Got Written Up, Cant Stop Thinking About It

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About a month ago I got written up for the first time, for a mistake make by the pharmacist that I reported. I've been at my job for about a year and a half working my first acute care nursing job on a TELE/ICU Step-down unit at our regional STEMI center. I work night shift and we are fairly understaffed and the administration "to streamline admissions" instated a policy that nurses on the floor are not entitled to report from the ED, we are just supposed to read through what minimal documentation is in the chart and hope for the best.

About a month ago I had a night where I got an ICU downgrade transfer and an ED admission at essentially the same time, the ED staff dropped the patient off while I was getting my downgrade patient settled and didn't notify me that the patient was here. Well the ED patient had come up on a Heparin gtt (hooked up and pump running) and between getting both of my patients settled, assessed, and safe, I wasn't able to really look into the heparin gtt other than confirming that the set units/hour on the pump was as stated on the order in the MAR, for about an hour. Once I had a moment to think, I realized that the heparin order made absolutely no sense as it was way way way too low to be appropriate. I double checked with a more experienced nurse that I was seeing what I was seeing and then called the on pharmacist and got the order corrected. In following with policy I filled out an RL6, our incident reporting system.

When I came in for my next shift about three days later, I was called into the clinical coordinators office and presented with a write-up for a medication error and put into mandatory heparin education (I don't disagree with the education). I agreed to sign that I had been presented with the write up, but I didn't sign acknowledging wrongdoing. I know I shouldn't be so bothered but now I have a write-up in my file for an issue that I really don't consider my fault, and that I did the necessary things to get rectified, the pharmacist had even admitted and put in writing that the error was on her side and not on the nursing side.

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This is a dangerous practice at your hospital and I would start looking for another job. Any hospital that would allow patient dumping onto another nurse without even informing them they are brought to the floor, no report, no nothing, is putting your license at risk.

The purpose of report is to see if you want to accept the patient. It is not a clerical step, it is a legal one. What you have described is also dangerous in terms of patient flow b/c you can't do two admissions at once, especially where one obviously required more monitoring,

You are one person. Don't feel bad about it at all.

Get out of there.

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Specializes in Critical Care.

I'm not clear why you were written up, particularly if you're the one who recognized the faulty order and triggered the correction of the order.

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Specializes in Critical Care.

As for the process of report, definitions of patient abandonment vary slightly from state to state, but in my state if the nurse who is transferring care to another nurse doesn't confirm that the receiving nurse has received and understood report prior to transferring care, then the nurse handing the patient off has committed patient abandonment.

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1 hour ago, ThatNurseThough said:

I know I shouldn't be so bothered but now I have a write-up in my file for an issue that I really don't consider my fault, and that I did the necessary things to get rectified, the pharmacist had even admitted and put in writing that the error was on her side and not on the nursing side. 

And you shouldn't be bothered by this why??

This is abusive, and saying so is not hyperbole. You are in a situation where someone can dump a patient with zero notification, you took care of a relatively minor problem in quite a timely manner under the circumstances, and then with a straight face your superior wrote you up for this?

The treatment you tolerate is the treatment you should expect in the future.

Please tell me you wrote this post d/t at least a minimal acknowledgment of self worth, and that you know you are not some POS who can be treated this way.

I am sorry this happened. You are in charge of what happens next.

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Specializes in ER.

I agree that you are not the person that committed the error. I'm stuck on what I would do next.

Put in writing your concerns about receiving patients without notice or report. Our hospital says JCAHO wants a face to face interaction so the receiving nurse can ask questions. It's odd that they would have different standards for different geographic areas.

You want to have on record that you saw the issue and notified your supervisor. I'd CC the ER manager too. IMO after that the onus shifts to them to change their system. I don't see how you could develop ESP and sniff out issues without being told the patient was there. Was your charge supposed to notify you?

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Specializes in Psych, Corrections, Med-Surg, Ambulatory.

I'm betting you have no union or this would not be happening. I would write a letter protesting the write-up. One copy for your manager, one copy for HR that you request to be added to your employee file, and one for you. Feel free to pass on another copy for anyone else whose cage you want to rattle.

State in the letter that you received an admit and a transfer simultaneously with no report on the admit or even being informed that the patient had arrived. Mention that JCAHO requires face-to-face report and to drop a patient off constitutes abandonment in many jurisdictions. (Not sure how it works where you are, but management probably doesn't know either and using certain words gets their attention.) Mention that the error wasn't yours but you caught it as soon as could reasonably be expected and corrected it, following protocol. State that you signed the write-up under protest and believe it to be a form of harassment.

This letter will be an ersatz form of "safe harbour" or unsafe staffing documentation. It lets TPTB know that you can't be held responsible for the unsafe position you were placed in and they should be happy you handled it as well as you did. It also puts them on notice that they can't just throw you under the bus to save their own skins from their poor staffing and hand-off policies.

Good luck.

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Specializes in LTC, assisted living, med-surg, psych.

Wow, that no-report business is a disaster waiting to happen. It could have been with your ED patient, if you hadn't corrected it ASAP given the fact that you had a simultaneous admission and transfer. I have yet to figure out how a nurse can be in two places at the same time, yet management seems to think we can do magic (and woe to us if we don't). That write-up is BS and should be protested vigorously. Good luck to you. Viva

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14 hours ago, TriciaJ said:

I'm betting you have no union or this would not be happening.

We aren't union at our hospital, which was a shock to me when I got hired as my last job was with the state and I was union and nurses and nursing staff had a lot of protection (even if they didn't protect us from constant mandation). Honestly, the way management is (when they are there) is a shitshow, I've brought up issues before and gotten reamed out and kind of thrown under the bus especially with dayshift staff. The nightshifters I work with are actually incredible for the most part and stuck up for me. I'm at the point where I'm coming up on a year and a half here and honestly I'm considering leaving next May once my contractual obligation and my lease are up if I can find another job.

If nothing else I'm going to leave this job being able to say that I've handled Tele/ICU/stepdown patients, neuro, renal, pulmonary and detox patients, and psych and corrections through my old job. And you know what, if I could handle being pretty severely assaulted at the prison, I can handle getting raked through the coals for another year if need be.

Realistically, even though everyone is saying that I should be mad, I understand that the way the administration and power system at my hospital currently is, nothing I say or do is going to change anything. I'm just trying my best to change what I can, and accept what I can't so I don't make myself crazy in the meantime.

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Specializes in Psych, Corrections, Med-Surg, Ambulatory.
2 hours ago, ThatNurseThough said:

Realistically, even though everyone is saying that I should be mad, I understand that the way the administration and power system at my hospital currently is, nothing I say or do is going to change anything. I'm just trying my best to change what I can, and accept what I can't so I don't make myself crazy in the meantime.

Sounds like you recognize they are dirtbags and you don't expect any better and you have a game plan for your next step. So you are right to try not to let things bother you too much. But at least write up your version of events for your own records. That way if you ever get called on to explain anything (to the Board or your next job interview) you'll have all the pertinent details.

Hang in there.

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2 hours ago, ThatNurseThough said:

I'm at the point where I'm coming up on a year and a half here and honestly I'm considering leaving next May once my contractual obligation and my lease are up if I can find another job.

As a matter of technicality, I would consider this contract broken by the employer. A lawyer can help them understand how/why, if necessary.

However -

2 hours ago, ThatNurseThough said:

Realistically, even though everyone is saying that I should be mad, I understand that the way the administration and power system at my hospital currently is, nothing I say or do is going to change anything. I'm just trying my best to change what I can, and accept what I can't so I don't make myself crazy in the meantime.

I give you credit for having a healthy attitude in general. I still think there's one more goal besides doing your best and accepting things and not making yourself crazy, though, and that is actually remaining professionally unscathed. I tend to believe that if someone either that unhinged or that unethical is in charge, there is significantly less likelihood of coming out unscathed because there is little to no reasoning/defense against their misguided motives and actions.

You can have a good attitude and still be alert/cautious. Hope you will do that. Best of luck! ?

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On 6/9/2019 at 5:10 PM, MunoRN said:

I'm not clear why you were written up, particularly if you're the one who recognized the faulty order and triggered the correction of the order.

I'm going to guess someone's friend was the one who made the mistake and they needed to blame someone. This happened me as a volunteer where my coordinator gave me a wheelchair that she swiped from a patient. The wheelchair turned out to be faulty and I got thrown under the bus for taking a non-hospital wheelchair and the coordinator got away because she was the manager's BFF.

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