Nurses writing up nurses?

Nurses General Nursing

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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.:crying2::urgycld:

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 completely agree with you. I wish incidence reports could/would be written up for every "little" thing. Who has the time though?? I swear I could add another 2 hrs daily writing them.

I just don't like writing up other nurses though, because we are all in the same boat. If something is missed I will bring it to the attention of the other RN the next time I see her/him, and I would completely appreciate the same so i can learn from it and be more aware the next time. As far as I'm concerned I think a huge majority of the time errors or near-misses are the fault of the healthcare system as a whole and I just hate putting someone's name it. We all have those days where it is unbearable and near impossible to get everything done... can't walk in to a room without being called back out, every phone call is for you, needy family members, demanding docs, pt going down the tubes, your near tears, haven't eaten or even gone to the bathroom and then get handed an admit.

If it is something that could have (or did) caused harm I will write one or I bring it to the attention of the assistant manager and she looks into it and goes from there.

A co-worker wrote me up once for missing an order to decrease an insulin dose. I had a horrible, horrible day that day. When she came in I was sooo behind and I was actually there 3 hrs late helping her so she wouldn't end up with as bad of a night as I had a day and also charting since I had NO time all day for that. Well, I guess I didn't audit one of the pt's charts and missed that order, and the pt ended up with a sugar of about 50 in the AM. When I got a copy of the incident report and order, there was no time written next to the order...so I do not even know when it was written and the previous order was signed off at about 5pm. So it very well could have been written after my shift ended. I refused to respond to or sign the report. I was just upset with the fact that the night RN saw how bad my day was, saw me near-tears and so stressed, i told her I tried to get my pts split up for the next shift and the charge didn't do that. I stayed to help get things under control, busted my butt for 15 hrs...and then am written up.

I just have a hard time doing that to another nurse.

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Very sorry that happened to you. It seems to me you had to much on your plate. It seems the patient did just fine without the pheregan. It would be different if it was life threatening but it wasn't. Don't let this eat you up or make you feel like your not a good nurse. Heck anyone that actually is working:nuke: and not sitting at the nurses' station on their butt:angryfire deserves merits. Keep your chin up! I'm sure your doing great. From what you explained, I think your doing excellent.:nurse:

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If the noc nurse noticed it and didn't document it somehow she was negligent in her own right.

It is NOT the responsibility of the oncoming shift to check the charting of the nurse that had a pt. before him/her. I know people that do this and it drives me crazy. I've learned to stay away from them. She shouldn't have ASSUMED she didn't give the med, maybe she just forgot to chart it. She should have left that nurse a note saying it didn't get charted and left the ethics up to that nurse.

Got too many people like that and it creates a hostile work environment. I'd leave if it's too rampant.

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It is NOT the responsibility of the oncoming shift to check the charting of the nurse that had a pt. before him/her.

Actually, in my hospital the night shift nurses do a 24 hour chart check. We check that all orders and meds from the last 24 hours have been entered into the computer system correctly, and we check that all orders have been implemented and meds have been given. If something has not been done, and there was no documentation as to why it wasn't, we are to write it up.

It works well. Unless you have a pattern of leaving something undone, you don't even get a note every time you get written up. If you *do* get a note, it's usually something like "FYI Jean, 24 hour chart check revealed that you didn't sign off an antibiotic on Mr. X in room 201 on 2/10/08 at 0300. Please remember to check your MAR before the end of each shift to resolve any issues and that if a med isn't given, please document the reason on the MAR. Thanks, Risk Management."

Incident reports don't just evaluate an individual's performance, they evaluate the entire system as a whole. Like, we switched to these new bedside documenting devices, and had several time inaccuracies within the first day. IT soon figured out that some of the devices had been set to stay at the same time that you logged in-it didn't auto refresh. So if you logged in at 8pm, and stayed logged in all night, it would document ALL of your meds and tasks at 8pm. Incident reports helped track where and how it happened.

Obviously that's a rather simple example, but write ups help identify where the system has broken down. RM uses the incident reports to track where errors occur, how they occur, and then what sort of follow up has been implemented to prevent such errors in the future. Why would you not help prevent future errors? Sure, addressing them individually may seem like the friendliest idea, but it completely bypasses any type long term solution. It also means such errors can't be tracked in a larger scope--at the hospital facility, or national level.

If incident reports are used in a purely disciplinary way, then no, I wouldn't be so quick to write one up. I suppose they are used that way in some facilities. In ours, at least, they aren't.

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Specializes in Cardiac Telemetry, ED.

I can't believe this thread is still going.

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I do not believe in nurses writing up other nurses unless a pattern of negligent behavior is evident. In some ways nurses need to be more like doctors who have professional respect for one another and will generally back up their colleagues. In the case of those that continually are messing up a write up can serve as a wake up call for them...

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Technically she did the correct thing.

{"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"}.

My understanding of the situation is that the medication was forgotten - not intentionally, and there was no decision made that the patient did not need it, and the nurse concerned did not mention it because she plainly forgot to give it. In australia we have a system (AIMS) where incidents such as this are "written up" on a form and collated nation wide. There is no intent to blame a nurse, dr or other health professional but rather to identify problems with the "system". I think in this case we would identify busy shift, workload, student supervision etc. We are all busy and I am sure that one can claim to be the "perfect nurse". Personally, if I was the nurse that discovered ther error, I would try to speak to the nurse concerned first. If it became apparent that this is a common problem, or that the nurse has issues with patient care, then I would file an AIMS form and speak to management.

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Actually, in my hospital the night shift nurses do a 24 hour chart check. We check that all orders and meds from the last 24 hours have been entered into the computer system correctly, and we check that all orders have been implemented and meds have been given. If something has not been done, and there was no documentation as to why it wasn't, we are to write it up.

If incident reports are used in a purely disciplinary way, then no, I wouldn't be so quick to write one up. I suppose they are used that way in some facilities. In ours, at least, they aren't.

We do a 12-hour chart check with the oncoming nurse (or 4 or 8 depending on how much time has gone by since a change of care givers). Going back 24 hrs is overkill, imho. And it is not done for the purpose of finding errors and writing them up. I couldn't work on a floor that operated like this.

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Specializes in CCU,MICU,SICU,CTICU,Renal, Recovery.

If someone gave a med and the order cannot be found , then you need to follow up with the nurse first, I may have been given in an emergent situation and not documentented in the chart properly, or if you work in a paper system, the paper could have been pulled out and is in the fax machine, or in a computer system the doc said i will "put the order in the computer" and he had not done so.. yet. Find out the whole story then if neglegent, take action. Have you people not heard there are three sides to every story? Get at least 2 of them.

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Absolutely, do not take it personally. An omission occurred- a report NEEDs to be filed. And yes, it is necessary for quality improvement to occur otherwise a potential problem may go un-noticed until something far worse happens. Sounds like good may already come from this report; hopefully new nurses will not be challenged with so many student nurses on one shift anymore!

Hang in there!

:D

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