Written up today for something stupid

Nurses General Nursing

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Hey all

I am angry enough this morning to spit fire. My manager wrote me up today because we had a patient on IVF@100 cc/hr who went into resp distress on my shift and i transferred him to icu. Here is the part she wrote me up for: The patient arrived on our unit a couple of days before i started working that week. IVF were already running when i received the pt. When I did the 24 hr chart check the fluids were not listed on those orders but on his admission orders ,which was before the 24 hrs. Why would she think that i would go past the 24 hr point looking for someone elses mistakes. The order that said the fluids were only supposed to run 500 ml was part of the admission order. I think she is trying to create a paper trail. Lately this woman has been very emotionally labile, so much so that at least a third of the dept has left for other jobs or other depts?

When u do a 24 hr check do you go days back to look for errors??

I always go back to look for errors when I make a chance to do so. But I think she wrote up the wrong person for this oversight. If others are leaving because of her, I think it is now time for you to start looking. You are probably correct that she is starting a paper trail with whatever she can come up with. Best to be proactive in this situation.

Specializes in Cardiology, Oncology, Medsurge.

Sometimes when it is the first day with one's patient it is wise to look through all the orders up to the admission to the unit. I can understand your frustration though. Had you attempted to get an order for Lasix prior to the transfer?

if it's your error, then it's other nurses error as well.

with me, i check admitting orders and subsequent ones as well.

but i'm pretty anal.

write a rebuttal and have it made a permanent file in your folder.

in the meantime, look for greener pastures.

on any forthcoming interviews, ask about turnover.

much luck to you.

leslie

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

I will go back about 48 hours......

Specializes in PACU, OR.

Sounds to me like you did everything right, barring the question re Lasix. If you went through the correct channels and requested this, then i can't fault your processes.

Not knowing your charting systems, I don't know to what extent you can be held responsible for a previous mistake, but it stands to reason that if the error occurred on someone else's shift, you alone should not have to carry the can.

I'm a firm believer in apportioning blame where blame is due, and I would not have blamed you for this; rather, I would have commended you for taking the appropriate steps in the patient's interest.

Let this be a lesson for all of us; read all the orders from day one, so we can make sure we haven't missed anything. Leslie, that's not anal, that's careful!

just keep your coolness take a deep breath. . .

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

Did she write anyone else up? Because every nurse who cared for that patient after the 500cc is also to blame and did she write up the nurse who did the 24 hour cheek that included the admit order? If not I'd go to HR and ask for the write up to be removed. What is the policy about checking orders is there a time limit to how far back to go? write a rebuttal and ask it to be place in your file........I'll bet the family or the MD complained and they are backtracking!!!!

You are correct Esme. The MD got involved. I think 1 person got fired over this. But even if i had gone back 48 hrs it wouldnt have helped. The order was further back than that.

My hospital has a policy that we must check ALL orders from that shift since they were admitted...takes a looooong time on nights. We are required to go through every single MD order and there can be a million of them if they have been admitted for a long time

Specializes in SRNA.

Where do you document your IVFs? Was it listed as 100mL/hr on the MAR and/or Kardex without a total of 500mL?

To answer your question: No, I probably would not go back several days to verify IVF rate. This ought to have been noted by whoever admitted the patient, whoever did the first 24h chart check, and noticed when the MD rounded the following day.

Unless there is a facility policy that requires you to go beyond the 24 hour check, I don't see how you're in the wrong. They're trying to cover their rear for something that ought to have been caught on multiple occasions before you ever stepped into the picture, in my opinion.

On occasion I'll go back IF there is something I find suspicious and IF there is time for me to do so. Unless I have both suspicion AND time, management can come out and check the chart for me. I don't have time for the increasingly heavy patient load and to do everyone else's jobs as well. 24 hour chart check, sure. Endless chart check? No.

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