4 common reasons nurses are written up and how to prevent it

From punctuality to communication, nurse leaders say they put a lot of thought into the process before writing up a nurse

Managers and administrators are not just sitting around thinking of reasons to write nurses up. At least that’s what Vernell Davis — a perioperative nurse and clinical nurse specialist of 17 years who has held just about every position in health care, from housekeeper to administrator — said during a recent Ask Nurse Alice podcast.

“We value each and every nurse that we have here at the bedside; they’re caring for patients and they’re taking care of the community, and we need our community taken care of because that impacts everything else,” she noted. " Leaders are not sitting behind the desk right now trying to get rid of people; we are trying to get nurses in.”

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That doesn’t mean nurses are never written up. It just means managers put a lot of thought into the process, Davis said.

“It’s very tough. It’s not the easiest thing to do,” Davis commented. “Because we know that we are going to be dealing with a lot of emotion. But as leaders, we look at the whole entire picture.”

These are the four more common reasons a health care professional is likely to be written up:

Being late

The coronavirus pandemic has led managers to adopt a more individualized approach to not being on time, Davis said, because less frequent public transportation, challenges of single parenting and other factors are affecting nurses differently.

“Timing and attendance during COVID was a really big thing. And as a leader we have to become extremely flexible to that,” she explained. “So it was like, ‘How can we work with you? Do we adjust your schedule and maybe give you 30 minutes more or you know, change you to a whole different shift that will work for you?’”

However, according to Nurse.org, Davis stressed the importance of nurses realizing that if their shift starts at 7, that doesn’t mean you arrive at 7 with a Starbucks in hand. “You need to be at report, at huddle listening to the information that was coming down and information that you needed to get from a bedside nurse,” she pointed out. “Huddle is the most important part of your day. Because you’re getting information — you’re getting the latest and greatest, and then you’re also sharing information with your leaders who need to escalate that. So being on time is important that you get that information and you’re also able to share things because the worst possible situation a person can be in is not knowing about these changes.”

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Attendance problems

Nurse leaders want to know about planned and unplanned time off as far in advance as possible because it’s their job to make sure the team can continue taking care of the patients while you’re away.

“She also offered the suggestion that if you’re feeling sick and waiting to see how you feel before calling into a shift, to instead, give your manager a heads up that you’re feeling ill — and then let them know if you feel up to coming in, instead of the other way around,” Nurse.org wrote. “That way, they can arrange back-up coverage ahead of time. It’s easier to call off a back-up nurse than it would be to scramble to find a replacement last-minute.”

Communication

Nurses are expected to communicate in a variety of ways: verbally, written, gathering orders from the computer, assessing patients physically and through family history and charts, and interacting with other health care workers, Davis said. There’s a lot going on, and poor communication can cause problems.

Davis said that if the issue comes down to an individual level with the nurse, it could be a situation that needs addressing. For example, she said, there was a situation where a nurse failed to label a patient specimen. The standard was clear on what the nurse was supposed to do.

“So when that nurse is distracted and does not follow the order of sequence of collecting specimens in that protocol, that could lead down the road of corrective action because those things are already in place,” she noted. “And that is a skill that is expected for you to have as a nurse.”

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Behavior

Both Davis and Nurse Alice said health care workers should conduct themselves professionally at work, which includes leaving their personal opinions and issues at home.

“So what that entails is, basically, you should come to work, be professional, be polite and be kind to your peers and the patients and the physicians, communicate therapeutically, and come to work knowing that you are a professional and that nursing is a profession,” Davis said.

“We know that there can be politics in health care, as a profession, you have to know when and where and the audience to have those types of conversations,” she clarified. “Some people struggle with that. Some people struggle with bringing in the professional and leaving the personal at home. And it’s really hard. So as a leader, you recognize it, and you try to talk to the individual.”

That being said, they added, always speak up if you are experiencing any type of threat, violence or abuse at work.

And if you are struggling at work and find yourself having frequent outbursts, Davis encourages you to talk to your nurse managers and leaders for mental health resources, communication classes, or religious services that might help. She and Nurse Alice encourage nurse leaders to find these resources and have them ready, because we all know that nurses are dealing with a lot right now.

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