Got a nurse aide fired... did I do the right thing?

One night, when we had a brand new charge nurse and I had a really sick patient in the back corner of the unit, two RNs who happened to be dating one another pulled two recliners out into the hall outside a patient room, set up a laptop on an over-the-bed table and cuddled up together under a blanket to watch Netflix. They happened to be right in front of the nurse's station where the charge nurse was doing chart checks. There's no way Gustav could have missed Jubal and Essie canoodling in the hall right under the security camera and in full view of anyone who came up or down the hall, ignoring monitor alarms and patient call lights. There's no way he could have missed Jubal's loud snoring.

About 3:30am, things finally settled down with my patient and I was just sitting down to do some charting when Gustav, Jubal and Essie burst into my patient's room followed by a security guard brandishing a video camera and the nursing supervisor. "I understand that you're Gustav's back-up for Charge tonight, Ruby" said the supervisor.

I allowed as to how I was. "I'm sorry I haven't rounded with Gustav since 10," I said, gesturing to the dialysis machine, balloon pump, RVAD, LVAD, pressors, Propofol and multiple units of blood hanging that co-workers had been kind enough to fetch and check with me. "I've been stuck back here with this guy trying to die. Is there a problem?"

Seems that Security had been entranced watching Jubal and Essie carrying on in a single recliner right under Gustav's nose and the single unit security camera. They'd been taking bets as to whether any children had actually been sired and sent a guy up to check things out. He arrived too late to witness conception but in plenty of time to record Jubal's snoring and Essie's drooling for posterity, note Gustav's lack of response to the above and to summon the nursing supervisor. Gustav was an employee of longstanding, but was in his first week of charge without a charge preceptor, and I was supposed to be there to "answer questions and help him trouble shoot." Because of that, I got summoned to the meeting with the manager, the nursing supervisor and the video evidence first thing that morning. The video was quite special . . . not the sort of thing you want to be watching with your nurse manager, the nursing supervisor and Security. My charting and the nursing supervisor's statement that "Ruby was in no position to see what was going on, back in the corner there" kept me from getting written up with the three of them. (Thank you for real time charting!)

Gustav was removed from charge, placed on probation and lost all of his tuition reimbursement for a year, delaying his NP for a year and costing him a ton of money. Jubal (going for his BSN) was also placed on probation, lost his tuition reimbursement and was so far along the disciplinary process that his next (somewhat less entertaining) transgression got him immediately canned. I'm not sure what discipline Essie received, but she was gone in a few months, off to anesthesia school. Gustav and Jubal loudly told anyone who would listen how unfair their consequences were, but Essie never discussed her consequences. Every nurse who was on the security video walking up and down the hall and NOT doing anything about the scene unfolding in front of the nurse's station was written up . . . we all have a professional responsibility. I dodged the bullet because I was in a three-bed room in the back of the unit with my own Pyxis, supplies and an employee bathroom right across the hall. Of course if I had walked past the nurse's station, I would have interrupted the show, having learned in my second year of nursing that "Failure to supervise" can get you canned faster than sleeping on the job will.

Nice story, Ruby, but your words will simply fall on the deaf ears of those who think the aide in question (and I can' t believe this thread is still going) deserved better treatment.

I had a similar situation in the hospital. I delegated a glucose check to my CNA. On my unit for some strange reason, RN's don't have access to the glucometers. He asked if he could do it after vitals and I said sure. This CNA already had a reputation for making up vital signs, and falsifying documentation. I had once reported him for documenting a respiratory rate on a patient when I knew he hadn't gone into the room (the vitals print out except the RR, I had come out of the room and he took the slip from me to chart it, he documented a RR even though I never wrote it down and he didn't go in to look).

An hour after I asked for the glucose, I couldn't find him, I had no value, and I had a pissed off endocrinologist on the phone. I found him eventually snoring in the break room. It took me yelling his name 4 times to wake him up and I still needed the glucose.

Remember you have a licence and everything you delegate (even if it is considered "their job") is still legally your responsibility. If that patient had been tachypneic and it had been missed, nothing happens to him. It's on me. If my patient's glucose had crashed, he's in the clear. I was negligent. Nurses and aids are coworkers and they are not our employees, but we are responsible for their work. Someone's desire to phone in their work comes second to your need to protect your license and (most importantly) your patients.

In both cases I did, have a private, non-confrontational discussion with the tech prior to reporting the incident. It wasn't easy or comfortable, but I told him I was reporting him. He was pissed. He didn't get fired till a year later after several other reports where put on file. Though he was very cold to me for a long time, in the end he did tell me he respected me more for having the respect to tell him first, instead of going behind his back.

Peer self mediation is probably the most difficult skill I have had to learn in nursing. But it builds trust and improves unit moral. Your boss probably didn't expect you to handle the situation completely on your own. They may have just been encouraging you to learn to correct your peers in the moment. I've often gone to my boss and just asked what I should say to my coworker. They want to know whats going on in their unit, but the more their staff can resolve without leadership intervention the better the unit runs.

I might have talked to the CNA if it was first offense, long term employee with a spotless record whom the patients love. This done not appear to be the case from what the OP wrote. In this case I would have done the same thing. Sounds like you did the right thing.