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:
Specializes in CCU,MICU,SICU,CTICU,Renal, Recovery.
Being in this profession for as long as I have I will never understand why nurses expire so mush effort cut each other down. Confront each other, communicate. Not this write you up behind your back and blindside each other. Other healthcare professionals do not do this like nurses, I believe that is one of the reasons we are not more advanced and respected by other participants in the direct care of out patients...
I cannot believe the number of nurses who state they would not write up an incident report! That totally undercuts your risk management's ability to find and correct common errors and system failures!
The example with the antibiotics not being hung because the roller clamp wasn't opened--and the charge nurse's advice was just give the next dose and let it go?! I can't believe it! Depending on the pt's condition, abx, and prognosis, the doc definitely needed to know about that--they might have wanted to prolong therapy, for example. That should have been written up; if the nurse has a habit of doing that, and no one addresses it, it will continue. And skipping doses of abx can most definitely affect a pt's outcome.
What is with the attitude that if we admit to making mistakes or if we point out mistakes we are undermining our sisters and brothers, that we are a narc? What about patient safety? What about truth and disclosure? Or is it CYA above everything else? Forget trying to improve the system, just make sure that no one gets caught? Disgusting and shameful.
Specializes in Med/surg, ER/ED,rehab ,nursing home.
I always try to approach the nurse FIRST. If I get an attitude from said nurse, then it is write-up time. Where I work, we have a nurse that "everyone loves" except the nurses that follow him. We have computer carts in which some nurses pull their medications, and then put them in the cart. I took his cart over when my shift started. Another nurse on my team had his group of patients. I did not even think to look in the supply area on "his cart" until 4 am. At this time I found two antibiotics, and a bag of IV fluid with potassium added. This nurse had actually put the room number on the IV antibiotics...Levaquin....which of course is given every 24 hrs. He reported that he had given this RX in taped report. BUT in having followed this nurse several times, one does not truly know. I wrote him up. Three missed doses on at least two patients, false charges, and possibly a false claim to have given this. It is easy to pull the RX, scan the RX, and scan the patients arm band ( or print on out to carry with you) AND NEVER GIVE THE MEDICATION. SO you can see the problem here. Attention problems galore for this really nice nurse. He has been phoned at home, talked to several times by myself and others. SO MAYBE THIS WILL GET HIS ATTENTION, IF I DO IT ENOUGH. Note: Patient has a resistant TB. among several other health issues.
So take the write up as a lesson that did not kill a patient, or injure anyone. I believe you will be extra careful in the future. If you had electronic RX administration records, it would have flagged in red the omission. Better late than never. Also the Phenergan was probably to keep patient from getting sick and vomiting from the Dilaudid. NOT as a pain relief measure. Don't give up on nursing. I,too, work very hard to do everything right, keep patients and family safe and happy, and to get along with my co-workers.
We are not told who "wrote us up"...so we can only guess.
Right now you are feeling picked on. That is normal. Yet you feel concerned enough to feel hurt by this. YOU WILL DO WELL . KEEP ON NURSING.
I guess my problems with individual nurses dealing with it on the private level is that individually, we have no idea of the scope of a problem. Unless you ALWAYS follow the same nurse every shift that you work, you really don't have much of an idea of how often, for example, that nurse forgets to unclamp an antibiotic. But then you don't have any idea how often any other nurses forget to unclamp the roller.
Risk management's job is to see how much of a problem it is on the individual level, as well as throughout the facility. If it is a huge problem, how will they know about it if they don't ever get incident reports about it?
I guess my problems with individual nurses dealing with it on the private level is that individually, we have no idea of the scope of a problem.
Exactly why I go to my charge FIRST. She needs to be in the loop on every potential problem, frequently knows things we may not, and may have the quickest resolution. This stop turns most things into non-issues.
Sometimes the next step is to call the doctor. He needs to be in the loop on his patient and needs a chance to resolve things. This turns most every remaining potential problem into a non-issue.
Now if these 2 things are done first, we've afforded the patient our best care.
For sure, the first thing NOT to do is sit down and start writing someone up. These reports may be read far in the future, or the reader may not know anything about the case, or the reporter may be making wrong presumptions that could be easily checked.
You are still completely undermining your risk management department.
How does your charge nurse know what happens on other units? Does she work every day, all day and night?
You are taking care of the issue and that particular pt for that moment; but you are competely ignoring the long term effects of not addressing chronic mistakes. Some of these mistakes are system errors--equipment, an IT issue, an issue between departments. Some of them are unit specific. But all of them occur in your facility and your risk management department is responsible for addressing them on a facility level.
For example, with the abx not being unclamped--perhaps there is a different piggyback mechanism that will prevent this. Or perhaps your risk management department will recommend that new nurses be specifically educated that this is an issue for nurses in this facility. Maybe it needs to be addressed in staff meetings, or merely as a reminder note in the med room.
Filling out incident reports is not about being vindictive or tattling. It is about improving pt care and hospital practice across the board. It is about personal and professional responsibility.
I think the nurse that wrote you up is being a bully. I have been in the bully's position when a medication was missed. My first thing to do is to check on how the patient tolerated the procedure granted they are oriented x's 3. If the patient complained how she had so much nausea and or vomiting during the procedure but feels fine now well then I would have to talk to you and tell you what happened. Then I would call the M.D. and tell them what happened and ask what does he/she want to do. Most of the time in my experience and I worked the same kind of floor as you when I was a new grad, the M.D. would say just explain to the nurse what happened and make sure it doesn't happen again. The only time I recall having to write someone up/incident report was when a chemo med was not given. That was major so no questions asked it had to be done. In your case the patient was comfortable during the procedure and no harm was done. I would just let you know and that would be the end of it. Your going to be more careful in the future just by being told what happened. Also they did give you way too many students and tasks. Hang in there. Don't be afraid to confront someone for writing you up either. A lot of nurses will test you to see how far they can push you.
I had a nurse say that my admission was not given any of their 10pm meds and that this happens all the time with my ER's! By the way the patient came to the floor at 10pm! She even went as far as saying that I walked to pharmacy picked up the meds and did not give them! It was a complete lie! The meds never came until after my shift, I knew this because I checked the med room at 11pm before going home and nothing was there. The next day my Mgr called me in her office and I showed her the M.D. order sheet that showed the time of the fax to pharmacy which was 10:30pm. I also said this is a complete and utter lie. I asked to be shown all these other patients that I done this to and guess what there was not one. So I was actually apologized to by my Mgr and I made it clear to the nurse that tried to get me in trouble that I had my eyes on her and I was not going to take any crap from her! She never bothered me again. Remember no matter how nice you are to people not everyone will like you. Sad but True.........
Specializes in CCU,MICU,SICU,CTICU,Renal, Recovery.
Risk Management....Risk Managment... Toyota study... Blah Blah.. I have submitted simple solutions for ideas in a half of dozen hospitals for reoccuring problems that could be fixed, but they always just want to look at thema nd have meetings with people who sit behind a desk and havent touched a patient for 20 years and took the route of working in risk managment not to fix a problem but to just get away from the bedside... If there is a problem with a nurse.. you talk to that nurse, hold them personally accountable as a peer and know that they will be watched but you let them know if they have a problem with a procedure or a policy they can come to me for help. We a professionals are to teach and educate our young not let them drown. If it a constant problem or if they are risking patient safety, ok, i understand. But this constant backstabbing and hiding behind the shield of risk management? If you care about the patients and you can fix the problem by educating you newer peers and give them the why and the how, it will make them a better nurse from that day forward. Let risk managment deal with inderdepartmental problems, where a solution requires a team to solve, but to write up nurses for the sake of writing up instead of talking to your coworker. And they wonder why this profession grows so slow....
I'm sorry that you got a write up. And I agree that you should ask the night shift nurse why she felt the need to write you up in the first place. My big question is this - If your nurse manager saw what a hard time you were having, why didn't she come help? It sounds to me that there needs to be some overhauling in the management department. I've worked with lazy managers before, but I would never let anyone on my team have such a bad go of things. None of the other managers I work with would either. As for the write up, you need to remember you can't please everyone all of the time and no one got hurt, so don't take it to heart.
I hate nurses that write up other nurses. It's so second grade.
I have to play Devil's Advocate here... I have never written up a fellow nurse, and honestly don't think I would have in this case - the question I would have to ask is did her oversight cause damage to the patient? I think I would have taken her aside the next time I saw her and let her know about the oversight. But two points have to be made... First of all, being written up is not the end of the world. In this case, the oversight was not intentional, or negligent, she was very busy. We've all been there. A well- written rebuttal could have lessened the impact here. But the most important point is that we are all legally obligated to be advocates for our patients. Would writing someone up have been more acceptable if the patient had suffered harm. Sadly not, in too many cases. We (society) have a lot of criticism for doctors because they go to great lengths to cover up for their peers, often at great expense to the patient. Let's not let that be the case with nurses - patients still trust us to do the best for them.
I have to play Devil's Advocate here... I have never written up a fellow nurse, and honestly don't think I would have in this case - the question I would have to ask is did her oversight cause damage to the patient? I think I would have taken her aside the next time I saw her and let her know about the oversight. But two points have to be made... First of all, being written up is not the end of the world. In this case, the oversight was not intentional, or negligent, she was very busy. We've all been there. A well- written rebuttal could have lessened the impact here. But the most important point is that we are all legally obligated to be advocates for our patients. Would writing someone up have been more acceptable if the patient had suffered harm. Sadly not, in too many cases. We (society) have a lot of criticism for doctors because they go to great lengths to cover up for their peers, often at great expense to the patient. Let's not let that be the case with nurses - patients still trust us to do the best for them.
I agree. If the oversight caused damage to the patient or had the potential to, then it should be written up. I maybe would have talked the fellow nurse in this case, it doesn't seem to me like harm was there. But writing up an incident doesn't have to be and should not be a vindictive act against a fellow employee, but instead is something that is necessary in our current system to make it work better for our patients.
:urgycld:
CaptGaston
65 Posts
Being in this profession for as long as I have I will never understand why nurses expire so mush effort cut each other down. Confront each other, communicate. Not this write you up behind your back and blindside each other. Other healthcare professionals do not do this like nurses, I believe that is one of the reasons we are not more advanced and respected by other participants in the direct care of out patients...