Seasoned ICU Nurse Lacks Critical Thinking - page 2

Last night shift I worked with 2 of my colleagues one who is one of the units senior staff nurses (SSN). We each have at least 10 yrs experience, she our SSN has about 30 years ICU experience. we... Read More

  1. by   blondy2061h
    Quote from hherrn
    Time isn't a cure for incompetence.

    So, you work with Sleepy and Dopey. Any of the other dwarfs work there?

    Other than Doc.
    Being an ICU I'm sure they get their share of Sneezy and every unit needs a Grumpy.
  2. by   All4NursingRN
    Lol yes I guess you are right time isn't a remedy for incompetence. Still sad.
    Quote from hherrn
    Time isn't a cure for incompetence.

    So, you work with Sleepy and Dopey. Any of the other dwarfs work there?

    Other than Doc.
  3. by   heron
    Work ethics and competence are two related but definitely different things. Perhaps an informal conversation word with your hospital's risk manager would help. It's amazing how fast lax management tightens up when they realize that unsafe nurses = potential patient injury = big malpractice settlements.

    It's a shame to have to get adversarial about it. Your description sounds like she's seriously unhappy in her job. Having to force the issue increases the possibility that she'll be treated more roughly than necessary. Not to mention the fallout for anyone doing the forcing.

    Still, as Davey pointed out, we are responsible for knowing our own limits and stepping back when they are exceeded. In my case, the solution was to go part time before I got so exhausted that I made a mistake that hurt a patient.

    No easy solutions here.
  4. by   Ruby Vee
    Quote from Nurse Beth
    Constantly falling asleep at the desk...any chance she is diverting?
    Or caring for an elderly parent with dementia issues? Or a young grandchild? Perhaps she has undiagnosed sleep apnea? Other medical issues? A husband who requires assistance with ADLs or some other reason she cannot sleep during the day? I don't know that I'd jump immediately to diversion, although that is a possibility.

    Sleep deprivation will make you psychotic within a week. I imagine that it wouldn't take quite that long for it to interfere with decision-making skills and critical thinking. When I was taking care of my mother (Alzheimer's), I was never able to get even an hour of sleep before Mom would be stuffing rags in the drains and turning on the water, shoveling wood into the woodstove until the stovepipes glowed red or running outside barefoot in only her nightgown -- in Wisconsin in January. By the end of a week, I was hallucinating. I had to be awake during the day to take Mom to her various appointments so she could be evaluated for assisted living, and I was unable to give her doctors a coherent history. I'm a nurse -- that should have been second nature to me.

    The fact that the 30-year nurse exhibited no critical thinking skills on the night in question does not mean that she never had them or that she's "lost it." Maybe all it means is that she needs more sleep. It would be a kindness to talk to her before going to management with your suspicions -- whatever those suspicions are.
  5. by   AutumnApple
    Quote from Nurse Beth
    Constantly falling asleep at the desk...any chance she is diverting?
    Quote from heron
    Yes. I simply can't believe that this nurse's performance would be that bad for thirty years without anyone noticing.

    That being said, if the OP's description is anywhere near accurate, she cannot be allowed to continue endangering her patients.

    OP, has anything been done so far to address the situation?
    Quote from Wuzzie
    Does she have trouble with finding her words? Has she always been this way?
    Glad to see I'm not the only one with a problem with the situation described by OP. As Heron said, it's hard to believe this has been the way the ICU nurse was for the past 30 years.

    So, I started to think that something new came along that has changed things for them. Right away, I thought "Maybe burn out that lead to diverting.........". That at least would explain the semi-sudden onset of falling asleep at the desk.

    But yes, as others have pointed out, there are other explanations too. When I was in trouble and it was affecting my job performance, I was directed to the EAP program. It saved my life. The advantage EAP programs have is: They'll help diagnose what the problem is, whether it be diversion or any of they other things people have mentioned. It's what they do.
  6. by   Wuzzie
    Quote from AutumnApple
    So, I started to think that something new came along that has changed things for them. Right away, I thought "Maybe burn out that lead to diverting.........". That at least would explain the semi-sudden onset of falling asleep at the desk.
    There is a form of dementia that has certain sleep disturbances resulting in daytime sleepiness as a hallmark sign. That combined with her inability to process input made me think of it right away. The onset is slow and insidious.
  7. by   ProperlySeasoned
    You sound like a reasonable person, and this is a well written post with legitimate concerns. Since patient safety is at risk, I would consider an EQVR. Since these are linked to the larger hospital quality department, it may force your managers hand, so to speak. I appreciate her years of service, but I would not want her taking care of me or my loved ones. Every patient deserves and needs an attentive, awake nurse.
  8. by   NurseCard
    I really have a hard time believing that there isn't something going
    on, other than simply a nurse being incompetent.

    This woman has been a nurse 30 years? Has always worked ICU?
    Or has she mostly worked in a different area and maybe just ICU
    for a couple of years? I've been a nurse a long time but if I went
    to a busy ICU I'd likely be tired and "incompetent" too. Seriously.
    It's just not in my makeup to work in that environment.

    Life outside of work very stressful? Mine has been lately and I
    won't lie, it's affecting my work a little bit. I'm working on it...

    Like Nurse Beth said... drugs maybe?

    There's SOMETHING else going on. This is not a 30 year ICU
    nurse who completely has it going on upstairs. Something isn't
    right.
  9. by   Been there,done that
    "I shrug and let her go." Whatever is going on.. you have been enabling. No way in Hades anybody sleeps while I am busting my hump.
    She is not able to fulfill her duties and needs to go. Most facilities have a strict policy regarding sleeping while on duty. If the nursing supervisor does not take action... go up the chain of command. She is a danger to patients.
  10. by   Purple_roses
    Quote from Been there,done that
    "I shrug and let her go." Whatever is going on.. you have been enabling. No way in Hades anybody sleeps while I am busting my hump.
    She is not able to fulfill her duties and needs to go. Most facilities have a strict policy regarding sleeping while on duty. If the nursing supervisor does not take action... go up the chain of command. She is a danger to patients.
    My management actually encourages night nurses to take a 15 minutes nap during the shift because studies have shown (according to them) that this improves outcomes. Now, not a single nurse in my short career thus far has taken a nap during shift because nobody has time for that lol.
  11. by   JBMmom
    Quote from Purple_roses
    My management actually encourages night nurses to take a 15 minutes nap during the shift because studies have shown (according to them) that this improves outcomes. Now, not a single nurse in my short career thus far has taken a nap during shift because nobody has time for that lol.
    My hospital is pretty strict with making sure nurses get their 30 minute break. If you miss it more than twice it becomes a discipline issue, for the nurse and the charge nurse. Depending on how I'm feeling I sometimes take a lap around the building to get some fresh air, or I take a 27 minute nap. I feel great after either one. I'm fortunate that my facility sees the importance of getting nurses off the floor regularly, I wish every work environment was as committed to ensuring their nurses get proper breaks. It benefits my coworkers and our patients.
  12. by   Mavrick
    I was having episodes of nearly falling asleep while I was charting. Then I noticed I was having a really hard time falling and staying asleep at night.
    Finally connected that with my increased use of Tramadol (for my RA pain). Stopped the Tramadol and now use acetaminophen/naproxen. Narcolepsy-like symptoms have disappeared. It was so weird though, to feel like if I didn't constantly keep my mind active I would fall asleep in the middle of the day.

    If this is new behavior for your SSN, I would be concerned for her deteriorating mental function. She needs a medical check up.

    If this is old stuff that your unit is just now noticing, your manager needs to do her job and and reassign this nurse to what her skill set can handle.
  13. by   Purple_roses
    Quote from JBMmom
    My hospital is pretty strict with making sure nurses get their 30 minute break. If you miss it more than twice it becomes a discipline issue, for the nurse and the charge nurse. Depending on how I'm feeling I sometimes take a lap around the building to get some fresh air, or I take a 27 minute nap. I feel great after either one. I'm fortunate that my facility sees the importance of getting nurses off the floor regularly, I wish every work environment was as committed to ensuring their nurses get proper breaks. It benefits my coworkers and our patients.
    I bet the nap does help a lot. I have a really hard time falling asleep during the day and usually just get about 4 hours of sleep before a shift, but once I'm on my shift I feel way too wound up...there's no way I would even be able to fall asleep. That's great that you also work at a facility that makes sure nurses get their breaks! My charge nurse and manager will come up and ask nurses if they've had it and encourage them to take one once 0200 is rolling around. Pretty happy with my hospital! I feel lucky.

    (Sorry OP for that mini-hijack!)

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