When you take over a patient assignment....

[Virgo_RN, BSN, RN]

...and spend hours cleaning up the mess left behind by the previous nurse, find several orders that were not addressed, causing delays in diagnostics, medications, labwork, etc., do you write an Incident Report? When I was on the floor, I would have, because it was widely understood that the purpose of IRs is not punitive, but for process improvement. In the ED I work in, the culture seems to be that when you write an IR, you are "writing up" another nurse. Since all IRs must be investigated, the nurse responsible for the errors/delays/omissions will know who wrote the IR, and the risk is that they may retaliate by not having your back, making life difficult, etc., especially if they are a popular and well liked person. It is highly likely that word will get out that you are "one of those" nurses who cannot be trusted. Anyone else ever faced this dilemma?

[Ivanna_Nurse, BSN, RN]

Virgo, I haven't faced the dilemma, but fear it as well. I am anxious to see what others have to say. Ivanna

[chillchick]

We are specifically instructed *not* to use names in incident reports... of course, we also don't file them for things like tasks left undone (unless, of course, they cause the patient to become unstable).

[Lunah, MSN, RN]

Can I assume that you wouldn't be comfortable addressing this directly with the previous nurse? That they probably wouldn't be receptive?

[PostOpPrincess, BSN, RN]

I have a direct face to face with the nurse.

Hopefully, he/she is receptive. If not, then I have to tell them that I need to go further if they are extremely defensive.

Patient care is my priority and if they are not doing what they are suppose to do, that's going to be a problem in the long-run and I don't have time for egos.

Safety first, egos last.

[scoochy]

I have never seen an incident report utilized for the purpose you spoke of. IMO, this situation warrants a 1-1 sit down to discuss your concerns. If you do not feel comfortable with this, enlist the help of your nurse manager, especially if this is commonplace with said nurse. The problems you encountered with this nurse concern performance issues, and that is the responsibilty for the Nurse Manager to address, rather than Risk Management, where I would assume incident reports are addressed.

[5n2_is4u]

Virgo, I feel your pain! The mess the prior shift leaves the room and the pt in is UNACCEPTABLE! I think it is totally unprofessional. Sure, sometimes the shift is totally nuts.....but a dirty commode? no IV even attempted? garbage can full and overflowing to the floor? Then you get the computer up and see that the initital assessment was never done! SOB pt without monitors on...grrrr. I did not write it up but I have promised myself if it happens again I will ask the offender to clean it up before they leave. If that goes badly then I will have to try another approach. I hate to be labeled the "rat" but I hate the mess even more. If the face-to-face doesn't work then you ahve to try soemthing else. If you don't address it---it will never change.

Good Luck. Let us know how it works out.

[Sehille4774]

...and spend hours cleaning up the mess left behind by the previous nurse, find several orders that were not addressed, causing delays in diagnostics, medications, labwork, etc., do you write an Incident Report? When I was on the floor, I would have, because it was widely understood that the purpose of IRs is not punitive, but for process improvement. In the ED I work in, the culture seems to be that when you write an IR, you are "writing up" another nurse. Since all IRs must be investigated, the nurse responsible for the errors/delays/omissions will know who wrote the IR, and the risk is that they may retaliate by not having your back, making life difficult, etc., especially if they are a popular and well liked person. It is highly likely that word will get out that you are "one of those" nurses who cannot be trusted. Anyone else ever faced this dilemma?

Well worse case scenario if u really **** the wrong person off as described above, all they would have to do is make up an accusation about u or call the state board or something. It sucks....I mean even if you are investigated and the findings are unsubstantiated, it can take years for the investigation to be completed and what would you do in the mean time?..you just never know! i dont like that others can hold so much power over you...What we need is to get away from the culture of "blame and shame' becasue that solves nothing. If you really want to address this issue, i hate to say this but think carefully about how you approach it..is their another way you can maybe talk with this other nurse "off the record" without turning it into a confrontational situation? You have to ask yourself how important this is to you and what you are willing to risk to fight it...

[ukstudent]

I will talk to the other nurse. If this does not solve the problem then depending on how bad the problem is I would go to the manager.

I have a real problem with using incident reports against other nurses. From what I have seen they are not used to make better systems but as a black mark on annual reviews so you would get a smaller pay increase.

It seems to be a way management can keep nurses separated and in-fighting. If it is truly just for improvements with systems then you should see doctors writing incident reports on other doctors, pharmacists writing reports on other pharmacists.

[Larry77, RN]

They way we do it is first you are supposed to approach the said nurse, then you talk to your charge nurse who documents a "coaching", then if the behavior continues the ED manager rights a formal "write up" which then goes in your personnel file.

Most of us charge nurses ask if you've talked to the person before we even think about getting involved and only on rare, severe cases do I get the manager involved right away. Our coaching form is saved in a secure file on the computer that each of us has access to so I can see if one of the other charge nurses has had the same issue with a staff member.

[Virgo_RN, BSN, RN]

All points well taken. I think I may have combined two separate issues in my original post. One issue is with the performance of another nurse, and yes, I agree this is best handled directly with the other nurse, if I care enough about it to take her aside. Personally, I take it as incentive to improve my documentation, so that I make sure to note in the narrative what time I assumed care and what condition the patient was in at that time. When things get hectic, my documentation suffers, and I need to work on that.

The other issue is delays in treatments and diagnostics that put the patient at risk for adverse events or unnecessarily increase their time in the ED. This is an appropriate use of the IR system, and we are required to IR any such events.

Two examples that come to mind are an order for a diltiazem gtt on a new onset A-Fibber that was written an hour before I took over the patient, I did not see it for a half an hour, then I had to pull the med from the Pyxis and set it up, so the gtt wasn't started until nearly two hours from the time it was written. The second was a CXR on a patient with fever and cough that did not get entered, and wasn't noticed until 3 hours after the doctor wrote the order.

The problem is that if I IR these incidents, NOT as a commentary on the previous nurse's performance, but as required by my facility as they are delays in treatment, the nurse that I took the patient assignment from will be questioned as part of the investigation, and the culture in the ED I am in is that this means I "wrote her up", even though that is not the case.

What is concerning to me is that I work in a "good" ED, and we see a high volume of patients, yet administration is talking about cutting staff. Events such as described above will certainly increase if staff is cut, but since nobody is reporting them because it is seen as "tattling", administration has no idea what the reality is. Another avenue I have used when I was working the floor was to file an unsafe staffing report with my labor union, but I have yet to hear of anyone in the ED doing this.

I guess, I could IR events like this and just make sure to talk to the other nurse and let them know why I did it, and that I didn't do it to reflect poorly on them. In an ideal world, that would be the simple solution. However, the culture here is such that I'm concerned my assurances would fall on deaf ears.

[vivacious1healer]

Most times, I will speak to the RN, and try to get some understanding of why things were left for me to complete; or inform them of what was not done. IF they are chronic violators, then it will be pointed out what needs to be done before they leave.

I have done incident reports when I have found narcotics in patient's rooms. One incident I recall was finding a scheduled narcotic in the patient's room, and pt was due for this very same medication by the time I discovered it. Pt unable to recall if they took a dose at all that day. Had to back track and look at the computer MAR (which stated it was given), looked into the Pyxis to see who had given the most recent dose, then followed up with a phone call to that RN at home.

Then I had to follow up with reporting it to the charge RN, floor manager, and writing up an incident report. sucked, but it had to be done.