write up

ohmeowzer RN, RN · Nov 25, 2009

well , i don't think the DOn was being petty at all.. a pt was hurt on your watch.. which happens , but you told the family member the pt was fine and then sent her to the ER, the family member was probably scared when she heard from the ER and PO'd because you told her the pt was fine. you did the right thing by sending the pt to the ER because she could of had a slow bleed and needed a CT ,, but you should of told the family she was going to be checked in the ER ,,,, the ER probably wanted to know what her normal LOC was ... no the DON did the right thing if the family wasn't notified the pt went to the hospital ....

CandyGyrl1985 · Nov 25, 2009

Do you think you told her she was going to the Er or are you sure you told her? Either way - it was an error that I am sure you will never have happen again. What you could have done to cover your butt was document that call you made to the family member and the basic statement you made.

Everyone makes mistakes... And just fyi - if you did accidentally forget to tell her she was going to the ER and or you told her the resident was fine when they were not- imagine what the family felt when they found out otherwise. Put yourself if their shoes if someone was caring for your mother, father, sister, son, etc... and this happened - would you want to know all the details even if they were scary? What if the resident had a bleed and died before the family was notified - that would have put you on the chopping block bc the family would have missed out on being at the hospital when she first arrived. Do you see where I am going with this. I wouldnt focus so much on the write up - but focus more on the what ifs - so you can be sure that if there is a next time- this error wont happen again.

Oh and I wouldnt tell the DON that you think you told her that her family member was going to the ER. To be honest it makes you sound really ditzy... (not to be rude, I mean no disrespect) The truth of the matter is, what happened to the pt was a HUGE deal and if I were the DON I would wonder why you would not remember something as detrimental as accurately informing the patients family of what is going on.

Best of Luck - try not to dwell on it. As I said before mistakes happen to everyone, we are human not perfect.

(sorry for all the grammar and english errors I having a lazy day and dont want to correct them lol)

Medsport, LPN · Nov 25, 2009

Well, no I wrote in the letter I was pretty sure I told them she was going to the ER. I'm 99.9% sure I did and an aide was even standing beside me when I called and she thinks I told them too. But like I said it was pretty hectic as we were just dealing with another patient before that and it was first thing in the morning (like 5:30AM) so the family member might not have been fully awake yet either. I did write that I would be sure to follow up better next time as I think was the main mistake as I probably should have called the ER to see how she was doing. We just usually pass it on to 1st shift if something like this happens and I was already there about an hour over cleaning up blood and charting. I also realize the first shift nurse is getting very stressed out and ready to quit and she has'nt been there as long as me. I think she's getting tired of getting everything dumped on her during the day. I know I could'nt do the day job as they have like 3 med passes plus extra stuff from management to do. The facility does have a pretty good turnover too. btw, I did get an offer to go 8 days a pay on first from my other part-time job, but its not enough hours and I don't think I can handle 1st yet anyway...

systoly · Nov 25, 2009

It's a matter of documentation. If you carefully documented your phone conversation with the family member and your documentation reflects that you advised the family member of the transfer, the write up is inappropriate and you can make reference to your documentation on the write up form - it doesn't matter whether or not there's a special section for it. If your documentation lacks, no matter what you actually said on the phone, the write up is doing you a favor, because this is a big deal (not petty) and so is documentation. I'm surprised no one said anything about not calling the Dr. (or the on-call) about the transfer. Please take this as a learning experience. If your facility does not have a checklist that goes with a resident injury related incident report, you could place yourself in a positive light by designing one, submitting it to your DON and show that you want to learn from this and help others avoid the same situation. Among other items, this list would list persons to call and update and also to document on each of this calls. I also suggest to ask the family memeber if they are going to the hospital and document their response.

VM85 · Nov 25, 2009

wow. thats hard- Id say wait to hear a response from your DON and then move on from there. Like a previous poster had said, I hope you documented your conversation.It is not the be all end all, if it sticks then oh well learn from it and move on- thats all you can do really. I just started at an Assisted living community and your job sounds so different from mine! I know it varies state to state, but basically I can only perform first aid & triage...and assess....mostly paper work. DIdnt know if Id like it, btu I love it and I am learning so much from being on this side of the fence, but also looking for a perdiem for a hands on job where I can use my skills. Id love to hear more about what your job descriptions entails! and good luck with the write up. Just cuz you got one does not mean youa re a bad nurse!

Medsport, LPN · Nov 25, 2009

Thanks for the replies. I guess you're right, I need to think of it as a learning experience. My charting did'nt have anything about the family response either. Come to think of it another nurse had reminded me to chart on certain things in the past that I had forgoton, so I need to chart things better. That's weird b/c when I was at the jail my charting was excellent according to the DON there, but my assessment skills were a little lacking. Its just the opposite here. It might be b/c the job is so different. It's more like a nursing home than an assisted living b/c its "aging in place" as residents are there until they die. So eventually a lot of them become hospice patients, but some of them stay a full code so its weird.

On my shift the first 4 hours or so is the main med pass to the whole facility. We have two sides, an assisted living side and an alzheimer's unit. The alzheimer side is "usually" pretty laid back, but a couple of the residents are now at the late stage of the disease and occasionally get violent so I have to try to talk them down and if that does'nt work give a tranquilizer injection (which is what happened right before the resident fell). Then I have to put away and order meds, see if there is paperwork or orders for the next day and then give a break to the other side aide. There are always a couple PRN meds too. If nobody falls or gets sick the rest of the night is pretty easy and I help the aides out where I can with laundry or setting up the tables. This is if we are fully staffed and have a third shift aide, which we don't have frequently because they don't have to be state tested, therefore they don't pay them enough IMO to keep them long. When this happens it makes for an exhausting night as I have to answer call lights and change people that need it.

All in all, its one of the best jobs I've had except for the fact I have no life outside of work as I sleep all day and up at night when everybody else is sleeping. Of course the pay is'nt the greatest and there are no benefits besides free food. It is very stressful when an emergency happens though as there is no RN to call and no specific doctor on call so its up to the nurse on duty to make the call. We usually just call 911 if its something serious and there is no real paperwork besides their emergency info we send with them. If it is something minor we can deal with we have a simple injury sheet we fill out and take vitals twice a day for a couple days. Now the day shift is a different story as its a lot busier as they have 2-3 med passes and calls to make, dealing with management, ect.

systoly · Nov 26, 2009

And that's all it should be - a learning experience. If my post was harsh, it's not because it was meant to criticise, but rather to make the point of how important this type of documentation is, because often times, good documentation is all we have on our side. Maybe this can be a learning experience for me as well. I'm thinking better word choice so as not to come across as criticizing while still making the point. Happy gobble day everyone.

skittlebear · Dec 22, 2009

You sound as though you are a new nurse? Always remember, CYA! This is very, very important. It will help your patients as well if you think this way.

Were you panicking during this emergency situation? Could this be why you couldn't remember if you told the family member that the pt was going to the ER? Are you the only nurse working on 3rd? How many pts do you have? It SOUNDS like you are overworked. Especially if you are taking care of patients that have alzheimers IMHO.

Also, I can't believe your facility doesn't have an oncall nurse?! I would probably RUN FAST from this place, to be honest. It doesn't sound safe, for the residents or the nurse.

The other posters were harsh but true. I completely agree with their advice. But...I do think sometimes the environment you work in can set you up for failure. All of these things you are describing...no oncall nurse, med pass taking 4 hours (which means you have a high pt load),an Alzheimers unit to care for as well, and high turn-over. You even mentioned that the day shift nurse is stressed and wants to quit. This place just screams...."RUN, don't walk, but ruuuun far away from this place", to me.

skittlebear · Dec 22, 2009

Sorry...duplicate post

Medsport, LPN · Dec 22, 2009

Thanks for the reply. Yeah, there is only one nurse on 3rd and just last week they were thinking of getting a PRN nurse as the other 3rd shift nurse was sick one day and they called me and I worked for her, but was glad she was'nt sick the next night too because I worked 3 12's in a row, had one day off, then 3 more 12's. The first shift nurse was really worried because she would have had to work 18 hours if I would'nt have come in. I don't mind the occasional OT (I actually need it), but sometimes its just too much. Anyway, I think they did'nt get the PRN nurse yet because our best 1st shift nurse who has been there the longest and also one other nurse put there notices in as they got offers for jobs with benefits, so they had to hire a couple people to replace them. I'm now seriously thinking of looking elsewhere as it won't be the same after they leave.

It's just hard to find something that is full-time fairly close to home that is'nt under-staffed. My ex got really lucky and got into a rehab (part of a hospital) and loves her job. I wish I could find something like that...

Medsport, LPN · Dec 26, 2009

Hey guys, I just noticed that they still have an ad for a nurse and they already hired two to replace the two that are quitting and the rumor is they are'nt looking for a PRN right now. It kind of makes me nervous that they may try to replace me or cut my hours. I probably should'nt feel that way as I think my status is pretty good. Although I have gotten two write-ups fairly recently, I thought they were kind or borderline and I wrote a note to try to explain both of them. I have started to apply for other positions and have a good lead for a job I want to apply to on Monday, but still you don't want to get fired as it does'nt look good on the resume. I guess there usually has to be a good reason though and the person would most likely be on probation first like I was at my last job, but officially got let go from that job due to "budget cuts".