Written up

[SassyRN93]

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?

[NotMyProblem MSN, ASN, BSN, MSN, LPN, RN]

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]

"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]

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]

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]

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]

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.

[Workitinurfava, BSN, RN]

She was held accountable just like you will be.

[Kooky Korky, BSN, RN]

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

Please point out my errors. I would like to get them corrected and appreciate your help. I do sometimes take short cuts.

As for telling OP it's not right up, it seems to me rather a kindness to point it out. She did use "write up" in other parts of her post, so I think she just slipped. It was not meant as a put-down, as you assumed it was.

I really think that people today do not really know that "your" means something belongs to you. Your child, your house, your heart. And that "you're" means "you are". You are tired, you are busy, you are confused. Their teachers were taught wrongly and passed the error on to them.

There are a couple of other irksome things people say but I can't think of them right now.

[Been there,done that, ASN, RN]

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

I feel AN exists to support fellow nurses. Calling out a frequent contributor on grammar.. is inappropriate.

This comment is in no way related to the OP's question.

MODS?