Written Up.....what is your take?

Published

I work in an emergency psych program that recently suffered the death of a patient (first death on site in over a decade....so it is a BIG deal).

In the aftermath I received a written warning citing me for not assigning rounds to the counselor (there is only one counselor who is fully aware that rounding is their job and customarily takes responsibility each and every night), not ensuring a bathroom door was locked (again a counselor duty), not monitoring a counselor's behavior who essentially dumped all her work on an orienting patient care tech, and not assisting a patient care tech in a patient search (again a function generally performed by a counselor). None of these incidents were related or contributed to the death of the patient (management explicitly admits this).

The whole scenario smacks of making someone "pay" rather than addressing the root cause and responsibility which in my opinion is....... you guessed it, staffing!

This environment is generally staffed (on nights....and remember this is an emergency environment) with two counselors, 1 RN and a LPN. Census may range from 5 patients to 30 with zero to 10 new intakes on any given night....and staffing is NEVER adjusted up regardless of acuity. As the RN I am asked to take responsibility for care of all triage/intakes and care for new intakes while supervising the counselor and LPN who care for those admitted for extended observation. We essentially run an Emergency department and an inpatient unit. Now at times I am asked to work without an LPN, which in my mind is downright UNSAFE!

On the flip side, some night i do jack squat. The manager likes to cite these kind of nights for the reason the staffing is as it is. Sure... the average hours of work each night might be 6 or so.... but that's an average, and you have to staff for those times when there are 12 hours of work to get done in 8 hours.

This particular night i was moderately busy. I proceeded no different than any other night nor different than any other nurse there would have.

My manager more or less minimizes the write up and it seems he needed to do this so that something was done....essentially someone had to "pay". However, I am concerned that I will be "witch hunted" in the future. For Pete's sake they couldn't even come up with something related to the death but had to review video tapes and come up with unrelated infractions.... done not by myself, but by subordinates.

I have accepted responsibility for poor performance of my subordinates. I am not convinced that I could have known about their lack of performance unless I had directly supervised their every move (obviously unrealistic). However, I am an old military man and you protect the troops.

How would you approach this whole situation?

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Specializes in ER, PCU, ICU.

Although this may be a "witch hunt" as you say, you should look at your nursing practice laws in your state. As the RN, you are legally responsible for everything that is done (or not done) by eveyone that you supervise, counselors, LPN, CNA, etc.

If you feel that the staffing at your facility is putting the patients in jeopardy, you should always write an event report citing the facts and your objection to the staffing. This way, your objections are in writing and if you should find yourself in front of the BON, at least you can defend yourself, Otherwise, you could see yourself in front of the BON and you could lose your license.

The other thing that I would do is seek the advice of an attorney. This is a matter that could go to court.

.... Nursing, touching lives one heartbeat at a time ....

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What I would do:

I think I'd want a copy of my position's responsibilities as well as the job descriptions and list of responsibilities of all the other staff. I would also ask my supervisor if there are any other expectations of me and the other staff that are not included in the job descriptions/competencies/responsibility lists that are policy - and get the other expectations in writing.

Once I familiarized myself with them, I would proceed to:

1. write any rebuttal needed to defend my actions and have it put into my personnel file - include any observations of not having been told that things were my responsibility, etc. as well as what I learned from the experience and what I plan to do from here on out.

2. gather the troops and tell it like it is. Explain that I have become aware that I am expected to have more responsibility and that I will be checking on their progress and asking them all for updates during the shift to ensure that all the i's are dotted for the shift. Ask for their input as needed.

3. keep a CYA documentation book of happenings, conversations, rumors, meetings with subordinate staff as well as superiors

4. pray that things return to "normal" and I don't have to look for another job or get fired.

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Specializes in ER, PCU, ICU.
What I would do:

3. keep a CYA documentation book of happenings, conversations, rumors, meetings with subordinate staff as well as superiors

Remember, this "CYA" documentation book is discoverable in court!!!!

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First, I'm sorry to hear of the unfortunate circumstances you've found yourself in. You're experiencing every nurses worst fear, and one that plays out all to frequently. That is, a facilities refusal to staff adequately resulting in harm to patients and damage to nurses professionally and psycologically.

That said, from the info. you've provided my first reaction is that you are accountable for anything that happens in that facility as you are number 1 in command. It may not be possible for you to supervise adequately due to limited time and/or resources but it's generally still expected. That's why as nurses we understand how importand staffing is to our patients and our license. IMO, you should evaluate how safe it is for you to continue to work for an organization that refuses to protect their patients and staff.

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Although this may be a "witch hunt" as you say, you should look at your nursing practice laws in your state. As the RN, you are legally responsible for everything that is done (or not done) by eveyone that you supervise, counselors, LPN, CNA, etc.

If you feel that the staffing at your facility is putting the patients in jeopardy, you should always write an event report citing the facts and your objection to the staffing. This way, your objections are in writing and if you should find yourself in front of the BON, at least you can defend yourself, Otherwise, you could see yourself in front of the BON and you could lose your license.

The other thing that I would do is seek the advice of an attorney. This is a matter that could go to court.

.... Nursing, touching lives one heartbeat at a time ....

I agree. And I think the facility may be looking for someone to "blame" so that their policies and practices aren't called into question should this go to court. You should definately fill out an incident report and keep a copy for yourself. I've heard that facilities are often held accountable for their staffing practices in a case like this which can save a nurse from incrimination.

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So sorry you're being put through this.

Actually I would consult with an attorney that specializes in nursing malpractice. It does sound like they are on a witch-hunt and are trying to build a case to hang you out to dry. Also as RN1989 suggested get copies of your job description and all other you are being held responsible for, along with all documention and written accounts of what you are being disciplined for.

There are legal cases where hospitals have been held accountable for their staffing practices:

A case involving Shirley Keck was the first malpractice decision specifically pinned on short-staffing:

http://www.msnbc.msn.com/id/4587667/

Another case involving a patient fall where the hospital was held accountable for staffing practices:

http://www.nursinglaw.com/bathfall2.pdf

Another case, found on appeal that a CNA/PCA was responsible for their own actions:

http://www.nso.com/case-studies/article/185.jsp

Just curious, is the counsellor considered not separate from the nursing staff and why would you be considered to be in a supervisory capacity over her?

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Specializes in Hospice, ALF, Prison.
What I would do:

3. keep a CYA documentation book of happenings, conversations, rumors, meetings with subordinate staff as well as superiors

Remember, this "CYA" documentation book is discoverable in court!!!!

Having been in a situation where I felt the need to keep documentation, and then unfortunately needed to use it I would vote for:

If you think you need to keep documentation, it is time to say goodbye.

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What baffles me is that these occurrences are completely unrelated to the death of the patient!

The paranoid part of me suspect they are attempting to establish a pattern of negligent behavior in case this ever comes to court. They can find no staff at fault in the client death, but perhaps claiming poor nursing can mislead a judge or jury to believe that staff, not hospital practice, was at fault. The bottom line is that I think the death may have been preventable had there been adequate level RN staffing (not LPN, or counselor, or other support staff)..... I don't want to get into it in case this post ever comes to light.

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Specializes in Med-Surg, Psych.

Look for another job ASAP.

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Specializes in LTC, Psych, M/S.

I just quit my psych rn job and your situation sounds extremely familiar to what i was dealing with. For the most part, the job was extremely boring. Very rarely would we ever have an 'incident' (i never dealt with a death) and when one happened it was this big flipping deal. I got written up as well over a minor infraction (long story). I just returned to acute care and in 2 months have dealt with more psych issues (including violent pts) than i ever did in the psych unit.

After my 'writeup' i did get worried that i couldn't really deal with a major incident b/c they just didn't happen that often and i and the other staff werent'' really prepared. I worked night shift - and usually we would all just surf the internet for several hours. I'm really sorry for what happened to you....all in all i wonder about the efficacy of psych units to begin with. And I got really tired of the 'frequent fliers.'

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Specializes in Med-Surg, Psych.
I just quit my psych rn job and your situation sounds extremely familiar to what i was dealing with. For the most part, the job was extremely boring. Very rarely would we ever have an 'incident' (i never dealt with a death) and when one happened it was this big flipping deal. I got written up as well over a minor infraction (long story). I just returned to acute care and in 2 months have dealt with more psych issues (including violent pts) than i ever did in the psych unit.

After my 'writeup' i did get worried that i couldn't really deal with a major incident b/c they just didn't happen that often and i and the other staff werent'' really prepared. I worked night shift - and usually we would all just surf the internet for several hours. I'm really sorry for what happened to you....all in all i wonder about the efficacy of psych units to begin with. And I got really tired of the 'frequent fliers.'

You didn't like psych nursing, but plenty of us psych nurses do like it. For both this poster and for others reading the post, please don't assume that this nurse's experience is typical or assume all psych nursing jobs are alike. I was bored in med/surg tho very busy. I find psych nursing much more interesting, deal with many more psych issues there than in my med/surg jobs, and I love being able to have time to eat and have bathroom breaks and even having time to surf the internet on some shifts.

And now back to the regularly scheduled program...

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