Concerned about competency of some coworkers...

[ama3t]

I hope this doesn't come off jerk-ish. I charge on my floor at night about 1/3 of the time. There are a few dayshift nurses that everyone, particularly all the charge nurses, is aware that these nurses make frequent mistakes, laps in assessment, etc.

Every time I make assignments and one of these nurses is working, I give them easier assignments because I don't trust them to handle higher acuity patients, which is obviously not fair to the other nurses. Some of the issues are bad, but don't cause any major harm: not doing dressing changes, meds given late, 1800-1900 meds left for nightshift because she "didn't have time."

But other more serious things have happened too, such as not reporting vital signs to the doctor, etc. This has been brought up to out management and I know they have had a couple meetings with one of the but nothing has changed.

The last night I worked one of my nurses got report from one of them that the patient had been "really sleepy" since afternoon. Upon assessment she was RASS -4! We immediately contacted the doctor of course (she was +2 the previous night) and she barely even opened her eyes as we drew her ABGs. pCO2 came back at 88! So to the MICU she went but all I could think was, how long did this get missed?

I file incident reports when these things happen because my direct supervisor said that was the most effective thing I could do, but I just feel like its not getting taken seriously! Is there anything else I can do? Anyone else deal with this?

[VANurse2010]

I hope this doesn't come off jerk-ish. I charge on my floor at night about 1/3 of the time. There are a few dayshift nurses that everyone, particularly all the charge nurses, is aware that these nurses make frequent mistakes, laps in assessment, etc.

Every time I make assignments and one of these nurses is working, I give them easier assignments because I don't trust them to handle higher acuity patients, which is obviously not fair to the other nurses. Some of the issues are bad, but don't cause any major harm: not doing dressing changes, meds given late, 1800-1900 meds left for nightshift because she "didn't have time."

But other more serious things have happened too, such as not reporting vital signs to the doctor, etc. This has been brought up to out management and I know they have had a couple meetings with one of the but nothing has changed.

The last night I worked one of my nurses got report from one of them that the patient had been "really sleepy" since afternoon. Upon assessment she was RASS -4! We immediately contacted the doctor of course (she was +2 the previous night) and she barely even opened her eyes as we drew her ABGs. pCO2 came back at 88! So to the MICU she went but all I could think was, how long did this get missed?

I file incident reports when these things happen because my direct supervisor said that was the most effective thing I could do, but I just feel like its not getting taken seriously! Is there anything else I can do? Anyone else deal with this?

I don't think you're being a jerk off, but your manager is correct that incident reporting is the way to go.. Unfortunately, it is extremely difficult to build a case to fire someone and a thorough paper trail is often necessary.

I've been known to pass some meds late, but you have to prioritize like with anything else. So your multivitamin scheduled for 0900 was passed at 1100, but you can bet that your transplant meds and IV abx were done on time.