Annoyed with nurses at PDN case (vent)

[SDALPN]

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.

[JustBeachyNurse, LPN]

What does the parent think? Parents often have the most weight in these kinds of staffing issues. Sounds like she has made some critical errors--sound alike/look alike drug. More concerning is that no other nurse caught the error. Wasting resources and supplies that can cost the family and/or the agency $$$. Money also has a big influence.

One suggestion is if parent happens to voice concerns to you, don't comment. Redirect the parent back to the nursing supervisor to discuss her concerns with the care provided by this nurse. Nurses have been pulled from cases for wasting supplies/resources.

[liveyourlife747]

Wow! Just wow! I would have to hold my tongue. She's obviously not being safe to the pt at all! I would continue to tell the agency what's going on until something changes. Make sure you document how the pt was found at the start of shift and what the off going shift reported to you. Man, some people do not need to be in PDN!

[tots24]

Yikes! I'd go crazy! Do you have a case manager you could talk to? I'm just curious, you said one nurse was let go for being incompetent...how much worse was she than this person? It sounds like she's being not only unprofessional and rude, but also unsafe (med errors, trach ties too loose, tangled lines, etc).

And bravo to her for not sleeping during her shift; what a champion

[SDALPN]

Yep, the incompetent nurse was that much worse. Amazing, huh? That nurse documented a blood pressure without a blood pressure cuff. Then went 4 hours without charting. And spilled formula in front of the parent and failed to clean it up or offer to help and watched while the parent cleaned it up. She kept going out a door nobody uses to smoke and the family didn't want that door used and didn't want nurses smoking at work. She documented things that contradicted each other. Like "lungs clear. Rhonchi, rales, and wheezing heard." So yep, it really can get worse. Oh yeah and she left me with a diaper that hadn't been changed all shift after bragging about letting CNAs go at her other job for the same thing.

[ventmommy]

Why isn't the parent just getting rid of her? Does the parent know these things have occurred? I would imagine that the nursing supervisor has an obligation to tell the parent about the med error. Also, isn't the parent going to know that supplies are missing? If insurance won't cover their replacement, it's coming out of the parent's pocket.

This nurse would not have gotten away with this behavior in my house more than once. My kid, my way. "Too hard" doesn't cut it with me. Find a different line of work.

[SDALPN]

The parent is new to how the supplies work. It will take time for them to understand how things work. The mom isn't the brightest bulb.

[LPN4life2004]

I've had the same thing happen, all I could do was report errors to my sup. CYA and document everything at beginning of shift that is going on. Fix what you have to. And pray nothing happens to the patient. Eventually either other nurses will talk to the sup and she'll realize it is a big problem or mom will figure it out and get rid of her. Have you ever tried ( kindly if course ) to try and help educate the nurse on things? The big one I had a problem with wouldn't listen. But it's worth a try.

[SinikRN101]

Coming from personal experience if the supervisor doesn't catch these things obviously they don't care. You telling/informing them isn't going to make one bit of difference until it comes time for state inspection. At least that was my experience, I could talk until I was blue in the face and all it did was make it seem like I was the problem. Luckily I didn't have anything that was dangerous, only completely annoying.