"Writing up" use or abuse

[zuzi]

What is your opinions? How usedfull it is? Did persons who using writing up they tried before write up and any other remedy methods? Is a habit for some persons to write up? Why do you think that they do it? How much professional reasons and how much personal ones are insiede? You have a policy for writing up? Managerial team encourage writing up?

Whatever do you think that all other nurses need to know about writing up ..let's share!

[mcleanl]

Who cares...ABX or blood first????? Did this really require that someone be written up? Why not just tell the "new" nurse that there may be a valid reason for hanging the ABX first. OR start a 2nd IV...there is always more than one option. I can't stand write ups for silly stuff like that. I understand repeat offenders getting a write up some stuff is just goofy.

[WalkieTalkie, RN]

The things I have written up are dangerous or potentially dangerous situations. For example, I once walked into my patient's room and the nurse had hung dobutamine (there was no order). The doc walked in and I asked him about it and he had told her dopamine (no order on the chart for that either).

I also have written myself up for giving morphine which technically was ordered only with dressing changes (patient wasn't getting a dressing change at the time, just having pain). I had floated to the burn unit and was unfamiliar with their usual order set.

The last thing I wrote up was when the docs on the surgery team accidentally canceled all my patient's abx even though she had confirmed pseudomonas pneumonia from culture and an increasing consolodation on x-ray (oops)... yes, that was dangerous too.

I don't write up petty "opinion" type issues.

[Penelope_Pitstop, BSN, RN]

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 my health care system, we follow this protocol as well. "Writing up" a person would mean contacting one's manager. We can "write up" a doctor on a web form, though.

Does everyone else have some sort of web or paper form to fill out for writing up a coworker?

[RN1982]

I only write up dangerous or potentially dangerous situations, not an antibiotic being a bit late because of a blood transfusion. Incident reports are only for situations that could have put a patient in danger.

[PeaceonearthRN]

Hmmm. When write ups are abused, does one think it could be 'big fish' 'small pond' syndrome?

If only one realized that their 'powerfulness' is driving great nurses away thus making their job harder every time someone quits!

My take is this: let the individual know and fully understand the protocol; then, if they continue to ignore how things should be done, write it up. We waste a lot of time having each other for dinner! :)

[truern]

We had a nurse that was forever looking for mistakes others made that she could write them up for. I took over her patients one day and found that she hadn't documented the *first* thing on them all day...no assessments, no treatments, no meds...nothing. I just took her the flowsheets and mentioned that she may want to document something before I made my first documentation. I *could* have written her up...she would, had the situation been reversed...but I didn't.

I think "writing up" should be for something SERIOUS...not petty stuff.

I was written up my first week off orientation as a new grad....for not dc'ing a foley that the night shift didn't d/c either and for leaving an IV for my charge nurse to do (I'd already replaced it once, and couldn't find another site) It was the night shift nurse that wrote me up. When I had my evaluation I asked where was the write up reflected and was told it WASN'T...that she was told she was unprofessional for writing me up.

[mcleanl]

Contagion...I think I would have handled all of those situations differently. I would have had the doc write to d/c dobuta and start dopa. I would have called the doc and got a one time order for morphine (I am pretty sure most docs would agree to this). And in the last situation I would have called the surgery team and told them to reorder the antibiotics.

[MultipNP, BSN, MSN, APRN, NP]

On our unit, while some write-ups are a necessary evil, most of them are ridiculously petty. I often think it is an indirect way of nurses saying, "we really don't like you -- it would be best if you left!"

For example, I got two write-ups in one day. They were PETTY. I was accused of not hanging fluids with Gentamycin because (quoting the write-up), "Gentamycin is toxic to the veins." Huh? Do these other nurses who think I'm dumb not realize that Gent. COMES pre-mixed with other fluids from pharmacy? They also didn't realize that I had called pharmacy to double check that I didn't need to add more fluids. The other write-up was regarding a patient telling a day shift nurse that her "night nurse ignored her all night long". I had checked on her Qhour and asked if she needed pain meds just before my shift ended. The patient was hardly conscious because of the medications she was already receiving. After asking my manager to please check my charting and watch the security video to see that I had indeed checked on my patients regularly, I never heard about it again -- and wasn't asked to sign anything.

I am still at the same job. It's two years later, and I haven't seen any further ridiculous write-ups on me. But I hear about them happening to other nurses. I encourage my newer colleagues to CHART EVERYTHING and just make sure they do their best since we have to protect ourselves from slander this way.

[StNeotser, ASN, RN]

Our write ups seem to happen depending on;

a) How popular the nurse who was at fault is.

b) How likely a family member is to complain.

Sad but true.

I made a med error a week ago which I admitted to, was proactive in writing myself up in the way of writing up all the med error paperwork, contacted both the family and the MD and didn't get written up because the family was understanding. It wasn't a very serious med error at all, but I've seen people get hauled over the coals for less.

[miko014]

We have a couple of nurses who will write up every single little thing. I think incident reports are for either big, dangerous events affecting either patients, staff, or visitors OR things that happen repeatedly despite trying other methods. Ex: we have a nurse who NEVER flushed her saline wells at the end of her shift. So they would go for like 12+ hours without ever being flushed, then the pt would ask for something, and when the next nurse would go to give it, they wouldn't flush. That got written up after talking to her many times about it. It's better now that we have posiflow caps for the IVs, but when we didn't, if you forgot to flush, you could kiss the IV goodbye - and she did it on a daily basis. Anyway, the only thing that worked for that was repeated write-ups - the manager even told us to do it every single time it happened.

Some might say that's petty, but she also didn't give her SQ heparins, which were due at the same time. It might be 3 or 4 hours overdue before the next nurse would find it. She just decided that it was more important for her to go home exactly on time than it was for her to give her last round of scheduled meds - which could have been given 2.5 hours before the end of her shift. It was out of control until eveyone started writing her up about it. The manager's exact words were, "you shouldn't feel bad about writing her up - if the situation was reversed, she would write you up in a heartbeat." And that was entirely true - she would write people up for forgetting to get a patient ice cream.

[FireStarterRN, BSN, RN]

Our write ups seem to happen depending on;

a) How popular the nurse who was at fault is.

b) How likely a family member is to complain.

.

There you have it, how very, very true. People usually write up nurses who are lower on the social ladder than them.

[caringchic]

look at all the differing opinions on which should have been hung first, proves my point about the write up I rec'd I am not convined there is a "right" way, it was a pt who had a total joint replacment w/ chronic anemia. The 3hr infusion of PRBC's delayed the ABX but I dont think either way would have created a substanially different outcome! Reiterates my prior post, write ups are ineffective for the most part!