Nurses writing up nurses?

nrsang97, BSN, RN · Jan 24, 2008

I feel it is better to sometimes talk to the person before writing a incident report. The med was omitted and didn't harm the pt. The OP shouldn't worry since no harm done. Sounds like she had a very stressful assignment and students on top of that.

Even nurses that have tons of experience forget something once in a while.

The nurse saying "I wrote you up" is what they are referring to as "horizontal voilence". OK that is a stretch, but some nurses write incident reports for everything. I am a firm believer in saying "Hey, when you were here yesterday during that biposy you didn't sign off the phenergan, did you give it?"

Talking to each other goes over better than saying "You didn't give that phenergan during that bone biopsy yesterday, so I worte you up." Don't you think?

Also a incident report isn't the same as being written up. Should that nurse wrote a incident report? If it is policy, then yes. Alot of the time those that wrote the incident reoprt say "I wrote up Mary Sue for not giving those meds." Some people think that they are really going to get someone in trouble when a incident report is written. A lot of times that is the case and thats why the one poster was referring to "Horizontal Violence."

RN1989 · Jan 24, 2008

I feel it is better to sometimes talk to the person before writing a incident report.

This is the nice way to be friendly with everyone. But this is the wrong approach.

It is against every hospital's policy that I have ever worked for to NOT write up errors. This has nothing to do with how you personally feel about the person involved in the error. It has nothing to do with whether or not you are a nice person. A mistake and even a near-miss requires an incident report per facility policy. If you do not follow hospital policy, you are opening yourself up for disciplinary action from your employer, the BON, as well as lawsuits. If you violate policy and the hospital is sued by that pt, even if what you did had no effect on the pt and is not the reason that the pt is suing, you can be hung out to dry by the hospital in their attempt to CYA. Anyone that violates policy is putting their job and their license on the line.

As I read some of these responses I am concerned about where the line of ethics resides anymore.

Agnus · Jan 24, 2008

I am a new RN, and I have been working on a med-surg floor for 8 months now, and up until this point things have been going well. Yesterday we had students on our floor, and I love having a student because I was one just a short time ago, but I had 4 nursing students on my cart, plus 7 patients to take care of, as well as a doctor coming in to do a bone marrow biopsy on one of my patients that I had to assist with, plus a new admission! Needless to say, I worked my tail off all day without even breaking for breakfast or lunch. Things were hectic but everything was given and done on time. Well, I came in this morning to find out that the night nurse who had my patients wrote me up because I forgot to give the ordered Phenergan to the patient before the biopsy. I did give the dilaudid which sedated the patient more than enough and she slept through the whole procedure. I spoke with my manager and she said that she saw how hectic it was for me, and not to worry about it, but I am shocked that this nurse who wasn't even there took it upon herself to write me up, and now this goes on my record. I love my patients, and it eats me up inside when I forget something, I admit my mistake, but should one nurse be allowed to write up another one without consulting the boss first? I've been crying all afternoon about this, and feel like I need to quit, the incompetence that I feel is immeasurable.:urgycld:

Goes on your record. That sounds like high school "this will go on my permanent record."

You are obsessing over piddly stuff. Let it go. It happens. Your manager has. I've written myself up numerous times.

crissrn27, RN · Jan 24, 2008

Can I ask what exactly you mean by "write up"? If it was just an incident report, that is not a write up. At least not where I am. Incident reports, in theory anyway, are just tools that track what problems are going on, and help determine the reason. Like maybe the floor needs more help, so nurses aren't missing lunch and breaks! If I miss a med, or make an error that needs an incident report, I expect who ever finds it to do one (even if its me!).

Everyone makes mistakes, and if that was the only one you made that day, you are doing a great job!

rn/writer, RN · Jan 24, 2008

Please do not equate this with tattling.

Part of the problem comes from the fact that there is no universal definition of "writing up" another nurse. In some facilities a write-up is nothing more than a written notation that something occurred. Rare is the nurse who has never been written up in that sense.

In other places, being written up can mean being given a written notice of discipline, a much more serious action.

The second example would indeed be too harsh for what happened in this instance. The first, however, is entirely appropriate and should not be viewed as punitive.

This is the only way to fairly gauge the effectiveness of a unit and it's staff. The conclusion that could be drawn from your "write-up" could be that proceedures like marrow biopsy take up too much of the floor nurses time and need to be done only in a special proceedures arena.

Until we stop ignoring errors for fear of making our colleagues upset, we will never achieve a safe health care culture in this country. There should be a non-punitive system in place in your hospital (and every hospital) where mistakes are recognized and addressed through examining the environment, systems and other factors that led to these mistakes.

Keeping track of errors and omissions is the most effective way to spot problems and prevent sentinel events. If three nurses who are otherwise dependable make a similar med error, that indicates a need to revamp the packaging or the routine for giving it.

There are times when we cover for one another, but there are other situations where doing so can lead to more problems because the causes will not be addressed.

Writing up another nurse is horizontal violence only when there are other issues and it is done with the intent of harming her.

ginger58, ASN, RN · Jan 24, 2008

No quitting allowed! Hey, 7 patients, students and lots going on--it's not safe. Not safe for anyone. To me you're a good patient advocate, you realized that the patient was sedated from the dilaudid. Things get forgotten when running your tail off. You're not incompetent, you're human. It would be nice if there was time to make calls, notify this one and that one, write this up but in the real world things happen and the shift flies by. Until all the states get nurse:pt ratios that are humanly possible this is the way it is for now. Be good to yourself. Give yourself a pat on the back for getting through nursing school and being out there taking care of patients.

Tait, MSN, RN · Jan 24, 2008

Filling out an incident report is not the same thing as initiating disciplinary action. Only a supervisor can do this. I urge everyone to remember this when they become upset at a coworker for bringing an error to the attention of the patient safety committee.

Thank you for the above post.

In addition, this is not an issue of personal attack, it is an issue of policy and procedure. The nurse did not do it to spite you, but to effectively document all aspects of the patients care.

The following article is one of many on the dangers of silence in hospitals pertaining to reporting med errors and other topics.

http://www.aacn.org/aacn/pubpolcy.nsf/Files/SilenceKills/$file/SilenceKills.pdf

Tait

"I LUV IT!" · Jan 24, 2008

i hate nurses that write up other nurses. it's so second grade.

i agree!

:banghead:

nyapa, RN · Jan 24, 2008

What I am wondering is if this nurse was not a supervisor, then, how does what she writes count on your record?

That's what I was wondering?

Cardiac-RN · Jan 24, 2008

Give me a break.

I have to disagree with you, Lindarn, this is not an act of horizontal violence. It is simply an act of a nurse complying with policy&procedure to 'write up' a found error so that risk management can be notified to observe for trends or system patterns. It is not 'getting another nurse into trouble' or 'being malicious' but recording an error in an objective way that can bring it to the attention of the people whose job it is to observe whether a nurse is having a multitude of errors, or a floor is having a particular type of error frequently, so that things could be addressed or changed if necessary.

Cardiac-RN

This is what is known as, "horizontal violence" that is directed at you by a co-worker. This practice is driving nurses away from the bedside in droves. There was no reason for the night nurse to write you up for that infraction.
This is so prevalent in nursing. It is a way to have some modicum of control over your peers, since nurses have so little control over anything else. It is a common practice in individuals who have little control and alot of responsibility, as nurses most often do. As I said, the practice is driving nurses away from the bedside big time. That doesn't excuse it at all.
Lindarn, RN, BSN, CCRN
Spokane, Washingnton

BrnEyedGirl, BSN, MSN, RN, APRN · Jan 24, 2008

I have to agree with some of the others here,..this doesn't sound like a "write up" as in a disciplinary action,.but a med error,.all med errors need to be written down,..it's policy and there is a reason for it,..as someone else stated these types of errors (as trivial as they sometimes are) are often exactly what it takes to make new policy IE,.bone biopsies should be done only in ICU or a special area dedicated to procedures requiring sedation and recovery time........for instance our hospital no longer allows IV fentanyl on the floor,.ICU/CCU/NTICU/ER etc only are allowed to push fentanyl,.this is because of a large number of respiratory arrests, and respiratory depression following IV Fentanyl,..it isn't that the nurses on the floor aren't capable of giving IV Fentanyl,.they just often don't have the time to keep a close eye on these pts, and it only takes one person to be found blue with sats in the 50's for you to re think your policy! This "write up" may actually end up making things better for you in the long run!! Just curious,.did this nurse "write you up" because the pt was vomiting post procedure and she had to call the Dr for orders? Hang in there,.mistakes happen to all of us,.we are human!

MAISY, RN-ER, BSN, RN · Jan 24, 2008

While reporting may seem like a good idea...the writer of the report had no way of knowing what the reportee's day entailed.

Incident reporting is important, but unless the nurse mentioned in the report gives the reasons why a med order may have been missed...it just makes her appear like the med was forgotten, instead of the truth....she is a new nurse, with full patient load, work to do and several students. The reporter has the right and perhaps obligation to make the miss known, but he/she also has the responsibility of getting the whole story so the report is accurate.

And I do believe it can be a form of horizontal violence...have seen first hand from experienced nurses to get rid of new nurses.

Maisy;)