Intolerant of RN errors

Okami_CCRN, BSN, RN · May 25, 2008

It is a combination of many things, One and most importantly is what you mentioned that Medicare is refusing to pay for hospital acquired infections and illnesses.

Second is that since people in the United States are so lawsuit prone hospitals are taking a stand against errors as a way to show patients and family members that mistakes are not allowed thus making calming down the situation.

Thirdly, a lot of patients where I live are Charity Care cases so if an RN makes a mistake the hospital loses money because now they not only have to treat the ailment but the error as well.

I do not believe that RN's or any medical staff member should be penalized because errors could be greatly diminished if there were safe nursing ratios.

carolCCRN · May 25, 2008

Wow, I thought I was just being paranoid. We just implemented a new computer charting program, and I swear it just makes it easier for management to find mistakes - mostly documentation lapses. WE EXPECT 100% COMPLIANCE AND ANY LESS IS UNACCEPTABLE!!! I've seen more "corrective action" in the months since Go-Live than I ever have. I'm not excusing poor nursing care, but after I've worked all night and done the best I could, I don't care to have a meeting with my manager because I forgot to chart a dressing change that I labelled, initialled and dated! I know, I know, "if it isn't charted, it isn't done".

mom4josh · May 25, 2008

I was called at home Friday morning, after working three 12 hour nights in a row, because I forgot to chart the telemetry readings on a patient. Didn't matter that the actual strips with the readings are placed on the chart.

And all I could hear in the background while my manager talked was the 23-year-old bimbo that I had reported off to going on and on about this and that. UGH!

:banghead:

You can do a million things right, but heaven forbid you forget to chart something that is essentially "double charting."

ktwlpn, LPN · May 25, 2008

Wondering if anyone else has noticed employers being less tolerant of errors? Didn't know if it was related to medicare refusing to pay for hospital acquired infections/illness/accidents.
:

I'm in LTC and the facility implemented a new policy a few years ago.Any significant error has to be reported to the department of health and they want to see that you have an education/prevention plan in place..We have a progressive

disciplinary program-and we have seen nurses let go.Both LPN's and RN's...

Atheos · May 26, 2008

Many industries expect 110% performance. In the military and law enforcement if you make a mistake people can die, in banking a mistake can cost money, sometimes millions. Why should nurses be held to a different standard?

Do I make mistakes? Oh yeah. Do I get angry when someone points one out? No. Learn from your mistakes and you make less.

If I always 'forget' little things, one day I'll 'forget' a big thing.

The other thing is we are paid to do right. In school we expected our parents to 'praise' our efforts but we are adults. We don't get praised for doing things right because that is what we are supposed to do. We get in trouble for doing things wrong because we are paid not to.

Jeffthenurse · May 26, 2008

Why should nurses be held to a different standard?

Because nurses are always thought of as guilty before having to prove our innocence which is the opposite of how our judicial system works! I don't know of any nurse who is perfect and I'm really disgusted that nursing administration won't back a nurse once she's/he's accused of making a mistake. And they wonder why there's a nursing shortage......

Riseupandnurse · May 26, 2008

Yes, I think there is more and more intolerance of nursing errors. One problem, IMHO, is that there are so many more possible errors. Every new piece of machinery is more complicated, the policies and procedures reproduce exponentially like rabbits, and all the rules are not only unbelievably complicated, they change every few months. Sometimes I believe we are just going to paralyze ourselves out of existence, and after clocking in we won't be able to do anything but freeze like deer in the headlights. I wish all the JCAHO, state, and other regulators would understand that the end result of all this micro micro managing is sometimes that the patients get care that is less, not more, safe, and ALWAYS much harder and unsatisfying for both the patients and the nurses. Example: Remember when we simply tried to help a patient's pain? Now it seems as though getting the number and the reassessment number are more important than actually achieving pain reduction.

carolCCRN · May 26, 2008

I'm not suggesting that errors of any kind should be overlooked. The original question asked if we saw an INCREASE in employer intolerance of nurse errors, and my answer is "Yes". Minor infractions that were once seen as educational opportunities are now being dealt with as progressive corrective action which starts as a verbal warning and progresses to termination. Now, if a nurse is so lax that he or she can't correct problem behavior and/or practice issues, then they should be let go. I give my best to the patients and staff on my unit every day that I work. As good as I think I am, and as tough as my exterior may appear, it pulled the rug out from under me to have to sign a verbal warning and know it was going in my file. In MY file. ME.

Now, I can speculate that administration is putting on the pressure because of the medicare issue, but I can certainly say that the atmosphere around here lately is punitive whatever the cause and it's not pleasant.

medpsychRN · May 26, 2008

Thanks for all the responses. I believe when a serious error occurs there needs to be some consequence. However, we are being verbally reprimanded for forgetting to sign something, date something or miss a section/spot on a form.

Staff has been told repeatedly we must make do with less. This translates to fewer staff and more responsibilities.

I work on a med/psych unit. We do everything but vents/cardiac monitoring. Ages 18 and above, taking the overflow from geropsych. Elderly patients are already at risk to fall. Put them on psych meds and it's worse. When I've asked to have patients placed on 1:1 for safety/fall risk, this has been denied. If the patient falls and breaks a hip I am the person responsible. It's tough to do that AND take care of the rest of my patients.

I haven't been written up. It's been implied I needed to manage my time better.

It's very stressful. The constant message is if you do something or don't do something you will be demoted, written up or terminated. We've been told "somebody's watching you" or "we'll be making surprise visits" on other shifts. Staff is paranoid and discouraged, demoralized. Wondered before I quit, if it's just this place or if it's all over.

Thanks

bollweevil · May 26, 2008

Wow, I thought I was just being paranoid. We just implemented a new computer charting program, and I swear it just makes it easier for management to find mistakes - mostly documentation lapses. WE EXPECT 100% COMPLIANCE AND ANY LESS IS UNACCEPTABLE!!! I've seen more "corrective action" in the months since Go-Live than I ever have. I'm not excusing poor nursing care, but after I've worked all night and done the best I could, I don't care to have a meeting with my manager because I forgot to chart a dressing change that I labelled, initialled and dated! I know, I know, "if it isn't charted, it isn't done".

Is it charted on the MAR or TAR? Must you also chart it in the progress note?

bollweevil · May 26, 2008

I was called at home Friday morning, after working three 12 hour nights in a row, because I forgot to chart the telemetry readings on a patient. Didn't matter that the actual strips with the readings are placed on the chart.
And all I could hear in the background while my manager talked was the 23-year-old bimbo that I had reported off to going on and on about this and that. UGH!
You can do a million things right, but heaven forbid you forget to chart something that is essentially "double charting."

Start screening your calls. I also hate double charting and avoid it at all costs. For instance, why must I chart on the Accucheck sheet what I did about a particular reading when I have already charted it on the MAR?