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Written up

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by Mluer001 Mluer001 (New) New

Recently I had my first med error that went through my hospital's Just Culture.

The error was that I missed a leukemic patients dose of prednisone. This was apart of the patient's oncology treatment.

Today my clinical manager informed me that outcome of Just Culture was that I be written up. I She further reviewed the unit policy of missing a medication.

I feel terrible about this whole situation. I worry for my patients and I want to do well as an RN. I've reached a year of RN experience and was just starting to feel confident.

Just seeing if anyone has insight on this situation and how big impact a right up will have on my career. How will this effect getting hired later on?

Davey Do

Specializes in around 25 years psych, 10 years medical. Has 42 years experience.

Welcome to AN.com, Mluer001!

It is understandable that you feel badly about your mistake, but we're human and we're going to make mistakes.

I remember the first time I was written up for a med error, 33 years ago.

I learned from that mistake, but went on to make many more throughout my career. I've never had a problem getting hired.

Live and learn and go on, Mluer001, to hopefully, make fewer mistakes than I have!

akulahawkRN, ADN, RN, EMT-P

Specializes in Emergency Department. Has 6 years experience.

Recently I had my first med error that went through my hospital's Just Culture.

The error was that I missed a leukemic patients dose of prednisone. This was apart of the patient's oncology treatment.

Today my clinical manager informed me that outcome of Just Culture was that I be written up. I She further reviewed the unit policy of missing a medication.

I feel terrible about this whole situation. I worry for my patients and I want to do well as an RN. I've reached a year of RN experience and was just starting to feel confident.

Just seeing if anyone has insight on this situation and how big impact a right up will have on my career. How will this effect getting hired later on?

If I read this correctly, you missed giving a dose of prednisone to your leukemic patient? If so, that's a med error, potentially in as much as giving an incorrect dose to a patient. At about 1 year, you start feeling more confident but you still have stuff to learn. That can be a dangerous place to be. This is a good time for you to review policies and review what you know and have learned. Think about how and why the error happened and see what you can do to prevent this from happening in the future.

Yes, med errors happen and everyone commits them at some point. We're human. We just do our best to have adequate safeguards in place that prevent the errors from actually causing a problem. Because of my own workload, sometimes I may end up giving a med a few minutes late (technically an error) but sometimes that's unavoidable as a med may not be actually available. Sometimes this "extra" time allows me to catch an error by the provider... I've been thanked more than once for catching an error.

Just don't let this mess with your head or your confidence. Learn from this and move on.

I'm in a similar situation as you and awaiting to speak to my manager. I been working at this unit for 6 months. I haven't been written up yet...but I sure I will be

I try my best in everything to not make mistakes but it just happened.

I'm worried about not getting hired for other jobs too..

Jedrnurse, BSN, RN

Specializes in school nurse. Has 29 years experience.

What is "Just Culture"?

klone, MSN, RN

Specializes in Women's Health/OB Leadership. Has 15 years experience.

I assume "Just Culture" is their incident reporting process?

I find it ironic that it's called that. If this is your first error, I think a write-up is a bit harsh.

No, one internal write up is not going to affect your nursing career. Learn from it; if you can do that, it will make you a better nurse.

brownbook

Has 36 years experience.

I am so disgusted that the whole made a med error, scared I'll lose my job or license mentality still exists.

Over 20 years ago leaders in the medical field proposed that medical errors be handled the same way the NTSB and airlines handle crashes. No one person is blamed, no ones job is threatened. What went wrong is investigated and whatever helps prevent it happening again is instituted.

You all may be to young to remember but airplane crashes used to be more frequent.

The nursing culture instills such blame and shame nurses are afraid to admit they made an error.

Over 20 years ago leaders in the medical field proposed that medical errors be handled the same way the NTSB and airlines handle crashes. No one person is blamed, no ones job is threatened. What went wrong is investigated and whatever helps prevent it happening again is instituted.

There are many inside hospitals and working in healthcare who would prefer to treat errors this way. But in general, hospitals are more interested in limiting their liability than they are in improving practice and outcomes, so blame is shifted away from imperfect systems and towards individual practitioners.

I hope you weren't understaffed. We were taught that every patient over 4 (day shift, med surg) DOUBLES your chance of making a med error. That said, everybody makes mistakes. Make sure you take every opportunity to learn from this error. That's how you get to be an experienced nurse.

Get your union involved right away.

How come you made the error? As someone else stated, maybe the med was not available? Maybe Pharmacy didn't provide it? Maybe you had to go to Pharmacy and pick it up and were late giving it because of their not timely providing it?

Maybe you somehow missed a new order?

What factors were involved in this error?

It does seem like you should have gotten a verbal warning first?

What exactly does a write-up (not right up) consist of?

There is no reason that a new employer should even know of this error unless you tell them. It's not like it gets reported to your

Board of Nursing or sent around to every other employer.

anyway, as so many have said already, errors are part of the miserable things that can happen in our field. You have to be relentlessly careful.

Own up to any wrongdoing on your part and also realistically assess the contribution of all the parts of your system that could have failed.

Take heart, life goes on. It's good that you feel terrible but don't feel like your life and

work as a nurse are over. I assume the patient got the dose as soon as possible once it was realized that the dose was missed and is OK.

Edited by Kooky Korky

BSNbeDONE, ASN, BSN, LPN, RN

Specializes in Med/Surg, LTACH, LTC, Home Health. Has 35 years experience.

How come you made the error? As someone else stated, maybe the med was not available? Maybe Pharmacy didn't provide it? Maybe you had to go to Pharmacy and pick it up and were late giving it because of their not timely providing it?

Maybe you somehow missed a new order?

What factors were involved in this error?

It does seem like you should have gotten a verbal warning first?

What exactly does a write-up (not right up) consist of?

There is no reason that a new employer should even know of this error unless you tell them. It's not like it gets reported to your

Board of Nursing or sent around to every other employer.

anyway, as so many have said already, errors are part of the miserable things that can happen in our field. You have to be relentlessly careful.

Own up to any wrongdoing on your part and also realistically assess the contribution of all the parts of your system that could have failed.

Take heart, life goes on. It's good that you feel terrible but don't feel like your life and

work as a nurse are over. I assume the patient got the dose as soon as possible once it was realized that the dose was missed and is OK.

Please re-read your post for grammatical errors before trying to correct someone else.

Ruby Vee, BSN

Specializes in CCU, SICU, CVSICU, Precepting & Teaching. Has 40 years experience.

"Just Culture" is a philosophy for addressing med errors that is based on viewing med errors as always have at least some amount of systemic fault, unless there is clear reckless behavior then there should be no write up, so it's odd that the "outcome of Just Culture was that I be written up".

https://www.partners.org/Assets/Documents/Graduate-Medical-Education/10_09_27_Just%20Culture.pdf

Perhaps it isn't the first med error.

We've all made med errors at one time or another -- I've made some doozies. We're all human, and humans make mistakes. The worst one I ever saw was the new grad on her first day off orientation injected 10 times the usual dose for digoxin -- and the patient died. She didn't lose her job or her license, but was transferred to a less acute setting for two years. Two years later, she was back in the ICU -- this time as a competent, well-respected colleague. She learned a mighty harsh lesson, but handled it well and survived with both a job and a license.

caffeinatednurse, BSN, RN

Specializes in Med-surg, telemetry, oncology, rehab, LTC, ALF. Has 5 years experience.

I assume "Just Culture" is their incident reporting process?

I find it ironic that it's called that. If this is your first error, I think a write-up is a bit harsh.

No, one internal write up is not going to affect your nursing career. Learn from it; if you can do that, it will make you a better nurse.

I was thinking the same thing. I made my first med error during orientation as a new grad. Technically since I was still on orientation, it fell on my preceptor's shoulders, but I was the one that caught the error. I had to fill out an incident report and speak with my manager the next day, but I wasn't written up. Seems a bit harsh to write her up for the first med error...

caffeinatednurse, BSN, RN

Specializes in Med-surg, telemetry, oncology, rehab, LTC, ALF. Has 5 years experience.

I never made the same med error twice (that I'm aware of). Hopefully you'll do the same. Learn from your mistake and move on. Try not to beat yourself up over it. It happens to every nurse, and any nurse who tells you that they've never made a med error, is lying.

No, an internal write-up will not affect your career or your ability to get a job later on down the road. I am curious as to why your manager wrote you up for it. My first med error was forgetting to give insulin to a patient coming off of a DKA insulin drip. The CBG was precariously close to the SSI cut-off, and I misread the number. I thought the CBG was within "acceptable" range for no insulin, when in reality, she needed 1 unit of insulin. I was counseled, and SSI was reviewed with me, but I wasn't written up.

As a supervisor, I reviewed med errors with several nurses at my old facility, and I was also responsible for reporting them to the DON. To my knowledge, no one was ever written up for one while I was there.

RobbiRN, RN

Specializes in ER. Has 25 years experience.

I'm in favor of the general idea behind "Just Culture," that the system is always partly to blame. But tucked into the package is the handy little notion that the employee will never show "reckless disregard" for the institution's policies and procedures. Arguably, no matter how much we want to look for failings in the system, a med error, and nearly every other shortcoming, will be violation of one or more of the myriad of policies and procedures that protect the institution. Even two decades ago, when we had a small fraction of the policies and procedures that govern current practice, we used to joke that they are there to protect the institution and make sure the nurse is hung out to dry if anything goes wrong. Is it really possible to work in full compliance of every policy and procedure?

My first, and last, real med error, was running a heparin drip at 10x the rate. I found found it myself in minutes, reported myself, and fortunately there was no bad outcome. But it only takes one like that to keep you really focused for a few decades. Learn, grow, and move on. I wish you a long and rewarding career.

cyc0sys

Specializes in EMS, LTC, Sub-acute Rehab. Has 6 years experience.

There are 2 kinds of nurses, those who've made med errors and those who will make med errors. Be glad you didn't do any serious harm, reflect on how it could be prevented again, and move on.

I got written up for 'missing' a dose of scheduled tramadol and the pt was sleeping. It happens.