I'm on a new case, meaning a newly trached patient. I'm the primary nurse on the case. I take care of the typical primary nurse duties such as ordering supplies and meds, inventory of supplies, Dr appts, etc. The case is a good case. The parent is involved but not exactly over-involved. The parent can be picky, but most parents are about something. I have been there from day one and even met the patient in the hospital before coming home.
We started off with a few nurses and I've oriented every nurse on the case in detail. We had a good number of nurses. But of course some were no call/no show and were let go (I just don't get that) and one was let go for being incompetent. The one that was let go for being incompetent made major errors that were beyond just talking to her about. Some of it even boiled down to common sense and decency...which can't be taught.
We have a couple of nurses that are wonderful! They are very knowledgable and have lots of PDN experience which helps things flow well. Everything is simple with them and I enjoy working with them. I come in after them and the patient is in good shape, the room is clean, lines aren't tangled, and I just pick up where they left off.
Then we have the nurses that I wish would just go away!! One nurse is getting on my last nerve! She works nights and I come in for day shift. I walk in and everything is a disaster. The patient is never in as good of shape as when I left. She claims the pt needs at least 4 times the oxygen during her shift that the patient needs on my shift or anyone elses. So I have to wean the patient off every day. Her documentation reflects that the patient has equipment that isn't in the room or ordered. The lines are tangled. The diaper is so loose that it will leak if I don't change it before the patient voids. The trach ties are so loose I can fit my hand between the tie and neck! If a new med or order arrives while I'm away she never copies it right...including writing the wrong route or wrong med. She thought certain supplies were changed daily that we only get 1 or 2 of per month. I explained that I take care of all supplies and changing them when they are due to keep them on schedule unless something breaks or whatever. But she still changed the supplies until we didn't have any more. We have a communication book and she doesn't bother to read it. I still leave notes about it so everyone will be on the same page. She has no clue. I can write in the communication book that a med was reordered at the pharmacy and that the mother was informed. And she will come to me a week later and tell me we are out. That tells me she didn't read and doesn't think to notify anyone until the med is completely out instead of giving time to order and pick up the med. She miscounted the number of doses of an antibiotic and cut the time short. She had no idea that another med was the generic version and told me we didn't have a certain med. I explained that we did and showed her and had to explain that it was the generic version. I listen to her whine and complain during report that the parent is picky when the parent is just telling her what works for the patient. One example is the diaper being too loose. The parent showed her how to put the diaper on to avoid leaks and she complained that she is too picky. However I don't enjoy doing a full linen and clothing change at the start of my shift. She told me one day it was too hard to put the diaper on the way the parent wants it. It happens to be how I've always put a diaper on and its quite simple. None of the other nurses are having this problem. She decided one day to put on the MAR shifts that don't exist with the hours the patient gets. But now she initials for the times that there are no nurses there. Then she put times down for cleaning equipment and changing trach ties. We have some things that are cleaned each shift or once a week or whatever. But the feeding pump doesn't need to be cleaned at 9am!!! It can get done any time during the day as long as it gets done. Shes creating more work for me. I was gone for a few days (after putting in 70 hours the boss made sure I got a 3 day weekend!) and she wrote the wrong med on the MAR and all the nurses after her just signed it without catching the error. So I came back and found it and discussed it with my supervisor and had to fix that problem. That time the med was a brand name but she wrote it as a generic...would have been fine except she wrote a sound alike name instead of the right med. My boss knows she isn't that good and has talked to her a few times. I'm just exhausted trying to keep up with all of the screwups so I don't miss a mistake of hers and make a mistake myself. And I'm concerned about the patients safety while she is there. The nurse also complains about how tired she is in the mornings and tells me every morning that she doesn't sleep at work (why would she feel the need to say that every morning to me?). She tells me its not her shift and she prefers a shift that the family doesn't want hours for. I tried to blame it on her being tired at first. But enough is enough! I can't make excuses for her anymore. I've really had enough!!
Any thoughts? Oh yeah, this has been going on for almost 3 months. Its not just like its been going on for a few days or something.