Could use your advice/opinions here...

Specialties Geriatric

Published

I'm new to this forum and I hope you don't mind me jumping right in and asking for your advice/opinion, but here goes.

I work in a nursing home and I'm the charge nurse on the afternoon shift. Basically, I'm the only nurse on shift with the exception of a nurse that comes from 6-9pm to help pass evening meds and do evening treatments. When I first started working there, (this past June), the 6-9 nurse was a great help and asset- whoever worked that shift always got all the meds and treatments done on one hall and usually all the treatments too -- this hall has anywhere from 22-24 residents. Now the problem: about a month and a half ago, a nurse (she's been an LPN for atleast 20 yrs I believe and has worked here for about 8) that was working the night shift was written up because after a resident fell, she supposedly did an assessment, said there were no injuries, and put the resident back in bed. The resident was also ambulated to the BR during the night. The next morning the am nurse noted an obvious internal rotation of the leg -- the resident was sent for x-rays and found to have a broken hip. This is the second time she's done this with a resident. As a result it was decided she could not be a charge nurse, needed to be under the supervision of another nurse and so has become the main nurse to work the 6-9 shift. UGH!!! It's been nothing but a nightmare for me! I've already given her verbal warnings for several things to which her reply is "I need an attitude adjustment." One particular thing she was warned about --- one of our resident's has a suprapubic catheter that we flush with Renocidin qod. This nurse proceeded to "flush" it using the balloon port -- she was forcing 60cc of fluid into an already filled 25cc balloon. The balloon of course burst, and guess who had to change the catheter -- me!! There are times that I have seen her giving scheduled meds as much as 3 hours late, she makes the decision to hold a med and doesn't notify the doctor, doesn't tell me she did it -- and I get the blame for it. She continually

stays an hour to an hour and a half over and there are still treatments and meds not done, which I then have to go back and finish up. There are nights that I don't get a dinner break just so I can keep up with everything of mine to do, and what she leaves undone. I have gone to the DON and to our staff development coordinator numerous times -- and somehow it all keeps coming back as my fault --- I'm the charge nurse, so I should be going to her at 9pm and ask her for report and tell her it's time to go home. And I should write out a detail of what needs to be done and when to help her out (apparently she's not expected to be able to follow the MAR like the rest of us). I did write this out just to say I've tried it their way -- she looked at it and set is aside. They've already had one of the other nurses come in and work a shift side by side with her to show her the routine and now they're asking me to do it again. I said "NO" -- she's already been shown and nothing changes. Am I just being overly sensitive here or am I getting the short end of the stick? When any of the other nurses work the 6-9 shift, everything is done, including all the charting that needs to be done for that hall -- and I go home on time! I have worked that shift, and on that hall, myself, and know it can be done, but she has the DON convinced that all there is time to do is pills and no treatments. I even do the most time consuming treatment on that hall, which is a wet to dry dressing on a ladies legs that have ulcers -- this lady will not allow this nurse anywhere near her and has told the DON that personally!

Ok, sorry, I'm rambling, but I really would appreciate your input.

Thanks!

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Wow! :eek: Sounds like a really sticky situation. She appears to be upset to have her skills questioned. She also doesn't seem very respectful of your charge position. She also gives the impression of being angry having to work a different shift.

I've always been told, before you go to someone with a problem, have a possible solution. What do you want this person to do and how do you suggest it get done.

If she wants a list of things she is supposed to do, give her one. Give her a time frame to have it done. Allow time to go over the list to see what she didn't complete. Make sure you have a job description of the position to go over with her if needed. Ask her for suggestions on how to get things done different. Give her credit for her experience. Use diplomacy when approaching her. Sometimes if you make the solutions sound as if they come from her, you'll get a better response. Keep a paper trail of things you do with her and what you have to do after her. Have a witness of what you have to fix. If you must speak to her to about a situation, make it out of public earshot. Learn from her and let her learn from you. Don't know how long you have been a nurse, but in 20 years things have really changed.

Good Luck!!!

Remember..... Change in inevitable, growth is optional!

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This sounds like bordering on incompetence.I really would be afraid to work with her. Someone needs to talk with her and try to find out what's really going on, be it personal problems, anger issues or just plain incompetence. Such poor assessment skills, putting a flush into a balloon port, not completing duties, Oh no, i would have to get away from her or get her away from me. Prehaps the years have taken their toll, but whatever it is, it's dangerous !!!!!!!!! Not only should she not be charge nurse, sounds like she should be a student still. I hope they don't keep overlooking these issues until she harms someone else

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That's the problem -- in my opinion she already has caused harm to residents. I mean putting a lady back to bed with a broken hip, saying there's no injury, and she gets nothing for pain relief all night? And I'm told that this is the second time she's missed a broken hip on a resident and just put them back to bed. And their solution is to just move her to a shift where she can be "babysat". And they keep changing the rules for her which just floors me. I'm going to give it a little more time, but then if something doesn't change, I'm going to tell them to put me on a different shift or give them my notice.

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My sentiments exactly !!!!!

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If diplomacy isn't the answer and your facility doesn't do enough, then I guess it's time to go to those higher up the chain. If you are Union, talk to you rep. Let them know what is happening and what you have done. Call the Nursing Board, the State Survey Agency, and the Ombudsman. Make sure you have the documentation to back up your allegations or it is in the facility somewhere these agencies can find it if the investigate. Anonymous calls can be made.

Good Luck!

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I totally agree that this is unacceptable. You have given her oral warnings many times, now give her written warnings just to follow protocol. However, I do believe that this is incompetence and needs to be reported to your State Board of Nursing. I would not hesitate to get on the phone. She is dangerous!!

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Hi Mtgirl,

I don't know about the US but in the UK we would firstly report her in writing to our managers who would have to investigate. She would then be reported to the UKCC which is the governing body for all nurses. They have a disciplinary court in which she would almost certainly be struck off. In England, it would be your duty to report it formerly!

Mike

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