Nurses writing up nurses?

[txRN07]

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:

[pepperann35]

Don't beat yourself up so much! Mistakes do happen--if your nurse manager said not to worry about it, then trust her and just try not to think about it anymore! Nurses do write other nurses up all the time--you'll come to learn which nurses you work with are quick to do so. Just take this experience as a learning opportunity; it will probably keep you from making the same mistake twice! At least there was no harm done to the patient. Maybe you should ask your manager if you can wait a little longer to have students with you--not that you're not capable, but the first year of nursing really needs to be a time when you're learning your way around and focusing on your practice--in my opinion, someone with only 8 months experience is still learning herself, and doesn't need the extra stress of mentoring students. Good luck and don't worry!

I agree with this poster. We all try and we ALL make mistakes. I have been a nurse for 18 yrs. Admit you made a mistake, take responsibility and move on. You sound like a very good nurse to me. Please hang in there!:redpinkhe:specs:

[leslie :-D]

i think this is being taken way too personally.

i consider a "write-up", a type of grievance.

this was not the case.

this nurse reported a med error, and according to the bon, it is indeed, reportable.

if you look at this a bit more objectively, it has nothing to do with you, and everything to do with the patient.

i am quite confident this nurse would have reported any nurse who did this.

please, take it for what it's worth:

nothing more, nothing less.

and, no.

this is not horizontal violence.

i can share many stories of backstabbing, mind-boggling behaviors from our colleagues.

and this, w/o a doubt, is not one of them.

wishing you the best.

leslie

[NurseCard, ADN]

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;)

Hmmmm... so then, if say I see on my MAR that the Phenergan appeared to have been omitted, then call the OP (or whoever) and ask them if they omitted the drug... it's appropriate to write that yes, the OP did omit the drug, and then go on to write a big long narrative, on the incident report, about what that nurse went through that day?

OR, is it more appropriate to just stick strictly with the facts? "Phenergan appeared on MAR as not given; RN from previous shift contacted; RN stated that medication was not given."

Or something in the middle?

[queenjean]

Part of my job as a night nurse is to do a chart check and a MAR check. If I find something that is missed that I cannot fix, I am supposed to "write it up" as an incident report.

If *I* don't address it, *I* look like I missed it, too, because I have signed off in the chart as having double-checked the chart and the MAR. Then it would be a double incident--the previous nurse missed it and I did, too. So I HAVE to write it up. I'm sorry that a mistake has been made, but how am I committing "horizontal violence" if I follow the hospital's stated policy and procedure for med errors?

Additionally, you have no idea of the circumstances. The MD might have been dictating his report later, asked the nurse about the missing med, and then thrown a fit about it, telling her she needed to write it up.

It *was* a med error. How exactly is it "horizontal violence" if a med is not given and a subsequent nurse writes an incident report? Now we are supposed to decide if it was inconsequential that a med was missed, and ignore it? How is that helpful? What if this isn't the first med that the OP has missed--but because no one committed horizontal violence by writing her up, she didn't know it?

I think this is a great learning experience for you. Like every time you make a mistake, I'll bet you dont' let it happen again. My first "write up" was when I forgot to unclamp a piggyback abx. I was grumpy that I was written up--but to this day I double check the clamp and watch for that first drop. If you are a good nurse, you'll take this in stride and learn from your mistake. No one expects perfection--then you'd be just freaky scary.

Don't fret about it; just learn from it and move on. Keep up the good work, and give yourself a pat on the back--if you could manage 7 pts and 4 students and only make one error all day, you are kicking butt just fine.

[MAISY, RN-ER, BSN, RN]

I guess my point is that it appears that the OP was "written up" and per her this "write up" goes in her file. That is not an incident report.

My understanding of incident reporting is, that it generally does not name a person(or can), just that something went wrong in the course of patient care. It is used for improvement, not to go in patient's chart-not to punish someone. * One of the major ways we improve our patient care.

If paperwork is going into this nurse's file it probably isn't an incident report, therefore there should've been a complete report of the entire situation if the OP must answer to it.

Not knowing if this nurse has experienced issues with the other, it may not be "horizontal violence" for this particular case. However, when nurses continually write up a nurse, or new grad they don't like...while letting the same offense go on others...it would be considered horizontal violence. It's intimidation pure and simple.

Maisy;)

[EmmaG, RN]

Technically she did the correct thing.

Everyone makes mistakes and it is horrible when the mistake is yours. But it is a mistake and any risk manager and attorney will tell you that any and all mistakes should be documented per hospital policy. This covers everyone. You need to separate yourself from feeling that you were picked on. You do seem to have had a lot of things going on but this does not mean that you did not make a mistake and should not be reported. In a good system, incident reports are used to fix system errors, not punish the person who committed the error unless it was an ongoing problem or horribly negligent. From what you describe, you had way too many patients and too many students for a newbie to be working trying to deal with all at once. The students should have had patients that were cared for by experienced nurses so that you only had to deal with the patients in your care - not babysit students too. This is a system error that needs to be corrected.

Exactly. This isn't a 'write up', it's an incident report filed because a med was missed. It's not punitive (or rather, it is not supposed to be) but a way of tracking errors so that hopefully in the future the same sort of error can be avoided or prevented. Many hospitals now don't even include the name of the person making the error, in an effort to encourage their staff to file these reports.

[BUTTERFLY63]

It's hard to be perfect! Even for nurses! You did the right thing by going to your manager. it sounds like she is on your side and understands what happend. Try not to beat yourself up about it. What is the night nurse like? I know we have some nurse on our unit that try to thow their weight around and intimidate the new nurses. Don't let her get to you it's what she wants.

[Mulan]

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.

Yeah, and you know what? When you leave that place and go somewhere else, they'll never even know about it.

[EmmaG, RN]

Many of the replies on this thread display the same sort of attitude that perpetuate these mistakes. It isn't a matter of 'gotcha'. Unless these errors are documented and the reasons and circumstances leading up to them investigated, they will occur time and again.

[putmetosleep]

I think this is a great learning experience for you. Like every time you make a mistake, I'll bet you dont' let it happen again. My first "write up" was when I forgot to unclamp a piggyback abx. I was grumpy that I was written up--but to this day I double check the clamp and watch for that first drop. If you are a good nurse, you'll take this in stride and learn from your mistake. No one expects perfection--then you'd be just freaky scary.

Haha! That was my first "med error", too! I was still on orientation and my preceptor was actually the one who caught it, so she didn't fill out an incident report but instead laughed with me and *taught* me to always double check the clamp. Boy, was I embarrassed :icon_roll But, it never happened again!

[rn/writer, RN]

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;)

I disagree. It isn't the reporter's job to sort out what happened. Think of the "write-up" as question presented to the unit manager. The manager is the one who should get the whole story and decide what, if any, further action is warranted.

The reporting nurse is likely to be working a different shift and probably has her hands full. It shouldn't be up to her to track down her co-worker, hear her out, and decide what to report and what not to report based on whether the circumstances were extenuating enough or not. It is her job only to raise a flag--without malice, without judgment--and report the facts of what happened.

The manager then is the one who then should investigate, contact the nurse, and decide what needs to happen next. Having nurses calling each other to account is far more likely to turn into a problem and/or a power struggle than having the nurse manager handle errors and omissions.

Yes, problems come in when there are difficult personalities involved, but that doesn't mean that informational write-ups (as opposed to punitive write-ups) are a bad idea. The concept is a good one with the intent to identify potential trouble spots and call attention to practices and procedures that may need to be overhauled.

The error I see people making on this subject is assuming that saying a mistake was made is the same as "ratting someone out." I'm sure there are a few who would misuse this important tool, but that doesn't mean we should throw it out. It ought to be possible to call attention to a mistake without adding condemnation to the equation. If it isn't, then that is a separate problem which also ought to be addressed.

We should make this kind of reporting safe enough that people will not fear for their jobs or feel sick and embarrassed when such a thing happens. Done properly, write-ups can focus on how everyone can learn and benefit from the experience and prevent the kind of sentinel events that create serious repercussions.

Keeping secrets and covering errors helps no one, least of all the patient.

[ERbunny]

I can't agree with you more. The nurse who discovered the error could be accused of "covering up" if there had been an untoward outcome. Lawyers do not think highly of nurses who may appear to be doing so.

fhe only way this could be considered any kind of horizontal violence is if the report was in any way derogatory to the OP. Variances and incident reports should be extremely factual, ie: the pt was found on the floor, without any mention that Nurse X had been lax in not giving the call light. I try to tell my orientees to avoid adjectives and adverbs.

I have a strong belief that behind almost every hospital policy there lurks a law suit, either past or potential. Our hospital has a separate form for reporting med errors, and a scoring system to evaluate and help nurses who are making frequent errors.

I have tried to read all the posts, forgive me if this has already been mentioned, but no acknowledgement seems to have been made that there seems to be a little lack of clinical knowledge here. It is highly unlikely that the Phenergan was ordered solely for its sedative effect. Rather I am sure the doctor wanted to prevent any nausea and vomiting from the Dilaudid during the procedure.

It sounds like your manager has done a good job with handling this incident. However I agree that you should not be dealing with students, you are too new a grad yourself. This is especially true if you can't tell the difference between an incident report and a "write up", which usualy involve behaviors which are unsafe, unethical, involve poor customer service, or poor relations with co workers. These should only be used in extreme circumstances, in my belief, and not for anything petty.

I have been a nurse for 40 years, so I know I have made an error or two along the way. I understand how devastating it can be. I am just glad that no patients were harmed, and tried to use my mistakes as learning experiences.

Good luck to you and best wishes.