Documentation Error

Nurses General Nursing

Published

I just graduated nursing school in Spring 2018. I started a job on a med/surg floor. I received orders over the phone to discharge my patient. I discharged my patient and realized a few days later I forgot to put in discharge orders before I discharged them. I'm so scared of losing my license!! Any thoughts??

Specializes in Medical Legal Consultant.

I believe that honesty is the best policy. When you make a mistake, it is better to deal with it up front rather than hide it. Boards appreciate this too. I suggest letting your manager know and asking for support on the best way to handle the situation. Make sure the documentation is noted as a late entry.

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