What punishment should this nurse get? - page 10

Had an interesting situation that came up and thought I'd throw it out for discussion. One of our staff RNs was found sitting in a chair and sleeping at the bedside of one of our ventilator... Read More

  1. by   Spidey's mom
    Quote from anneliese
    Reading this thread reminds me of the saying....."we eat our young".
    Which direction are you pointing the finger? Seems like all sides have gotten a bit hot.

    "nurses eating their young" is an old wive's tale anyway . . . we buried it months ago on a thread and just about everyone tossed a shovel of dirt on it.

    I think this discussion, while hot, has not been about anyone eating anyone.

    Some are just incredulous that this would warrent firing and a call to the BON while other are just incredulous that it wouldn't.

    steph
  2. by   Nurse Ratched
    Moderator note:

    We value ALL opinions at allnurses - I ask everyone to kindly do not attack other posters for having one. Please keep your focus on the post, not the poster.
  3. by   NRSKarenRN
    Quote from lost in boston
    [FONT=Arial Narrow]To All,
    [FONT=Arial Narrow]I do not believe that as an isolated incident in a dark room at 0500 should result in termination. As anyone who has ever worked the night shift has fought sleep while charting, taping, talking or driving. I have fallen asleep at RR crossings as I just leaned back for a min.!! Only to be rudely awakened by a blowing horn and an Irate driver. We all need to watch out for each other as help us realize that we are not perfect. A stern warning as we call LEVEL ONE....which means 90 days, no OT,no occurences, no tranfers...then POOF all gone. I do not believe that over one time sleep that the BON would revoke anyone's license unless it was "The Final Straw" with some horrible out come. Have pity...Have mercy!! We all can become sleep deprived. Boston
    Lets look at the salient points from OP:

    1. Patient was very restless.... constantly watching him throughout the night shift because of the fear of him pulling his trach out....found he would settle down when someone sat with him and held his hand.

    2. Periodically during the night different staff members sat at his bedside.

    3. Nurse in question says that at 5am she had caught up on all her charting and told her co-workers that she was going to sit down in the room with the patient. She sat down, took his hand and he immediately quieted down

    4. She sat back and the next thing she knew someone was waking her and telling her it was 7am.

    5. RN was found sitting in a chair and sleeping at the bedside of one of our ventilator patients at 7am. This is a really excellent nurse.

    6. Facility rules clearly state "no sleeping on the job."


    I've been involved in similar situation on nights caring for restless vent dependent patient, sitting at a bedside + holding hands to calm patient with heavy eyelids...

    Working nights on a unit with vents, patients are rarely left alone for two hour intervals---usually someone is in: RT, aide, lab, primary nurse etc., but those golden moments of uninterrupted time do occur.

    When faced with exact same situation I looked at INTENT.

    1. Was RN deliberately sitting in chair in the room to catch some sleep (wrapped up in blanket hiding behind curtain as I'd seen a fellow nurse do on more than one occasion)? NO

    2. Was the RN providing care? YES
    By using "therapeutic use of self" she had calmed a restless patient and prevented trach dislogement, thereby maintaining airway.

    3. Where her patients truly abandoned? NO. Other staff were on the floor, she informed them of her whereabouts, most likely expecting they would keep an eye on her patients, as she probably did theirs while they sat with this patient.

    I've had as many as 6 vented patients by myself on nights as LPN and RN on Resp/Telemetry unit working 12/12. Sometimes you get busy with a critical situation and don't get to fully assess other patients for 2 hour intervals. Staff on floor are always attuned to listen to the vent sound/alarms and glance at hallway tele monitor (old days). Are those patients abandoned cause I didn't see them for two hours: NO. Same applies here.

    When we'd have a patient like this or knew other staff had major disaster brewing, I'd usually stick my head in the room every now and again to make sure they weren't drowning. There could be a dozen reasons why other staff didn't come in room: busy with own patients, maybe this RN was patent's primary nurse so no relief expected.

    A lot boils down to who found the RN asleep. The one time I found my partner nodded off sitting with patient after several brutal nights, just woke her up eyes closed only few minutes and she was able to spring into action.

    Fifth time I had another RN tell me it she was napping as her patients quiet, had refused to assist restarting difficult IV for me (she was unit expert) and I'm tearing my hair out, well that patients chart I needed to review with supervisor just happened to be on the table in our conference room where she was sleeping and the supervisor observed her that way for over 30 min.

    RN was contrite over incident.

    For this type occurrence, my recommendation is same:
    [FONT=Arial Narrow]
    [FONT=Arial Narrow]
    [FONT=Arial Narrow]A stern warning as we call LEVEL ONE....which means 90 days, no OT, no occurrences, no transfers...then POOF all gone.
    However, I'd keep report in my personal files for 1-2 years, only send to HR if repeat incident.

    If other type staff involved that found patient, I'd carefully discuss with them situation, RN apology and that disciplinary action taken. PERIOD---never tell what that action is.

    Hopefully this cooling off interval will bring back focus to the case and not posters and my comments provide food for thought.
  4. by   Thunderwolf
    Let the judgement of the board stand as per NRSKarenRN. The bench rests. Case closed. Appropriate judgement has been rendered.


    Further discussion is welcome, but disrespectful arguements (as indicated by Nurse Ratched) that plead little towards the benefit of the thread will close it.

    (Need a gavel smiley here)
    Last edit by Thunderwolf on Oct 13, '05
  5. by   horatschki
    I think it is sadly unfortunate, let alone in a nursing shortage crisis, that we can not make minor exceptions for our hard-working, often stressed-out, sleep-deprived nurses of this country and bend a rule!! This was a harmless incident that definately needs to be addressed but firing will only put you one more nurse short and she will go off and get another job elsewhere.
    On a larger scope, I think it's very important to look at how healthcare facilities can unintentially potentially abuse staff sleep cycles. Some of the thoughts I have 1) did the nurse work safe number of hour shifts that week? 2) Was there mandated overtime that evening 3) Does the nurse rotate day and night schedule bi monthly? 4) Was the nurse working an extra shift or traded with someone else? 5) Is the nurse forced to work night shift at the facility, would she much rather prefer a day shift schedule?
    When it comes to falling alseep at the wheel (literally sometimes) I think the main cause is the erradic shifts nurses, especially new or traveling nurses, are often forced to do in order to comply with facility schedules.
    I am aware sick people need 24/7 care. I don't have the answers to better scheduling but hopefully with continued studies and new
    literature regarding sleep deprivation facilities can begin to take scheduling more seriously.
  6. by   Thunderwolf
    Thank you, horatschki, for pulling the thread back to topic/issue.
  7. by   madwife2002
    I had a troubled nights sleep over this thread and I am glad things have been addressed, I personnally was very concerned re the attitude towards how mistakes are dealt with and feel reassured that Nurses are not fired for their first offence. I am due to emigrate soon to take up a nursing position in AZ and I had nightmares about being sacked. I am a very experienced RN who has been fortunate enought not to make mistakes that I am aware of, but you can never say never.I am going to work nights so I am hoping this unfortunate incident never happens to me and I shall be consuming Red Bull to attempt to ensure I never close my eyes. I worked nights last week and I felt so sick at 5 am that I walked the floors to ensure I didnt.Once again I am thankful for some sensibility to this thread.
  8. by   Thunderwolf
    At this present moment, there are "13" pages to this thread. Here is the original post in order to refer back to so folks don't lose sight of the issue. Sometimes, longer threads, such as this one, need the original post thrown back up to help members stay on topic.

    Had an interesting situation that came up and thought I'd throw it out for discussion.

    One of our staff RNs was found sitting in a chair and sleeping at the bedside of one of our ventilator patients at 7am. She tells me that the patient was very restless and they had been constantly watching him throughout the night shift because of the fear of him pulling his trach out. They found he would settle down when someone sat with him and held his hand (how basic can nursing care get?). So, periodically during the night different staff members sat at his bedside. The nurse in question says that at 5am she had caught up on all her charting and told her co-workers that she was going to sit down in the room with the patient. She sat down, took his hand and he immediately quieted down. She sat back and the next thing she knew someone was waking her and telling her it was 7am. She jumped up and worked on giving her 6am meds and ended up giving an oral report to the oncoming shift (we tape report).

    A very serious decision has to be made here. This is a really excellent nurse and I'm afraid there will be no choice but to fire her and report her to the Board of Nursing. I understand that she did not intend to fall asleep and that she was helping the patient, but rules are rules, aren't they? How I wish this hadn't been reported. Our facility rules clearly state "no sleeping on the job". Our Human Resources Office and the Director of Nursing will make the final decision. What do you all think?
    As I see it, the nurse is described as "an excellent nurse" who fell asleep...for how long in a two hour period?....very hard to say....but, bet you it was not for 2 hours. It happens! If a single occurrence, is it the end of the world?....NO! I bet if anyone was tired enough, or lets say exhausted enough, from rotating shifts or working stretches, it could happen very easily. Let's not forget this nurse was described as "excellent". Let's not lose sight of that fact. Is this reason for a dismissal? Lord, I hope not. The only error she made was not acknowledging that maybe she was too tired to assume this duty. We all have limitations. She simple underestimated. Again, the question begs "why was this reported" in the first place. Also, a judgement error on the one who did the actual reporting.
  9. by   tiggerforhim
    Well, for what it's worth, no one has really (except in the first of the thread) mentioned the hospital and BON's policies. There is a similar thread about a nurse sleeping on break and the DON is writing her up. Anway, in NC it is almost always a firing offense to be caught sleeping from the Board's standpoint, and our hospital has a policy of firing those found sleeping on the job. That's it. No questions. The stand is pretty much unambiguous. However ,the other issue is BEING CAUGHT or FOUND sleeping on the job, and then being reported to the BON/Nursing Administration. I would be interested in knowing what actually happened to the nurse in question. And by the way, I also work night shift.
  10. by   canoehead
    I think a great deal of weight should be put on whether it was a willful act or not. Some workers look constantly for a chance and a place to sleep, or watch TV instead of working- any excuse will do. Others work hard and just get caught in a situation where they didn't get enough rest and are trying to make it through the night safely.

    If a nurse has a history of tucking away in a quiet corner to avoid work I think a harsher response is called for.
  11. by   bluesky
    Quote from stevielynn
    I think what some of us are surpised about is the lack of understanding about errors in nursing and how that is normally handled.

    This situation does not warrant immediate firing and a call to the BON.

    As a nurse, I know that med errors, lapses in judgment, fatigue, are all things that may happen to human beings at one time or another. Nursing is set up so that those errors can be addressed in a professional and compassionate manner - it happens every day - someone makes a mistake and it is handled, without talking to the BON. Without getting fired.

    There are even programs for addicted nurses to get better.

    And the fact that you don't seem to be aware of this aspect of nursing is what bothers me and maybe others when you say fire her and call the BON.

    Once asleep, she didn't make the choice to sleep for 2 hours. There was a systems error here where the patient needed a sitter and there was no sitter . . . since this happened and was reported to management, hopefully it will be handled and fixed.

    steph
    Excellent post, Steph.
  12. by   traumaRUs
    I received my Emergency Nursing Journal yesterday in the mail and one of the articles talked about the stress of shift work. I know personally, I worked nights for many years and it was often difficult to get adequate sleep. I was very fortunate that I never fell asleep at work - although I did fall asleep driving home from work one morning and drove off the road (15 miles - rural area). I have found in my life that it is better not to judge others too harshly - you never know when you will need understanding, mercy and compassion.
  13. by   CoffeeRTC
    Hey...I gave up reading a few pages of this discusion. When things are debated so quickly, how about trying the chat room? It is great.

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