"Writing up" use or abuse

eriksoln, BSN, RN · Feb 19, 2009

I think its a necessary evil. If someone is doing things that are dangerous, it needs to be reported. When the nurse writes up someone, then it is documented that the nurse has seen the issue and management has been notified.

The problem starts when nurses use write ups as a............forum to vent frustrations. They get personal, they target certain individuals over others and write up ticky tacky offenses. This passive aggressive finger pointing is not what they are for.

For instance, when I was a CNA, there was a nurse on the unit infamous for writting up people over every little thing not done when she came in. Orders that got written during report that were not put into action and signed off got a write up. A pt. who complained about pain anywhere between the initial assessment and a half hour after that (so, say she starts at 7......pt. complains of pain at 8) would get a write up. The list goes on forever. There was never a week that passed in which she was not pulling out the pink slip. This is, as I already called it, passive aggressiveness.

Overall, because of the abuses, write ups hurt the nursing profession. I've said it many times before, we are our own worst enemies. Look around, there are threads dedicated to the lack of respect we get, the poor treatment we receive from doctors and the slanted view the public has of us. These problems are primarily our own doing. We are so quick to taint each other and point out everything wrong with our fellows........everyone else is just following suit. Write ups (of the abusive sort) promote this behavior of nurses slandering other nurses.

A friend of mine used to say:

"You know the saying.........Give someone enough rope and they will hang themselves. Well, with nurses, its..........Give them five minutes to talk and they will hang themselves."

I agree, a forum to report unsafe behaviors and practices is necessary. But the passive aggressive behavior has got to go. Or, generations from now, we will still be hearing about "Nursing is a profession, but others dont think so" in school and have our forums filled with "No one respects us." threads. Why should they, we dont respect each other?

caringchic · Feb 19, 2009

I couldnt agree more, when I was first out of school I got my first write up one week out of orientation. I thought I was using "critical thinking" and opted to give my PRBC infusion second unit prior to giving a scheduled ABX. A senior nurse thought it shoud be the other order. What I learned from that has stuck w/ me since, 7 yrs and counting, most of the times write ups are a difference in judgement where a clear policy has not been determined and nursing judgement is not a one size fits all model.

Write ups should be used after other interventions fail; number one intervention education, or when something clearly is against policy, or blantly dangerous!

The rest of the time it is a bunch of catty women primarily being ridiculous! I have yet to see a man be so vindictive and backbiting in transition of pts!

RN1982 · Feb 19, 2009

Um priorities here. I think the PRBC transfusion would be more important.

FireStarterRN, BSN, RN · Feb 19, 2009

Um priorities here. I think the PRBC transfusion would be more important.

Ah, but she had already given one unit and the abx would probably only take a half hour to infuse. :twocents:

I vote for giving the abx, then hanging the second unit. :coollook:

FireStarterRN, BSN, RN · Feb 19, 2009

(and I'll be watching you, TraumaNurse, to make sure ya do it my way, or the highway!)

:lol2:

RN1982 · Feb 19, 2009

LOL...and I'll be doing it my way.

flg8tr · Feb 19, 2009

Write-ups are, for the most part, the adult equivalent of a young child telling on someone to their kindergarten teacher. An expression of social ineptitude and lack of conflict resolution skills, used mostly by small, petty individuals.

Magsulfate, BSN, RN · Feb 19, 2009

When you have a nurse doing the same stupid crap over and over again, even after talking to him/her about it, that is when it's time to write it up. Come on people, it is absolutely rediculous that some nurses think they can get away with the crap that they do. Sitting in their little corner, doing BARELY enough to keep their job and keep their patient's alive, not being teamplayers.... charging for 2 oxy's and only taking out one and undermedicating said patient who has a bad pain issue... thinking this is okay and nother is wrong with it...... calling in 5 minutes before the shift starts, calling in once a week or more.... being a witch to everyone on the unit including your patient's family,.... embarrassing our whole hospital by being rude to the nurse from another hospital your getting report from....

I could go on.

Some nurses just need to be written up.

caroladybelle, BSN, RN · Feb 19, 2009

Ah, but she had already given one unit and the abx would probably only take a half hour to infuse.
I vote for giving the abx, then hanging the second unit.

I work Hemo/Onco, and unless the H/H was really, really low/and or pt was profusely bleeding.....the ABX (if of short duration) would be priority.

It all depends on the situation.

allnurses Guide · Feb 19, 2009

I think it's a US thing, and may be related to the likelihood of litigation.. I've worked in a few countries, over 12 years, and *never* encountered this before. In other places, you write incident reports for incidents or near incidents related to staff or patient safety. You speak to your manager about other issues and they handle it. That's what a manager is for.

In the US, I imagine people are more likely to sue for being fired, and hospitals need to have the written documentation.

caroladybelle, BSN, RN · Feb 19, 2009

I think it's a US thing, and may be related to the likelihood of litigation.. I've worked in a few countries, over 12 years, and *never* encountered this before. In other places, you write incident reports for incidents or near incidents related to staff or patient safety. You speak to your manager about other issues and they handle it. That's what a manager is for.

Unfortunately, many managers don't "handle" it.

A nurse gets transferred onto my unit. She came from urology, but had worked for many years as an "office" nurse for a local pain control MD. She was also a friend of our manager.

After several monthes of missing/incomplete/incorrect I/Os on chemo patients and repeated, REPEATED!!!! med errors, especially on narcs - reported to the manager, we started writing up every error...which often amounted to several a shift....on a 12 bed unit.

One expects someone that worked urology to be able to calculate I/O, and someone who set up prescriptions for a pain MD to know the difference between 60mg MS Contin and 60mg MS Instant Release.

Management continued to do absolutely nothing.

Nurse finally got written up for the first time, when I came in to find an antibiotic (a cephalosporin) hanging on a pt, having run dry. The IV clotted off, the last recorded med hung 5 hours prior, the drug had the wrong name on and that med was not even ordered for the pt.....and the pt had a PCN allergy.

I left the job just in time. Shortly after, despite having multiple med errors after the ABX incident, said nurse continued to work...until she hung a 24 hour bag of chemo on a pt and screwed up on the rate, causing it to infuse much too rapidly, which did result in complications for the pt.

She went on to work in another facility, until she got busted for a positive tox screen.

Sometimes, you have to force managers to do their jobs, for the good of the patients.