Question about co-worker competence

  1. Hello everyone.

    I am relatively new to this forum, and I came specifically to ask a few questions. I have read these posts and I have a lot of respect for the responses I have seen here. I work in a relatively small community hospital ICU, and we are having a problem with some incompetent nurses. Management has been very reluctant to deal with the problems and we have been left in a difficult position on more than one occassion. We have recently started a supposed "self-govering" body for our unit and we are looking for advice on how to address this issue. We have had to rearrange assignments and schedules related to incompetent nurses, and I truly mean incompetent, not new nurses or inexperienced ICU nurses.

    So, my questions are...

    (1) Does anyone have any advice as to a different way for us to address this. NUMEROUS incident reports have not been effective. I am talking issues like inability to read the cardiac monitor, an unawareness that albumin is a blood product, an inability to turn on a portable oxygen tank. I hate to sound so mean, but it is really hard.

    (2) If you are in this position, how do you handle complaints from other nurses who have to take sometimes unfair assignments to keep the patients safe from the incompent nurses?

    (3) We are looking for some sort of written "standard" we can create that everyone must meet to work in our unit. (We really have nothing that is required to deem you "competent" to be an ICU nurse.) Any suggestions?

    We are a relatively small hospital, with no pharmacist or supervisor at night, so we are really dependent upon each other to help out at night. The weakness of some of our staff, nurses who have worked here for years, is really hurting us. Help us, please!

    Thanks in advance for any help.
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  2. 18 Comments

  3. by   TazziRN
    There should already be a written standard: proof of ability to read rhythms, knowledge of ICU meds, etc. These should all be competencies for any critical care nurse and if the compentencies can't be met then the nurses are placed in non-critical care units.
  4. by   Myxel67
    [QUOTE=NightICURNBSN;2223733]Hello everyone.


    (1) Does anyone have any advice as to a different way for us to address this. NUMEROUS incident reports have not been effective. I am talking issues like inability to read the cardiac monitor, an unawareness that albumin is a blood product, an inability to turn on a portable oxygen tank. I hate to sound so mean, but it is really hard.


    Except for inaility to read the cardiac monitor, the other items are things that can be remedied quickly. In my first year as an RN, I asked a coworker if a blood consent was necessary to hang albumin. Most of the other nurses working that night were mystified. I still find many nurses who don't know that albumin is a blood product.

    What are the requirements to work in the ICU? Most hospitals require ACLS, and to get ACLS, you need to be able to interpret heart rhythms. If adding this requirement would leave you with no nurses, job could require that ACLS be completed in one year. Another requirement might be 2 years of experience on a cardiac telemetry floor.

    Is there any orientation or critical care course at your hospital? I know you say the hospital is small, but just what kind of orientation do nurses get before coming to ICU? Nurses don't come out of nursing school, or with many years experience on a non tele floor, with the knowledge & skills necessary to work in the unit. The only thing scarier than working with an incompetent nurse in ICU is being that incompetent nurse and trying to figure out how you're going to get through another shift without hurting someone.
    Last edit by Myxel67 on May 28, '07
  5. by   TazziRN
    Quote from Myxel67
    The only thing scarier than working with an incompetent nurse in ICU is being that incompetent nurse and trying to figure out how you're going to get through another shift without hurting someone.
    True ,but only if those nurses know they do not have the competence level to work ICU. I've worked with nurses in the ER who did not understand why they were asked to leave the ER.
  6. by   Ms.RN
    [quote=nighticurnbsn;2223733]hello everyone.

    i am relatively new to this forum, and i came specifically to ask a few questions. i have read these posts and i have a lot of respect for the responses i have seen here. i work in a relatively small community hospital icu, and we are having a problem with some incompetent nurses. management has been very reluctant to deal with the problems and we have been left in a difficult position on more than one occassion. we have recently started a supposed "self-govering" body for our unit and we are looking for advice on how to address this issue. we have had to rearrange assignments and schedules related to incompetent nurses, and i truly mean incompetent, not new nurses or inexperienced icu nurses.

    does your hospital have a nurse educator? why not use them and educate nurses who are incompetent? let nurses take acls classes, give them inservice in areas where they are lacking knowlege. what is nurse manager doing about this? one of their duty is to evaluate nurses performance and do something about it. its their job on the line too, not just incompetent nurses. .. if a nurse manager feel these nurses are putting patients life at risk, then i think they need to be terminated.
  7. by   blueheaven
    Quote from NightICURNBSN
    Hello everyone.

    I am relatively new to this forum, and I came specifically to ask a few questions. I have read these posts and I have a lot of respect for the responses I have seen here. I work in a relatively small community hospital ICU, and we are having a problem with some incompetent nurses. Management has been very reluctant to deal with the problems and we have been left in a difficult position on more than one occassion. We have recently started a supposed "self-govering" body for our unit and we are looking for advice on how to address this issue. We have had to rearrange assignments and schedules related to incompetent nurses, and I truly mean incompetent, not new nurses or inexperienced ICU nurses.

    So, my questions are...

    (1) Does anyone have any advice as to a different way for us to address this. NUMEROUS incident reports have not been effective. I am talking issues like inability to read the cardiac monitor, an unawareness that albumin is a blood product, an inability to turn on a portable oxygen tank. I hate to sound so mean, but it is really hard.

    (2) If you are in this position, how do you handle complaints from other nurses who have to take sometimes unfair assignments to keep the patients safe from the incompent nurses?

    (3) We are looking for some sort of written "standard" we can create that everyone must meet to work in our unit. (We really have nothing that is required to deem you "competent" to be an ICU nurse.) Any suggestions?

    We are a relatively small hospital, with no pharmacist or supervisor at night, so we are really dependent upon each other to help out at night. The weakness of some of our staff, nurses who have worked here for years, is really hurting us. Help us, please!

    Thanks in advance for any help.

    You need to create standards/competencies that are specific for your unit with consequences if staff is unable to meet them. How does your nurse manager feel about this? Sounds like she is dropping the ball! What about your director of nursing?? It doesn't matter what you write up or how many policies you come up with if your higher ups are not going to back you!!! I worked for 15 years in a small community hospital !CU and we had some incompetant people come through. I will have to say we had a proactive NM and DON.

    If they are that bad, maybe a call to your state nursing board may be in order.
  8. by   TazziRN
    Another question: are you union? My last place was union and if the staff thought an assignment was unsafe there was a form s/he could fill about about unsafe assignments, basically saying that if anything negative happened because of the assignment (staff or otherwise), "ain't my fault, man!"
  9. by   loricatus
    Quote from wantobern
    does your hospital have a nurse educator? why not use them and educate nurses who are incompetent? let nurses take acls classes, give them inservice in areas where they are lacking knowlege. what is nurse manager doing about this? one of their duty is to evaluate nurses performance and do something about it. its their job on the line too, not just incompetent nurses. .. if a nurse manager feel these nurses are putting patients life at risk, then i think they need to be terminated.

    i was just thinking the same thing. if the hospital doesn't have an educator, the education role should fall on the nm. another idea, somewhat mentioned by another poster, is to standarize competency in the form of a checklist and evaluate each person on the unit based on that, at least, on a yearly basis. if the competencies aren't met 100%, either a remediation program should be set up or a transfer to another unit made.

    i am curious if the nurses who do not know how to work the equipment, or lack critical knowledge, have been mentored by any of the competent staff. it is one thing if they are ignorant because of a poor orientation and lack of team work; and, quite another thing if they incapable of learning once assisted.
  10. by   anonymurse
    Sounds like a problem for Staff Development. If they can't be trained, now that's a horse of a different color.
  11. by   P_RN
    This sounds like something bigger than the staff should have to deal with. Is there a hospital risk manager or lawyer? This is totally WRONG. You and management also know about these nurses....it should be a danger sign witha big red exclamation point. If something goes wrong, and you knew the nurse with that patient is incompetent then you are enabling the whole situation. Letters/incident reports notwithstanding you are in jeopardy.
  12. by   Myxel67
    Quote from TazziRN
    True ,but only if those nurses know they do not have the competence level to work ICU. I've worked with nurses in the ER who did not understand why they were asked to leave the ER.
    Taz

    Unless they are totally clueless, they know. Apparently incident reports are being written as a means of reporting less than competent nursing care. Also, they see schedules having to be juggled to acccommodate them.

    One reason I even mentioned this is that at my previous hospital, TPTB decided to start floating me to CCU and ICU (I worked tele and was vent certified). (they preferred to float me rather than use Agency--cheaper) I was the only RN in our hospital to be floated to the units and I was supposed to get only thouse pts who were ready to go to tele. CCU/ICU regular staff would take more complicated cases. I admit the worst part of it to me was the paper work, but I did have to refuse some of the assignments they tried to give me--Fresh CABG straight from OR, very unstable vent pt,etc.

    The self governing idea seems to be management trying to get out of doing their job.
  13. by   pebbles
    I would suggest calling your licensing body to find out what can/should be done.

    Reporting incompetence and unsafe practices of other nurses is part of your legal responsibility. Most often, this is done through managers, but if your manager isn't responding - either go up the management chain (which could get you burned) or go directly to the licensing body. Let them do the investigating. That's their job.
  14. by   emmycRN
    Quote from NightICURNBSN
    Hello everyone.

    I am relatively new to this forum, and I came specifically to ask a few questions. I have read these posts and I have a lot of respect for the responses I have seen here. I work in a relatively small community hospital ICU, and we are having a problem with some incompetent nurses. Management has been very reluctant to deal with the problems and we have been left in a difficult position on more than one occassion. We have recently started a supposed "self-govering" body for our unit and we are looking for advice on how to address this issue. We have had to rearrange assignments and schedules related to incompetent nurses, and I truly mean incompetent, not new nurses or inexperienced ICU nurses.

    So, my questions are...

    (1) Does anyone have any advice as to a different way for us to address this. NUMEROUS incident reports have not been effective. I am talking issues like inability to read the cardiac monitor, an unawareness that albumin is a blood product, an inability to turn on a portable oxygen tank. I hate to sound so mean, but it is really hard.

    (2) If you are in this position, how do you handle complaints from other nurses who have to take sometimes unfair assignments to keep the patients safe from the incompent nurses?

    (3) We are looking for some sort of written "standard" we can create that everyone must meet to work in our unit. (We really have nothing that is required to deem you "competent" to be an ICU nurse.) Any suggestions?

    We are a relatively small hospital, with no pharmacist or supervisor at night, so we are really dependent upon each other to help out at night. The weakness of some of our staff, nurses who have worked here for years, is really hurting us. Help us, please!

    Thanks in advance for any help.
    First, I don't consider Albumin a blood product. It's a colloid like PRBC's, platelets, and FFP, but as far as I know not administered the same.
    To answer your question, I would try advocating for some education programs for these struggling individuals. Perhaps a post-graduate ICU course which includes dysrhythmia instruction.
    Do you have an education department in you hospital? What kinds of classes are provided for continuing ed?
    I definately don't think these nurses should be written off as incompetent if they are actually TRYING to do their jobs. Maybe they just need a bit more instruction and mentoring from senior staff.

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