So let me start with last shift. One of the assistant managers told me she had to speak to me regarding my ''documentation'' so now I'm thinking what now? Over the last few months I've made it a habit to have excellent documentation and even in my last evaluation which was 2 weeks ago they said my documentation was good.
So getting right to it. She wanted to give me a verbal warning because during her ''chart review'' she found that a second set of cardiac enzymes was not drawn on a patient. Ok understandable. So I asked did the patient decompensate? No she said, the patient was fine, but she still needed to basically write me up about this. And might I add I had this patient a week ago. I had to stop and think and comb through the chart to remember who this patient was and what she was here for.
Then the second complaint was that I did not do my double charting. Yes they want us to double chart. They want us to chart in one computer system, then re-chart in another computer software system after the patient is admitted, and although I did two complete and spot on assessments of the patient within 10 hours (patient was completely stable) I still deserved to be reprimanded because I did not do my ''double charting" as I call it.
Now I already received a ''verbal warning'' because once again during a ''chart review'' the manager said I had no focused assessment of the patient, which was wrong. She failed to read the entire chart and looked over where I documented my focused assessment, but she was still able to ''get me'' on the write up because the patient was under ICU evaluation. Mind you the patient (who was to be an ICU eval because she vomited a small amount of blood twice at home, none on my time, completely hemo stable, and A&O) This occured during shift change and the patient had become an ICU eval literally 45-60 minutes prior to shift change and I was scrambling around trying to make sure she was on fluids, med drips etc.. but I had stopped to give report, therefore I was not able to placed the patient of the monitor, BUT a full report was endorsed to the evening nurse.
So on this second write up I'd just had enough. This time I had to have my delegate present. The delegate was peeved. She said do you know how many times this happens? You might as well write everyone up! She said she knew plenty of nurses that committed the same mistake and where was their write up, why weren't they sitting in the office as well?
It seems as though they love ''reviewing my charts'' and finding anything to bring up to me.
Now I understand being warned for something, but both patients NEVER decompensated, both were actually completely stable.
To be honest I just feel so terrible. I work in a crazy busy level 1 ER, where we get up to 14 patients sometimes, some of them being critical, intubated, hypotensive. Literally every shift I give 110%. I can understand if the patients decompensated, I'd take fully responsibility,but honestly I feel as though since I'm not a favorite of theirs, they try to ''get me'' you know?
This is the same place who gave new grad nurses (myself being one) only 2 weeks of unit training before throwing us on our own. I NEVER had anything major happen to a patient that was directly my fault, I've never suffered from the big mistakes a new grad can make working in a high pressure area, but yet it's as if they can still find something to slap in my face.
I am appauled at the way management treats there own nurses here. You get no credit, no respect, but if you do anything wrong, BAAM, like lightning they catch you. What kind of environment is this to work in?
I'm seeing more and more who they want to succeed and who they are trying to tear down. Nurses come and go here often.
I just cannot believe they are really picking at straws. No other of the new grads I started with have had verbal warnings for this type of stuff. Favoritism is big there.
The managers literally snoop around and pick on nurses, what is wrong, was wasn't done, etc...
I am more floored than anything, I cannot believe this.
Sounds like there may some major problems with equity & fairness if others are not being disciplined for the same infractions. But, since discipline is supposed to be confidential, does the OP know that this for a fact? Is it possible that the OP just doesn't know about others' being disciplined?
Another important issue. Performance issues are all about the behavior that was chosen - NOT the outcome. If discipline is based on outcome, it would really be unfair. Outcomes can be influenced by other factors, such as 'luck' (bad or good). For instance, two drunk drivers are speeding through intersections without stopping at red lights -- one doesn't hit anyone, and one does. Should the punishment be different just because one was lucky enough to avoid hitting another car?? Does that make him "guiltier" than the one who was lucky?
Never try to justify your behavior based on outcomes...it just comes across as making excuses and not taking responsibility. The right way to do it is by defending the process by which you chose your actions... "Due to the tight deadline/limited amount of time, I had to prioritize my actions and I chose to do X instead of Y because based on the information I had at the time, it would produce the best outcomes for the patient" This is a far more convincing argument.
This is what nursing is like for many people. If your a pet you can get away with anything and if they don't like you they can write you up for the pettiest things. And now with the big brother computer it makes it even easier for them to do this.
Just do your best and be on the lookout for a better job if need be. Hopefully the manager will move on and leave you alone or have enough other work to keep her busy.
Funny thing is I've never seen this type of petty harassment in other job I've done outside of nursing. I feel sorry for people who have not worked outside of nursing and think every job is like this and it is not!
This is what jobs, especially nursing is like. If they are items to be disciplined or written up then suck it up and that is what it is. i said this in another post, no one cares how much you do well until you don't get chairs fast enough for 54 visitors. Maybe you are wrong, maybe you are right and they are targeting you. we don't know but if you feel this way, maybe you can start looking for a new job now. sometimes the pets can get away with anything.
It looks like you are being targeted. Please start looking for a prn job at the very least. If you get suspended or terminated by mistake you will have something to fall back on. Having that back up plan makes you more confident :) .
So getting right to it. She wanted to give me a verbal warning because during her ''chart review'' she found that a second set of cardiac enzymes was not drawn on a patient. Ok understandable. So I asked did the patient decompensate? No she said, the patient was fine, but she still needed to basically write me up about this. And might I add I had this patient a week ago. I had to stop and think and comb through the chart to remember who this patient was and what she was here for.
Then the second complaint was that I did not do my double charting. Yes they want us to double chart. They want us to chart in one computer system, then re-chart in another computer software system after the patient is admitted, and although I did two complete and spot on assessments of the patient within 10 hours (patient was completely stable) I still deserved to be reprimanded because I did not do my ''double charting" as I call it.
Now I already received a ''verbal warning'' because once again during a ''chart review'' the manager said I had no focused assessment of the patient, which was wrong. She failed to read the entire chart and looked over where I documented my focused assessment, but she was still able to ''get me'' on the write up because the patient was under ICU evaluation. Mind you the patient (who was to be an ICU eval because she vomited a small amount of blood twice at home, none on my time, completely hemo stable, and A&O) This occured during shift change and the patient had become an ICU eval literally 45-60 minutes prior to shift change and I was scrambling around trying to make sure she was on fluids, med drips etc.. but I had stopped to give report, therefore I was not able to placed the patient of the monitor, BUT a full report was endorsed to the evening nurse.
So on this second write up I'd just had enough. This time I had to have my delegate present. The delegate was peeved. She said do you know how many times this happens? You might as well write everyone up! She said she knew plenty of nurses that committed the same mistake and where was their write up, why weren't they sitting in the office as well?
It seems as though they love ''reviewing my charts'' and finding anything to bring up to me.
Now I understand being warned for something, but both patients NEVER decompensated, both were actually completely stable.
To be honest I just feel so terrible. I work in a crazy busy level 1 ER, where we get up to 14 patients sometimes, some of them being critical, intubated, hypotensive. Literally every shift I give 110%. I can understand if the patients decompensated, I'd take fully responsibility,but honestly I feel as though since I'm not a favorite of theirs, they try to ''get me'' you know?
This is the same place who gave new grad nurses (myself being one) only 2 weeks of unit training before throwing us on our own. I NEVER had anything major happen to a patient that was directly my fault, I've never suffered from the big mistakes a new grad can make working in a high pressure area, but yet it's as if they can still find something to slap in my face.
I am appauled at the way management treats there own nurses here. You get no credit, no respect, but if you do anything wrong, BAAM, like lightning they catch you. What kind of environment is this to work in?
I'm seeing more and more who they want to succeed and who they are trying to tear down. Nurses come and go here often.
I just cannot believe they are really picking at straws. No other of the new grads I started with have had verbal warnings for this type of stuff. Favoritism is big there.
The managers literally snoop around and pick on nurses, what is wrong, was wasn't done, etc...
I am more floored than anything, I cannot believe this.
It doesn't matter if they didn't decompensate-your managers are trying to get you to think on your feet and anticipate problems and understand the potential adverse effects of inaction or other mistakes. They don't want to wait until someone actually does decompensate to talk to you-that's the whole point of the warning.
You are a new grad. You should not only expect you will be scrutinized more than an experienced nurse, you should welcome it. I agree that your orientation sounds really inadequate. But you also seem very very defensive and unable to tolerate constructive criticism. Most new grads are corrected multiple, multiple times, yet you really have only noted a few instances of this, so your reaction seems a little overboard to me. You are going to make mistakes, but you only learn from them if you are aware you have made them. If you had been assigned a preceptor for much longer than you were, you would be getting constant "critical" feedback, but this is how you learn and improve. There wasn't even one day during my critical care internship where my preceptor didn't give me at least a short list of things I either could have done better, things I forgot to do, or things I did poorly. It's a shame you weren't put in an emergency medicine internship with classes, homework, tests, and a long term, monitored preceptorship. But you weren't, so rather than freaking out over having your mistakes pointed out to you, you could look at all these as learning opportunities. The fact that others make similar mistakes "all the time" is really irrelevant. You want your practice to be as perfect as it possibly can-knowing that it will never be perfect-regardless of how others practice. If you are ever sued, you must meet established guidelines of standard practice-saying that everyone else on your unit does the same will not cut it if you (and they) have deviated from SOP.
You have some legitimate concerns, particularly as it pertains to the double charting nonsense, training, and nurse to patient ratio for a new grad. Approach your manager with these in a calm manner and be ready to tell her specifically how you would like these concerns to be addressed. Be very, very careful about playing the race card. It may well look as though you are using this as a way to avoid taking ownership of your actions. If race is indeed an issue, begin documenting every instance of it as it occurs so that down the line you can be very specific rather than looking like a complainer who just cannot admit her practice needs improvement. Don't worry about other nurses and whether or not they are being criticized in the same manner. Even if true, it has little to do with whether or not you are making errors that could/should be corrected in the name of patient safety and excellence of your own practice.
As for others not being disciplined, I fail to see how you could know this. Others may get similar treatment but keep it to themselves or even deny it in an attempt to save face. You really only know what's happening to you.
Try to stay calm, be less defensive, and understand that the first year of any new grad's career is often little better than low grade misery. If you are truly being put in a dangerous position and you fear for your license, address that immediately with your supervisors. Otherwise, view this time as a stressful yet ultimately very productive time in your career. You will only come out stronger for it.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
so let me start with last shift. one of the assistant managers told me she had to speak to me regarding my ''documentation''
so getting right to it. she wanted to give me a verbal warning because during her ''chart review'' she found that a second set of cardiac enzymes was not drawn on a patient. ok understandable. so i asked did the patient decompensate? no she said, the patient was fine, but she still needed to basically write me up about this.
then the second complaint was that i did not do my double charting. yes they want us to double chart. they want us to chart in one computer system, then re-chart in another computer software system after the patient is admitted, and although i did two complete and spot on assessments of the patient within 10 hours (patient was completely stable) i still deserved to be reprimanded because i did not do my ''double charting" as i call it.
i don't expect you to like my feedback, but i hope you take it to heart and i hope it helps you.
chart audits are a fact of life in nursing -- they serve a valuable purpose in that they help us to improve our documentation skills. if your unit has a policy in place that patients get a second set of enzymes so many hours after the first, you should have done the enzymes. whether the patient decompensated or not is not the point -- not even part of the point. the point is, if you're supposed to do the enzymes, you should have done the enzymes.
and as far as the double charting goes -- it's a pain in the butt, to be sure. but if that's the policy where you work, that's what you do. if you didn't do it, you do deserve to be reprimanded. your employer has a reason for the requirement to chart in two places -- you may not think it's a good reason -- it might not even be a good reason. but since that's what you're supposed to do -- and you already know you're supposed to do it -- then just go ahead and do it that way. choosing not to do so does indeed mean that you deserve to be reprimanded.
now i already received a ''verbal warning'' because once again during a ''chart review'' the manager said i had no focused assessment of the patient, which was wrong. she failed to read the entire chart and looked over where i documented my focused assessment, but she was still able to ''get me'' on the write up because the patient was under icu evaluation. mind you the patient (who was to be an icu eval because she vomited a small amount of blood twice at home, none on my time, completely hemo stable, and a&o) this occured during shift change and the patient had become an icu eval literally 45-60 minutes prior to shift change and i was scrambling around trying to make sure she was on fluids, med drips etc.. but i had stopped to give report, therefore i was not able to placed the patient of the monitor, but a full report was endorsed to the evening nurse.
so on this second write up i'd just had enough. this time i had to have my delegate present. the delegate was peeved. she said do you know how many times this happens? you might as well write everyone up! she said she knew plenty of nurses that committed the same mistake and where was their write up, why weren't they sitting in the office as well?
if the person looking through your chart didn't find the focused assessment where she expected to find it, that's a problem regardless of whether the patient should or should not have been an "icu eval." anyone who picks up your patient's chart needs to be able to find the information they need where they expect to find it. or should the physician have to dig through the entire chart to figure out where you decided to put your focused assessment today? if you're involved with a code on another patient, and someone comes to help out with this patient, shouldn't they be able to instantly find the assessment where they expect to find it? i'm not sure why you think your assistant manager was out to "get" you on the write-up -- it sounds like a perfectly legitimate write-up to me, even though i know only your side of the story.
if the patient is an icu eval -- for whatever real or bogus reason -- they need to be placed on the monitor even if you have to delay report to do so.
it doesn't matter -- or it shouldn't -- what other nurses do or do not "get away with." if you want to be the best nurse that you can be, you need to take these criticisms to heart and work on them.
this is the same place who gave new grad nurses (myself being one) only 2 weeks of unit training before throwing us on our own. i never had anything major happen to a patient that was directly my fault, i've never suffered from the big mistakes a new grad can make working in a high pressure area, but yet it's as if they can still find something to slap in my face.
i am appauled at the way management treats there own nurses here. you get no credit, no respect, but if you do anything wrong, baam, like lightning they catch you. what kind of environment is this to work in?
i'm seeing more and more who they want to succeed and who they are trying to tear down. nurses come and go here often.
i just cannot believe they are really picking at straws. no other of the new grads i started with have had verbal warnings for this type of stuff. favoritism is big there.
the managers literally snoop around and pick on nurses, what is wrong, was wasn't done, etc...
i am more floored than anything, i cannot believe this.
you're an adult now, in an adult job. the fact of adulthood is that no one is going to go out of their way to give you kudos for doing the things you're supposed to be doing. they will, however, talk to you about it if you're not doing the things you're supposed to be doing. by your own report, you're not doing the things you're supposed to be doing, and even though you seem to have rationalized it to your own satisfaction, you're in the wrong. if you've never have a patient decompensate, that doesn't make you right. it makes you lucky.
Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
Double charting is a liability, I say this all the time at work. We will soon implement an electronic medical charting system that will eliminate the whole double charting thing.
*** Good luck with that. Every electronic system I have ever used, including all the main, popular ones, had plenty of double or even tripple charting. In addition there are usually plenty of paper fomrs to fill out with the exact same information. For example at my current hospital blood sugar check are automatical uploaded to our computer chating system when you doc the meter. But of course we keep a written log at the bedside that eventualy goes into the patient's chart. Just one example of many.
Just from what you stated in your first post it seems that you are under special scrutiny. I would seriously consider searching for a new job. When management is determined to "get" a person, it is usually only a matter of time.
i don't expect you to like my feedback, but i hope you take it to heart and i hope it helps you.
chart audits are a fact of life in nursing -- they serve a valuable purpose in that they help us to improve our documentation skills. if your unit has a policy in place that patients get a second set of enzymes so many hours after the first, you should have done the enzymes. whether the patient decompensated or not is not the point -- not even part of the point. the point is, if you're supposed to do the enzymes, you should have done the enzymes.
and as far as the double charting goes -- it's a pain in the butt, to be sure. but if that's the policy where you work, that's what you do. if you didn't do it, you do deserve to be reprimanded. your employer has a reason for the requirement to chart in two places -- you may not think it's a good reason -- it might not even be a good reason. but since that's what you're supposed to do -- and you already know you're supposed to do it -- then just go ahead and do it that way. choosing not to do so does indeed mean that you deserve to be reprimanded.
if the person looking through your chart didn't find the focused assessment where she expected to find it, that's a problem regardless of whether the patient should or should not have been an "icu eval." anyone who picks up your patient's chart needs to be able to find the information they need where they expect to find it. or should the physician have to dig through the entire chart to figure out where you decided to put your focused assessment today? if you're involved with a code on another patient, and someone comes to help out with this patient, shouldn't they be able to instantly find the assessment where they expect to find it? i'm not sure why you think your assistant manager was out to "get" you on the write-up -- it sounds like a perfectly legitimate write-up to me, even though i know only your side of the story.
if the patient is an icu eval -- for whatever real or bogus reason -- they need to be placed on the monitor even if you have to delay report to do so.
it doesn't matter -- or it shouldn't -- what other nurses do or do not "get away with." if you want to be the best nurse that you can be, you need to take these criticisms to heart and work on them.
you're an adult now, in an adult job. the fact of adulthood is that no one is going to go out of their way to give you kudos for doing the things you're supposed to be doing. they will, however, talk to you about it if you're not doing the things you're supposed to be doing. by your own report, you're not doing the things you're supposed to be doing, and even though you seem to have rationalized it to your own satisfaction, you're in the wrong. if you've never have a patient decompensate, that doesn't make you right. it makes you lucky.
grow up, take the criticism and learn from it.
you and i essentially said the same thing, but you said it soooo much better.:) hopefully the op can drop her defenses long enough to take what you've said to heart and recognize it for the helpful post it actually is. people who are validating her feelings of being the victim are not doing her any favors imo.
You and I essentially said the same thing, but you said it soooo much better.:) Hopefully the OP can drop her defenses long enough to take what you've said to heart and recognize it for the helpful post it actually is. People who are validating her feelings of being the victim are not doing her any favors imo.
if your nursing license could talk, it would probably call you and beg you to be more compliant with policy as the autonomy you exercised will probably not protect you if you went to court and had to defend your actions.
you will have something to fall back on. Having that back up plan makes you more confident :) . 
HouTx, BSN, MSN, EdD
9,051 Posts
Sounds like there may some major problems with equity & fairness if others are not being disciplined for the same infractions. But, since discipline is supposed to be confidential, does the OP know that this for a fact? Is it possible that the OP just doesn't know about others' being disciplined?
Another important issue. Performance issues are all about the behavior that was chosen - NOT the outcome. If discipline is based on outcome, it would really be unfair. Outcomes can be influenced by other factors, such as 'luck' (bad or good). For instance, two drunk drivers are speeding through intersections without stopping at red lights -- one doesn't hit anyone, and one does. Should the punishment be different just because one was lucky enough to avoid hitting another car?? Does that make him "guiltier" than the one who was lucky?
Never try to justify your behavior based on outcomes...it just comes across as making excuses and not taking responsibility. The right way to do it is by defending the process by which you chose your actions... "Due to the tight deadline/limited amount of time, I had to prioritize my actions and I chose to do X instead of Y because based on the information I had at the time, it would produce the best outcomes for the patient" This is a far more convincing argument.