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:
My main point was regardless of whether it was an incident report or a write up the person doing the incident report or write up still should have all the information.To do this you need to speak to the person(s) involved. From reading the original post this person did not bother to obtain any information. She made an assumption and reacted to it. I learned a long time ago never assume anything in nursing. I find it disheartening to read that so many people think this nurse was right in writing this nurse up without speaking to her first.
Again, I disagree.
If I find a med error, I write an incident report stating the facts as I know them "phenergan was omitted and not given during procedure "x". My job is done.
To further investigate the process as to why this error occurred is the job of the risk manager and the manager of the unit. Upon their investigation it may involve other people like the unit educator, charge nurse, etc. But the person finding the errors needs to merely state the error.
I'm not saying that's what I would have done. I have called nurses at home and asked about certain things. But it merely adds to the report "phenergan not given, nurse says she was stressed and busy and forgot, and patient tolerated procedure fine without it".
But if the truth were told, I would never have written an incident report over such a minor incident. I would have kept it between myself and the nurse involved.
When i was in my grad year i caught a med error from one of my friends at work. It wasn't a huge deal but the orders had been changed from the day before and the nurse gave an extra dose of an antibiotic. I had to write an incident report, absolutely hated doing it because it was my friend but i knew i did the right thing. My friend didn't take it personally, she was upset but she understood that if the situation was reversed i would expect her to do the same as i did.
I agree that you shouldn't take it too personally, it's not about blame it's about protecting the patient, the hospital as well as staff as well. You had a heavy load to deal plus looking after students as well. Some advice I can think of in future if you given this sort of load is to delegate tasks to aides/students within their competence to free you up to do other things, to report to management if you given an unrealistic and unsafe workload.
I haven't read all the replies, but on the first page of the replies, no one mentions what you should have done to avoid being so harried in the first place. With that load of 7 patients, one of whom is having a procedure at which you must assist, you have no business taking an admit, much less 4 students!! Simply tell the charge nurse that you can either take an admit or assist at the procedure, but not both. You should not have to miss lunch to do your job.
If you lose your job for standing up for yourself (and your patients), so be it. Find a better one. You are standing up for your patients because you cannot possibly do the 7 you have justice while taking on another one.
The incompetent person is the one who wrote to give phenergan with the pain medication. According to the City of Hope pain specialists, phenergan does not potentiate pain medication. Phenergan is an anti-emetic and a CNS depressant. It should be used for nausea and vomiting, not as an adjunct to pain medication. This practice, especially in the elderly, puts them at risk for complications from oversedation.
If Phenergan was ordered and you did not give it, then you went against the doctor's order. This is not within your scope of practice. If you did not give the Phenergan because of too much sedation, then you should have told the doctor the situation and allowed him to decide whether or not you should give it. If you did not give it because you forgot, you should have notified the doctor that you forgot to give the med but that the patient was very comfy with the Dilaudid. You could then have documented that the Phenergan was not given, doctor notified, no further orders.
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.
If you are conscientious in your duties, this isn't going to harm you. Take it as a learning experience. You need to know what your limitations are and work to prevent something similar from occurring again. I know that it is hard not to wonder if they are out to get you. So many nurses use incident reports to be vindictive that it can make you paranoid. Don't let it. Learn from it and go on. And when the shoe is on the other foot, you will know that it is your duty to report errors when you find them, even when it isn't the popular thing to do.
If more people wrote up incident reports on ALL of the errors and problems that occurred every day in every hospital - we might actually be able to show the public the purposely understaffing and under-training causes errors and deaths - not the actual persons involved. Few errors are the result of one person, they are a result of a terrible healthcare system.
I do agree with some of what RN1989 said. However, we are taught the we are responsible for all of the medications and interventions that we provide. We are not supposed to blindly follow dr orders just because he ordered them. If you were to follow an order that was incorrect and caused harm to a patient, you can bet that you would be held responsible, regardless of what the dr wrote.
This may be going off the subject a bit but, as far as not gving ordered meds, if it is something that a pt should not have (ie sedation on a sedated pt, or b/p meds for someone with hyoptension) we do not have to call the dr for all of that. We just simply note why it was not given. We are taught that we are autonomous in our practice, we have all been to school and have a liscence. That being said, we are also responsible for giving meds that are ordered and needed.
It is not up to a co worker to police your practice, that is what management is for.
Thanks to all! This has been a valuable and timely discussion for me, too. I'm a 52 yr old nurse who graduated with a BSN last May (07), but delayed working due to family illnesses/deaths. I began a med-surg internship in the fall and was hired onto a very busy general surgical floor in Dec. I'm still 4 weeks short of my 90 probation period and had my 1st "incident" report filed against me this week. I felt devastated when the news was delivered to me at the beginning of my shift. I wasn't sure what it meant. I couldn't just shake off the emotional impact, but tried to stuff it and keep on trucking throughout the night so I could care for my patients.
In doing the 24 hr chart check, I'd overlooked a "missed order" from the dayshift and signed off on the chart, so both the dayshift nurse and myself were named in the report, I understand. While giving my report the evening I returned to take over my group, the new dayshift nurse tersely said, "By the way, you have an incident report against you b/c you checked off a chart with a missed order, so the manager will probably be talking with you. It was for a pt with a newly placed peg tube who was suppose to have had a feeding before going home. It didn't get done, but fortunately, it didn't prevent him from going home, so you're not in a lot of trouble." She tends to be an uptight and unhappy nurse. I wasn't sure how to "read" her.
Interestingly, on 2 occasions when I took over the care of her pts at the end of the day, I've found IVPB antibiotics hanging on the IV pole that were never connected to the fluids to run from the previous shift. I asked my charge nurse what to do about it and she told me that since it was time for me to give the next dose, to simply go ahead and give my dose and not to worry about it. I now understand that I should have probably written that incident report as a medication omission. We document in computers, so she'd scanned the med into the computer, but not gone ahead and run it... or had a failed hanging. Since I didn't see her the next morning, I didn't alert her to her error.
I've only been a nurse since last summer. Only been working for 4 months. I still feel so green and have so many nights when I wonder if I made the right decision about pursuing a nursing career this late in life. I'm on a floor where I feel more like a machine than a nurse. It's nonstop for 12-13 hours. The only time I sit down is to do chart checks, which is when I try to eat a sandwich. I never dreamed nursing would be like this. I thought at night I'd have time to listen to pt's tell me their concerns, give backrubs, etc. I feel like I'm playing "Beat the clock" all night long, running on adrenaline. I can see how easy it is to make mistakes under this pressure.
It's been helpful to read through these comments. I know I need to not take the incident report as a personal attack , but an opportunity for growth. ( BTW, I did stay around to speak to my manager, who was understanding and said he just wanted me to learn from it.) It's still difficult not to flay oneself for personal errors against the patients we've promised to care for... to not begin to doubt one's capabilities and competence.
What a new appreciation I have for nurses in all walks of life now! Thanks to all of you who have shared your wisdom and experience on this forum.
I agree with lindarn. There are so many things that happen, and the most frequent and serious ones I see are transcription errors by the pharmacy and secretaries. And yet these don't get written up. They get fixed by the nurse.
Now when a nurse does something or doesn't catch something and another nurse catches it, that nurse fixes it (by passing it back to the person who made the error if they're still there, or herself if not) and then:
(1) does nothing further because nothing is warranted, or
(2) tells the charge and lets her investigate and decide whether it requires reporting, or
(3) reports it herself in a fit of self-righteousness or in unreasonable fear it'll somehow fall on her.
We have a predominantly non-blame culture. Nursing supervisors, when resolving a situation, give out little rewards with the compliment "good catch." Also alleviating bad feelings is a Pyxis-based system that keeps accurate records that speak for themselves.
There's an awareness that if there's a significant irregularity, it's the doctor who needs to know about it before some computerized reporting system. And frequently the doctor will ask a couple of questions and say "no problem" or "that gives me an idea; why don't we try this?"
Basically things don't get covered up or magnified, they get brought to light and fixed. I like it that way. There's a huge difference in everyone's performance if they know everyone's watching their back instead of trying to stick a knife between their shoulder blades every time they turn around.
I think we should remember too that sometimes it is the error that is written up and not the specific nurse. Sometimes there is a process that needs to be evaluated to determine if it could be done better to prevent errors in the future. We shouldn't take writeups personal everytime. Your manager said not to worry so chalk it up as a lesson learned and concentrate on your shift today.
Specializes in med/surg, Icu/Ccu. ER, PACU, HHC, LTC.
As many have said disciplinary action comes from a supervisor or manager, therefore your co-worker was following procedure and reporting a missed med: that means a doctor's order was not carried out. Your manager should have had you make a late entry and document what was not carried out (and why) to cover yourself. I am sure the doctor would have no problem co-signing this order. Yes-- some, in fact, many co-workers make it their business to try to find things to get others in trouble, and after over 30 years of nursing I wonder how they do their work effectively and properly. Night nurses are often given the job to go over the days events and check for errors so they do not go unnoticed, and as we are all human this is ok. Use this as a learning experience and stop beating yourself up. If you made it through the day with that many students under your feet and only eight months experience, you are fine. With time you will learn which nurses are just trying to *stir* and which ones are just doing their jobs correctly. We all make mistakes and because you care and are a good nurse it makes you upset.
I disagree that she did the right thing. Writing someone up is something that should be done only after ALL the information is obtained, and then if the situation warrants such an extreme measure then do it. The nurse never spoke to her to get that information. Writing someone up goes in that persons personel file and will be used against them on evaluations. If you are going to have such an effect on a co-workers professional life at least give them the courtesy of explaining the facts. It is not your "duty" to write people up.
I agree here. We have a hard enough job, without making it harder. What if she actually gave it and just forgot to sign it off (she said she didn't but I am supposing)? Then the "write up" or "incident report" would be invalid. Find out the facts first and let your supervisor know, and let them do the reports. I don't really want to work with someone who is always writing people up. That does not make for a friendly work environment.
Was this a true write up or just a med error report?--She (as well as you) is probably required to write up missed meds. In the last hospital I was at we were encouraged to write up med errors, for patient's safety as well as not become responsible ourselves.
I am so sorry to hear of your experience. I can totally sympathize. I would bet that your deepest sadness is over the quality of the noc nurse's deed. It feels harsh, inhuman, unrelated to reality, totally loveless. What good did she accomplish by doing this? What was solved? How does a write up improve this situation so it will not happen again? Rules and regulations, while they are helpful guides, have become icons for many people. They miss the bigger picture. The nurse acted not out of compassion and a loving interest in the big picture and an interest in how to prevent such things from happening. It seems to me that when nurses do such things, one can almost see the chest just swelling with pride and self-righteousness. She did the right thing, after all. SHE did not make a mistake.....
Now, if she had been in the same circumstance, I doubt that she would have felt that it was right for someone to write her up. Why? because we are really (mostly) not criminals, but human beings....and ones with good will and training and the intention to fulfill everything just as we are meant to. And when circumstances of our work become so extreme that something is overlooked, then perhaps, rather than be written up--which solves nothing--perhaps we can look at the circumstances surrounding the situation to see what we might do better in the future so as not to create another such situation which would lead to someone being so overwhelmed as to make an error.
I have worked with nurses who are not too interested in their jobs and make errors out of a very different orientation than the one you had.
There is a saying that certainly rings true: nurses eat their young....and I see it all of the time. I hope you will be able to realize that this is one of the not-so-nice facts of working in the medical field. But, your dedication and caring for the patients is something just wonderful -- for the one who is a patient. The medical field needs more nurses like you....don't let them chase you away.
:urgycld:
Tweety, BSN, RN
36,297 Posts
Again, I disagree.
If I find a med error, I write an incident report stating the facts as I know them "phenergan was omitted and not given during procedure "x". My job is done.
To further investigate the process as to why this error occurred is the job of the risk manager and the manager of the unit. Upon their investigation it may involve other people like the unit educator, charge nurse, etc. But the person finding the errors needs to merely state the error.
I'm not saying that's what I would have done. I have called nurses at home and asked about certain things. But it merely adds to the report "phenergan not given, nurse says she was stressed and busy and forgot, and patient tolerated procedure fine without it".
But if the truth were told, I would never have written an incident report over such a minor incident. I would have kept it between myself and the nurse involved.