Written up today for something stupid

Nurses General Nursing

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Hey all

I am angry enough this morning to spit fire. My manager wrote me up today because we had a patient on IVF@100 cc/hr who went into resp distress on my shift and i transferred him to icu. Here is the part she wrote me up for: The patient arrived on our unit a couple of days before i started working that week. IVF were already running when i received the pt. When I did the 24 hr chart check the fluids were not listed on those orders but on his admission orders ,which was before the 24 hrs. Why would she think that i would go past the 24 hr point looking for someone elses mistakes. The order that said the fluids were only supposed to run 500 ml was part of the admission order. I think she is trying to create a paper trail. Lately this woman has been very emotionally labile, so much so that at least a third of the dept has left for other jobs or other depts?

When u do a 24 hr check do you go days back to look for errors??

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
D**n! Who has time anymore to check all the orders on everyone, during the 24 hour chart check?? I agree, it is prudent, and may prevent a lot of problems, but, heavens to Pete, if I did this, I wouldn't have a single minute leftover for patient care!

I have always checked "important" things...........like meds; coumadin, heparin,pain meds or insulin. I also check IVF, to double check the order and if the fluid needs to continue. A few of the most overlooked meds and biggest mistakes either by ommision or not discontinuing.

Specializes in Management, Emergency, Psych, Med Surg.

Was the IVF not written on the MAR? When I have time I go through all the orders and make sure the kardex is up to date and that everything is on the MAR. I don't trust anyone.

Specializes in Psychiatric, Home Health, Geriatrics.
just keep your coolness take a deep breath. . .

...and start looking for something else. :twocents:

I have always checked "important" things...........like meds; coumadin, heparin,pain meds or insulin. I also check IVF, to double check the order and if the fluid needs to continue. A few of the most overlooked meds and biggest mistakes either by ommision or not discontinuing.

I'm not disagreeing with you, but I think you're missing my point.

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
I'm not disagreeing with you, but I think you're missing my point.

I know you aren't disagreeing with me. I didn't miss your point. There is never enough time to get things done. What I meant to say I would try to focus what I checked up on that was greater than 24 hour check. I think the OP if she was written up state in her rubuttal or comment section state that the actual error occured with the first 24 hour check. That the person that transcribed the order made the error,but,technically then everyone who followed and didn't "catch" the order also made the same error. so everyone then made the error,sad but true. It seems no matter how hard we try we as nurses get blamed for everything. It's hard and seems impossible. When I was a sup. On rounds I would ask if anyone needed help checking charts or I would go to the floor getting slammed with admits and do the orders. Which is why I always left late..:lol2: I do know what point you were trying to make and I wanted to say I feel your pain.:redpinkhe

I know you aren't disagreeing with me. I didn't miss your point. There is never enough time to get things done. What I meant to say I would try to focus what I checked up on that was greater than 24 hour check. I think the OP if she was written up state in her rubuttal or comment section state that the actual error occured with the first 24 hour check. That the person that transcribed the order made the error,but,technically then everyone who followed and didn't "catch" the order also made the same error. so everyone then made the error,sad but true. It seems no matter how hard we try we as nurses get blamed for everything. It's hard and seems impossible. When I was a sup. On rounds I would ask if anyone needed help checking charts or I would go to the floor getting slammed with admits and do the orders. Which is why I always left late..:lol2: I do know what point you were trying to make and I wanted to say I feel your pain.:redpinkhe

OK guys, we may all just be splitting hairs here, but it seems that the OP was getting reamed for something SOMEONE ELSE failed to do. That is: a perfectly normal, expected action of a nurse to do a 24 hour chart check, PROPERLY. It's in the job description, people. We learn it in nursing school, or at least in orientation.

When you sign that box, you are attesting that you reviewed those orders, they were transcribed PROPERLY.

When I see blank spaces I will go back and check again; but if I can't trust YOU to do such a simple thing, I may as well just go home now! I can't idiot proof everything, that's down to the manager that hired this nurse in the first place! And no, everyone that followed and did not catch the order " did NOT make the same error", they looked at the sig and trusted the nurse that attested to her review. I don't have the time or the luxury of backtracking (unless something seems odd at report). You get paid the same salary as I do, and I'm not going to babysit or second guess you. I CANNOT do my job and yours as well, and the manager who reviewed this is BEYOND unrealistic. AS are most managers I come into contact with lately. A CNA made a charting error with I/O's, so the PTB decided that CNA's can no longer enter I/O's, only RN's can do that. Oh, yeah, just one more task on my already overburdened shoulders, and reward sloppy practice by giving the guilty even LESS to do.

Oh, and housekeeping complained, so now the nurses are expected to remove the SCD pumps, IV pumps, keofeed pumps, and all the suction tubing/collectors before housekeeping wil deign to enter the room. $55.00 for housekeeping? Yeah, THAT's budget conscious!

Specializes in ICU, ER, EP,.

Let this be a lesson for all of us; read all the orders from day one, so we can make sure we haven't missed anything. Leslie, that's not anal, that's careful!

Are you crazy? :eek: We can have patients for three weeks, with the chart thined every few days!!!!!! This is not good advice, this is pratically impossible!!! I don't know where you work as an RN, but your suggesstion is not one that could be put into practice unless you work an observation unit!!! No offense but nope...

A 24 hour chart check is just that, I would have refused to sign the paper after writing my rebuttal, then I would go up the chain of command until I had that paper returned to me and placed in the shredder...

HECK NO!

Specializes in PACU, OR.
Are you crazy? :eek: We can have patients for three weeks, with the chart thined every few days!!!!!! This is not good advice, this is pratically impossible!!! I don't know where you work as an RN, but your suggesstion is not one that could be put into practice unless you work an observation unit!!! No offense but nope...

A 24 hour chart check is just that, I would have refused to sign the paper after writing my rebuttal, then I would go up the chain of command until I had that paper returned to me and placed in the shredder...

HECK NO!

True, when you're talking about long-term patients it's like wading through War and Peace... I like to check back to admission letters though, where I work they're usually kept in the file. Anyway, any transcriptions made by the nursing staff are supposed to be ratified by the MD within 24 hours; I suppose it works something like that there? And I agree, the OP was definitely unfairly written up!

Specializes in Med Surg.

Working in a place where we have a lot of swingbed patients we are at an especially high risk for this sort of thing. Since swingbed stays can last up to 21 days, checking the entire chart every time we midnight line them isn't always practical, particularly when there are doctors who feel like they aren't doing their job unless they write a couple of pages worth of new orders every day to justify the extended stay.

Specializes in ICU/PACU.

Good idea to go through every order, but even in the ICU sometimes I don't have time and I only have 2 patients. I can't imagine doing this on the floor. Of course I'm sure many of you do.

The manager should start thinking like a manager and instead of just writing you up, maybe think about ways to prevent this error from happening in the future and supporting her nurses. This is why I like physician computer entry orders so much. Also the Kardex if you're using paper orders still.

Still a good idea to go back and check the order for the maintenance IV fluids. I haven't had that situation happen but I've had times where the order says 75/hr and it's going at 125/hr by mistake.

Specializes in NICU Level III.

Being in NeoICU we have a lot of "chronics" that are there for months on end...up to over a year. Going back more than a few days is not reasonable.

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