Coworker not following through....

[SheriLynnRN]

I followed the same nurse for the last couple of days, I work evenings and she works days. It seems like everytime I follow her, there is alway some issue of another that she mentions in report, the she obviously is aware of, but neglects to follow up on. Yesterday we had a pt whose continuous G-tube feeding was d/c'd because she had a high residual, 800 cc. The TF was stopped at 7 am. This nurse told me in report that she had "checked a residual" at 1300, she explained that she had stopped pulling back after 120 cc and that she had put it all back in. Of course I was wondering how much more was in there. This pt has aspiration issues, so all of her "PO" meds were being via the G-tube. The first thing that entered my mind was, if she is not digesting or absorbing the TF, then how is she going to get any therapeutic effect from the meds? I mentioned this to the offgoing nurse and she just kinda shrugged, and said something like, "Well, I used it for her meds all day." So I checked the residual myself and pulled off 450 cc. I discarded it. I told the charge nurse what I had found and my concerns about the meds. She called the doc and the meds were switched to IV.

Today I followed her again. One of the pts had a foley cath which had been draining amber urine with no sediment since his admission. During the day shift today the urine turned rusty red with sediment. She reported this to me before she left. After I assessed the pt, I reported the urine to the charge nurse and we sent a specimen for UA. The results came back that the RBC were very high and the urobilinogen (s/p) was quite elevated.

These issues seem important and relevant to me. I can't figure out why she is not reporting these types of things to the charge nurse and following through on them. Obviously she notices them, because she is mentioning them in report. I hate to use such a cliche term, but where is the critical thinking here? This lady has been a licensed nurse longer than I have been alive! I've noticed issues with meds too. If night shift forgets to give a 0700 med, she doesn't follow up on that either, she apparently just thinks it's not her shift so it's not her problem. A pt went all day without her nitro patch because nights forgot to put it on at 0700. Checking the MARS is part of the job description right?

Sorry so long, just had to vent. I feel very awkward about reporting this stuff to the nurse manager because of the senority issues. I also don't want it to seem like I'm just mad because she is passing stuff on to me, or didn't tie up her loose ends. It's like she's oblivious, not even aware that these things are important.

[BackInTheGame]

i have a co-worker exactly like this. she'll get urine specimins and then say that we need an order to send it to the lab. ok so what's stopping her from getting the order for a u/a when she's the one who obtained it? usually by the time i get on the floor at 3 the specimin is room temp at best and i for one, refuse to get an order on urine that's already been collected by someone other than me if i have no earthly idea how long it's been sitting around. i also hate the fact that she leaves it just lying on the desk without bagging it. yuck. several evening nurses don't say anything because she intimidates them but i refuse to go down for someone else's oversight. it's one thing to say "hey so and so is having some dark or cloudy looking urine, you might want to see if it happens again and maybe get an order for a u/a." fine, i have no problem with that but don't leave your work for me to do. i'll gladly stay over to make sure all my work is done. to me, it's only fair that i finish what i started so what makes her so daggone special, right?

[Daytonite, BSN, RN]

SheriLynnRN. . .I read your post and it brought back some memories of my very first real acute hospital job. I was working the night shift and followed an older, veteran nurse on the 3-11 shift who was doing the same kinds of things. She had been in some kind of cushy job and had just transferred back to a staff nursing position. She was obviously having problems keeping up and everyone was letting her get by because she was known by most everyone since she had worked at the hospital for so long. At first I was kind of dumbfounded and tried to pass it off as perhaps she just had an unusually busy shift. But, every time I followed her it was always something, and more likely it was two and three somethings that I ended up having to take care of that she had ignored. Sometimes she told me what hadn't gotten done and sometimes she said nothing. I think what made it all the more difficult was that she was so much more older than me. Remember I'm a baby boomer and I was raised to be respectful of my elders even if I saw they were wrong. In any case, night after night she was leaving me with dry IV's (we didn't have IV pumps in those days), foley drainage bags bursting at the seams, N/G tubes or IV's pulled out hours before and never reinserted and blood still waiting in the blood bank for the transfusion to be started. Grrr! I had to often restart a couple of IVs and empty foley bags before I even got my own shift work started. After a few nights of doing that I came in one night and just made rounds on the patients of hers I would be taking over and gave her a list of IV's that were dangerously close to empty or already empty and foleys that needed emptying and asked her to please fix them before I got out of report. My heart was pounding. Well, she flitted around, I was told, but she fixed every single one of them. I started doing this every time I saw I was following her. The IV and foley situation got better, but other stuff started getting discovered--after she had gone home. I finally took her aside one night and told her that I had found XXX the last time I followed her, that this was the second or third time she had left me with problems from her shift that had not been fixed and that I was miffed that she had done this to me. I waited a little to see what she had to say, which was nothing, and then I told her that if it continued to happen I was going to talk to our head nurse about it. I can't really report how it worked because she was very nervous and had patient assignments that differed from mine. After two weeks I never saw her again. I don't know if she transferred or quit or what. I truly felt bad for her. I think she was having a problem keeping up with what she was supposed to be doing (time management). Sometimes you just have to muster up the courage to stand up for yourself. Be nice, but call the attention of these people to what they are doing and let them know that it's affecting your work and that if they don't correct this and start pulling their weight you'll have no choice but to let the manager know what is going on.

[SheriLynnRN]

Daytonite,

I would have pulled my hair out in that situation. It sounds like you handled it very well.

This nurse infuriates me, not so much because of tasks left undone, but because of an apparant lack of insight of her part. It's almost as if she doesn't realize that the data she collects, and the things she observes during her assessments actually matter. She's not putting two and two together most of the time.

She has been a nurse forever, and she openly admits to burn out at times, so maybe she's just going through the motions and not thinking anymore? I'm not sure, but the times that I question things, all I get in return is a blank stare, like she doesn't get what I'm trying to say.

I'm not really sure how to report something to my NM that I can't fiqure out how to explain.

[Daytonite, BSN, RN]

SheriLynnRN. . .you do like I did. You keep pointing out what she is failing to do. When you find her repeating the same errors is when you tell her that if she does it again you're going to report it to the NM. Then, what you do is to just either tell the NM verbally or write it down. You just report the facts. "I came on duty on xxx date and xxx left this for me to do. This is a regular problem with her that I have discussed. She has told me she would try to do better, but has made no improvement. I'm having to follow up on her work before I can even get mine started." Something like that. The NM needs to know about this nurse's performance so she can do some investigation herself. Chances are that you are not the only person she is doing this with. The NM can't help her improve if she doesn't know what the problem is.