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.
I'm going to guess someone's friend was the one who made the mistake and they needed to blame someone.
I doubt it.
These actions are so nonsensical and so obviously demeaning and discouraging that there is no explanation except that they are simply part of a culture of routinely doing things in ways that ensure employees feel powerless and effectively remain disempowered. That's all there is to it.
Specializes in Psych, Corrections, Med-Surg, Ambulatory.
55 minutes ago, JKL33 said:
I doubt it.
These actions are so nonsensical and so obviously demeaning and discouraging that there is no explanation except that they are simply part of a culture of routinely doing things in ways that ensure employees feel powerless and effectively remain disempowered. That's all there is to it.
Exactly. You're kept too busy defending yourself to speak out about poor management practices. That's why I say keep a record of everything like this. You might not want to rock the boat while you're employed, but you can toss a few grenades on your way out the door.
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
You haven't heard? Apparently nurses have 15 arms, 25 eyes, and 30 legs. We do it all, everywhere, all the time. Well, according the ragged logic management uses.
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.
Yes, I have seen errors on one shift, but the nurse on the next shift didn't catch the other shifts error as timely as the managers thought they should. Guess who gets the write up.
Specializes in icu,prime care,mri,ct, cardiology, pacu,.
You can be the person who makes policy changes. No you can’t be in 2 places at one time, and if you’d gotten report from the ED, getting the second patient wouldn’t have happened.
you can write a rebuttal to the write up, send as everyone says.
But do your research probably on your own time, bring that with written recommendations to policy change to your management. You may get further. If you can prove standards of care elsewhere and what the JCaho wants, you may save someone else’s frustration and maybe save a life.
Specializes in ICU, Telemetry, Cardiac/Renal, Ortho,FNP.
Don't sweat it. Seriously. I was in a similar circumstance where my mgr. asked me for constructive feedback since I came from a different hospital chain. I gave some regarding collecting lab samples on the unit, it was a flawed system and prone to error of mislabeling. Well, I got stung and mislabeled a sample from the very problem I pointed out and he was more than happy to write me up instead of fixing the problem. There will ALWAYS be people like that. You are not here (in nursing) to appease the knuckleheads, you are here for your patients. Let them do what they want and you keep doing the right thing. The beaurocratic nonsense will, unfortunately, always be present.
At what point is enough, enough?! Heparin is a dangerous drug we all know that. How could someone possibly send a patient to a floor on heparin with no verification of the order by both nurses? Here is a list of the people who should know that this happened:
Charge nurse of both units
Nurse manager of both units
Pharmacy Manager
Chief operating nurse
Nursing education
Board of Nursing
Hospital Accreditation Board
Joint Commission
The patient
Institute of Medicine
Doctor who wrote order
Institution Quality Assurance
USP-ISMP
FDA Medwatch
IOM
Yes I have time on my hands...but if the powers that be can mandate such protocols for a medication why the hell are incompetent nurses allowed to drop off patients on heparin w/o face to face reports?
Specializes in ER - trauma/cardiac/burns. IV start spec.
Not calling report is not only dangerous but stupid (probably should not say that but it is true). Sure we wanted to get patients upstairs asap but we never just dumped a patient upstairs without report. We would not call during the last 30 minutes of shift. The floors had too much to do with shift change coming.
As far as the write up I cannot begin to understand that - you found the error and corrected it. The pharmacist admitted it was her mistake. That was a good catch. Sometimes (to me) it seemed that write ups were done just to "complain". I swear there was a dart board in my Manager's office with our names on it and once a week she threw a dart to see who she was going to "counsel". I was called to my managers office because she had to give me a complement from one of the Ortho Docs. He also requested that when I was working if any patient of his needed splinting I would be assigned that job. My manager was so livid that she "counseled" for a comment I made at the desk 3 months earlier and then told me about the Doc. She got more angry when I told her that the Doc's comments were more important to me than her petty complaint. Not in those words but you get the gist.
Do not let this write up get under your skin. You will never know who got on their high horse but you did right. Be proud that you caught the error.
However you might want to find a new hospital where report is still called. Not giving/receiving report is a dangerous thing.
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.
I'll bet JC would be very interested in the fact that no report is given prior to patient transfer. Even an anonymous report. Your BON might be interested also.
I'll bet JC would be very interested in the fact that no report is given prior to patient transfer. Even an anonymous report. Your BON might be interested also.
I agree. It's a pretty crappy way to transfer patients
I worked at a hospital that switched to a system in which the floor nurses received no report and were expected to monitor the room assignments in epic see when a new patient was added. The ER would then roll the patient to the floor 15 minutes later. We were often caught off guard, especially at change of shift. We were told we could call the ER if we felt we needed additional info but all I ever got was attitude, if the nurse was even still available. Anyway.... a few months after the Joint Commission inspection, that practice was ended and the ER went back to calling report.
I hope your hospital eventually goes back to calling report
JKL33
7,038 Posts
I doubt it.
These actions are so nonsensical and so obviously demeaning and discouraging that there is no explanation except that they are simply part of a culture of routinely doing things in ways that ensure employees feel powerless and effectively remain disempowered. That's all there is to it.