Overweight nurse unable to physically manage her responsibilties

[Nascar nurse]

Advice please..

We have a very heavy nurse that works in our SNF. She is very pleasant to both residents & coworkers, she is very reliable and always comes to work, picks up extra shifts when needed, etc. Her actual nursing knowledge is average at best (does need some guidance with appropriate decision making skills related to resident clinical needs). She has been employed by the facility for several years now.

The problem.. she has always been very heavy and as she has aged (probably around mid to late 50's now) she is having increasing difficulty moving about the facility and being able to manage physically providing care. She requires a cane to walk on the the unit, leans heavily on the handrails for additional support. Takes an office chair with her on med rounds so that she can sit as she is gathering meds for each resident, leans on resident beds to support herself for treatments (think both elbows on the bed propping herself up and only using her fingers) and I can't imagine she could ever do CPR.

We admittedly have been turning a blind eye to her for some time because she is really a nice lady with a big heart. Not only do we not want to "hurt her", we also have to take the whole disability act into consideration. We also know she is probably the only working adult in her family and they rely heavily on her income.

The ugly.. We can't keep ignoring this. We have had 2 family complaints within the past week. Both families saying, "although we really like Nancy nurse, we are afraid if Mom had a medical emergency Nancy Nurse will be unable to physically care for Mom." Once said her physical disability is impairing her ability to provide safe care (it takes a very extended period of time just for her to get down the hallway).

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For all you experienced managers, how do we best handle this?

[VivaLasViejas, ASN, RN]

That's amazing...........I don't know how she manages bedside nursing at all if she's that heavy.

When I hit the 350 mark last summer, plus a few pounds over, I could barely walk from one end of my building to the other without panting like a hound-dog in summer. (I was in management then; since I went back to LTC as a charge nurse, I've dropped almost 40 lbs. and am in better shape than I was five years ago.) I also got out of breath and sweaty just getting dressed in the morning and putting on shoes and socks..........forget actually TYING my shoes, so I wore nothing but backless clogs, or sometimes even step-in slippers on days when I was so edematous that I couldn't get a shoe on in the first place.

The only thing I had going for me at the time was dignity---I just couldn't bear the fact that at only 49, I could no longer get around my workplace---and that was what made me finally decide to do something serious about the weight.

My point is, it sounds like your nurse hasn't reached that level of discomfort yet. And until she does, I'm not sure there's much more you can do for her. If she can't do the physical part of the job, or adapt to a non-physical job, you don't really have much of a choice. I feel bad for her, because I know what it's like to be that big and out of condition...........but "facts is facts", and you can't risk the lives of your residents for political correctness.

I don't envy you.........having to lower the boom on people who were doing their best but whose performance was still inadequate, was one of the reasons I left management. Good luck in whatever you wind up doing with/for this employee.

[southernbeegirl, BSN, RN]

i weigh 350lbs and i work my tail off. so i may not be able to run as fast as others to a code, i DO get there! if i say anymore i'll be even more pist so ima hushup right now.

[achot chavi]

It probably would be better not to emphasize that the nurse was 'overweight' in your title, but instead discuss more of her physical decline that's interfering with her ability to be a bedside nurse.

Weight and physical appearance are very touchy subjects.

I disagree, we are professionals and overweight was the correct term, "fat" would have been insensitive,

The disabilities that this nurse is experiencing is mostly due to her overweight situation, a disability on many levels but an accurate term.

I think Nascar has shown much sensitivity to this nurse and I applaud the way she has handled the situation.

It would have been easier if Nascar had to deal with a tired nurse who is sick with cancer and depleted from treatments,at least she could blame the illness...Here she is blaming a legitimate "illness" that unfortunately is not recognized and treated by the nurse herself. Not many other professions would have shown as much tolerance and sensitivity and support as was shown here (acc 2 Nascar).

This was a most difficult situation, as the nurse did not take responsibility for herself (on many levels) and pt care was "compromised" (It is not normal for a nurse to be so tired after 2 days work in a row...and being tired doesn't lend itself to proper pt care).

I will pray for this nurse to find the strength and guidance and help for herself.

[Bettie P]

The treatment nurses I have seen on the job were busting their butts for eight hours going from one end of their assignment to the other with no time to rest. If this person can not handle normal nursing duties, I can't see her handling treatments.

Agreed. For Heaven's sake...we're way beyond a mobility assistance issue here. She can't even manage to remain upright unsupported long enough to carry out one treatment. I'd hate to think of the increased infection and cross-contamination risks that would come from the treatment nurse leaning on the bed of every resident who needed a treatment.

I think Nancy Nurse should consider applying for SSI. She has probably worked to the best of her ability for all her life. She is older and in failing health, and surely sounds like she would qualify for disability benefits. Perhaps the facility caseworker could assist with this. The OP could assist by documenting how Nancy Nurse has tried to keep up with her duties but is increasingly is unable to do so.

[Havin' A Party!, ASN, RN]

Management need not determine the reason that an employee is no longer functioning per the spec.

I'd remain strictly on the issue of nonperformance.

If the employee states a cause, then the employer may have to offer whatever reasonable assistance would be available to similar employees, and satisfy other applicable (legal, contractual, etc.) requirements.

[Nascar nurse, ASN, RN]

Achot Chavi - Thanks for the kind words.