Web site spotlight: Sample memo for supervisor notification

Staff Development Weekly: Insight on Evidence-Based Practice in Education, October 31, 2008

Use a memo like the following sample to notify your supervisor of a competency issue on your unit. When writing your memo, be specific by identifying the competency issue and your correction plan. Keep a copy for your records.    
Confidential memo
Date: March 4, 2008  
To: Mary Smith, RN, director of nursing
From: Paul King, RN, nurse manager
Re: Annette Long, RN, staff nurse

On March 3, 2008, I received an incident report identifying that Annette Long, RN, made a medication error on the third shift on March 2, 2006. Specifically, Ms. Long failed to give a 53-year-old male diabetic his sliding-scale insulin dosage. According to previous incident reports, this is the third insulin error Ms. Long has made within the last two months.

To address this issue, the following remediation plan has been initiated:

  1. Ms. Long will be counseled by myself concerning her reoccurring medication errors
  2. Ms. Long will take the medication administration exam through the continuing education department by March 10, 2006
  3. For the next month, Ms. Long will work with a preceptor to monitor her insulin administration

If, after this remediation, Ms. Long continues to have competency issues regarding insulin administration, additional measures will be implemented. I will keep you informed of the above. Please contact me should you have any questions.

Editor's note: This excerpt was adapted from "Supervisor notification memo," found in the Tools Library at Get a free trial membership that will give you 30 days to test drive all the exciting features on the Web site.


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