rapid response team that took the patient off your hands to icu when it occurred? Was the surgeon not available when paged during the rapid response?

close