Coworker not following through....

Justhere, BSN, RN · Jun 19, 2006

You might want to try to talk to her about your concerns. If that doesn't work, report her.

I was in the same situation, one particular nurse was always forgetting to give a med or doing a dressing change. After I reported her it got better. But if they think they can keep dumping there responsibilities on you and you do nothing it will never get better.

allnurses Guide · Jun 19, 2006

Kinda to go off on a tangent... I wish I could report stuff like this to a charge nurse, instead of the doctor, and have HER call! Some nurses are afraid to call docs for anything not perceived to be life threatening. Not me of course. :) If I were that nurse, especially if I worked day shift, and ESPECIALLY if I only had to tell the charge nurse!... I would have reported those things. If I had to call the doc I would have done that also. Actually, I wouldn't have called at night over the tube feeding issue unless the patient had pills THAT NIGHT that had to be taken. Otherwise, the doc already knew that the patient wasn't digesting the tube feedings. Seems like he would have already DC'd her po meds too when he DC'd the tube feeding.

I would have called about the redness in the urine probably, regardless of what time.

No telling why the nurse you followed isn't following up on stuff. Probably either laziness, or she simply doesn't realize that they are important issues.

**canoehead, BSN, RN** · Jun 19, 2006

Is she afraid of speaking with the docs? What about her charge nurse- is she aware that so many things are being neglected? If she knew surely she would check in with this nurse and keep a close eye on her. I would report these issues in writing since she knows enough to pass them on for you to intervene, she should be doing the work herself.

KMSRN · Jun 19, 2006

Kinda to go off on a tangent... I wish I could report stuff like this to a charge nurse, instead of the doctor, and have HER call! Some nurses are afraid to call docs for anything not perceived to be life threatening. Not me of course. :) If I were that nurse, especially if I worked day shift, and ESPECIALLY if I only had to tell the charge nurse!... I would have reported those things. If I had to call the doc I would have done that also. Actually, I wouldn't have called at night over the tube feeding issue unless the patient had pills THAT NIGHT that had to be taken. Otherwise, the doc already knew that the patient wasn't digesting the tube feedings. Seems like he would have already DC'd her po meds too when he DC'd the tube feeding.
I would have called about the redness in the urine probably, regardless of what time.
No telling why the nurse you followed isn't following up on stuff. Probably either laziness, or she simply doesn't realize that they are important issues.

I disagree with telling the charge nurse. The RN is in charge of their patients - why add another level to the process? It is one more opportunity for misunderstandings and mistakes. The patient's nurse needs to deal directly with the physicians etc. We should be moving toward more professionalism and autonomy, not less.

SheriLynnRN · Jun 19, 2006

I disagree with telling the charge nurse. The RN is in charge of their patients - why add another level to the process? It is one more opportunity for misunderstandings and mistakes. The patient's nurse needs to deal directly with the physicians etc. We should be moving toward more professionalism and autonomy, not less.

Not to start a debate about the charge nurse issue, because in theory, I agree with you. But, the fact is that there IS a charge nurse on my shift and the established procedure is for her to call the docs. This works fine for me, it keeps me from calling a doc that three other nurses have called in the last ten minutes, and more importantly, it saves me from having to memorize the quirks and preferences of 20 different surgeons. I make a point to stay close by the nurse's desk when the charge nurse is calling a doc on one of my patients. That way I can hear exactly what is said and be right there to answer any questions that come up. I do consider the pts that I am assigned to to be MY patients. I feel that I am passing the task of calling on to the charge nurse, not the responsibility. I've heard other nurses say many times, "I told the charge nurse, and she never called, so it must not be a big deal." This is definately not my point of view. These are the same nurses who would never follow a doc into one of their pts rooms when he/she is making rounds, they feel like they are intruding. I march my fanny right in there, and I feel free to interject if the pt is not being forthright with the doc, or is describing symptoms that differ from what they told me.

That was longer than I thought it'd be, but my point is that I feel completely responsible for MY pts during my shift, and I don't understand why other nurses don't feel the same way.

SharonH, RN · Jun 19, 2006

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.

I'm sorry to get off-subject a bit but you really shouldn't discard the residual or is this something that has changed? The rationale is that you can upset the electrolyte imbalance by discarding. Also, I think I would just talk to your co-worker in a nonjudgmental manner. I can understand your frustration but always talking to the charge nurse might not always be the way to go. Perhaps she can give you a rationale for her actions.

SheriLynnRN · Jun 19, 2006

I'm sorry to get off-subject a bit but you really shouldn't discard the residual or is this something that has changed? The rationale is that you can upset the electrolyte imbalance by discarding. Also, I think I would just talk to your co-worker in a nonjudgmental manner. I can understand your frustration but always talking to the charge nurse might not always be the way to go. Perhaps she can give you a rationale for her actions.

Venting about work situations in this forum is sometimes frustrating in itself, because it's nearly impossible to convey all the minute details. I'll try to address a couple of things that were asked.

If I were just routinely checking a residual, such as prior to giving meds or a feeding, I would replace what I drew off, assuming it was a reasonable amount. In this case, I aspirated 450cc, and the tube feeding had been stopped over 8 hours before. If the stomach were emptying properly, there wouldn't have been anywhere near this much in the stomach. I will also discard residual if a pt is nauseated or vomiting, or if the abdomen becomes distended.

Also, I spoke with the charge nurse about the clinical situations involved here, just the facts. I did not go to her with my issues regarding my co-worker. I did question the other nurse about these things during report, and she just shrugged me off.

Are there other nurses out there who have experienced this issue before who are willing to share what the situations were and how they handled it? I guess I'm just looking to "bounce" this subject off a few other nurses.

SharonH, RN · Jun 19, 2006

Venting about work situations in this forum is sometimes frustrating in itself, because it's nearly impossible to convey all the minute details. I'll try to address a couple of things that were asked.
If I were just routinely checking a residual, such as prior to giving meds or a feeding, I would replace what I drew off, assuming it was a reasonable amount. In this case, I aspirated 450cc, and the tube feeding had been stopped over 8 hours before. If the stomach were emptying properly, there wouldn't have been anywhere near this much in the stomach. I will also discard residual if a pt is nauseated or vomiting, or if the abdomen becomes distended.
Also, I spoke with the charge nurse about the clinical situations involved here, just the facts. I did not go to her with my issues regarding my co-worker. I did question the other nurse about these things during report, and she just shrugged me off.
Are there other nurses out there who have experienced this issue before who are willing to share what the situations were and how they handled it? I guess I'm just looking to "bounce" this subject off a few other nurses.

That's interesting. I never heard of that. Is that a policy in your institution?

As for your situation, I think we've all encountered them. In my experience, all you have to do is confront the nurse involved(once again in a nonjudgmental manner). This usually leads them to think twice. If that is not effective, then you can take it to the charge nurse. You won't make any friends that way but at least your patients will be taken care of.

Indy, LPN, LVN · Jun 19, 2006

There is a nurse where I work, opposite shift from me, that in my opinion, made a lot of "incompleteness" style mistakes. Not taking off orders, not timing out meds, not sending med orders to pharmacy, etc. If an admission came after noon on any day, and it was her patient, you could bet something wasn't done.

When we had a patient that was discovered to have an acute abdomen one night who had been hers, and the "word" was that she let him lie around in pain all day, I spoke to the charge nurse for her shift that day. Not to be nosy so much as to ease my mind! The story was SO much different from what I'd heard. The charge nurse had been monitoring the problem with the primary nurse and had been on the phone with the doctor. Things were done. The patient was not neglected. There was adequate follow through, but we aren't psychics and so the problem wound up being more serious than previously thought.

So it was kind of a "wake-up call" for me... I've been assuming this nurse doesn't do her job, so I've been trying to assume that less. We will see what happens. I'm discovering gossip, along with inadequate reporting, to be a larger evil than lack of follow-through. The days where there seem to be a number of things not done are really most likely tied to a dayshift where they admit an insane number of patients and docs round on them immediately, grab chart, and hide it so orders are being taken off when I show up for report.

/ramble mode off

TazziRN, RN · Jun 19, 2006

Regarding the missed nitro patch, that in itself warranted a QRR (incident report).

As for the other things, document each incident privately. If things come back later and you are questioned, you need the documentation to back yourself up. I understand your concerns about seniority, but if this nurse's care is detrimental to pts, it needs to be addressed.

UM Review RN, ASN, RN · Jun 19, 2006

There is a nurse where I work, opposite shift from me, that in my opinion, made a lot of "incompleteness" style mistakes. Not taking off orders, not timing out meds, not sending med orders to pharmacy, etc. If an admission came after noon on any day, and it was her patient, you could bet something wasn't done.
When we had a patient that was discovered to have an acute abdomen one night who had been hers, and the "word" was that she let him lie around in pain all day, I spoke to the charge nurse for her shift that day. Not to be nosy so much as to ease my mind! The story was SO much different from what I'd heard. The charge nurse had been monitoring the problem with the primary nurse and had been on the phone with the doctor. Things were done. The patient was not neglected. There was adequate follow through, but we aren't psychics and so the problem wound up being more serious than previously thought.
So it was kind of a "wake-up call" for me... I've been assuming this nurse doesn't do her job, so I've been trying to assume that less. We will see what happens. I'm discovering gossip, along with inadequate reporting, to be a larger evil than lack of follow-through. The days where there seem to be a number of things not done are really most likely tied to a dayshift where they admit an insane number of patients and docs round on them immediately, grab chart, and hide it so orders are being taken off when I show up for report.
/ramble mode off

So true! I always try to give the benefit of the doubt to the previous shift--it gets crazy sometimes, and nursing is a 24-hour job. I'd probably just try to take the other nurse aside and ask her what happened with those patients and discuss (not berate) her options for actions, and all that.

We all have "education gaps" and we can all learn new things from one another if we keep an open mind and focus on helping one another, rather than critiquing each other's work.