Concerns about a nurse

Triddin · Jun 12, 2018

I would probably discuss your concerns with her first, but that's me personally. Could you go higher than the manager in the system. Worst case scenario, you could create a detailed list (and ensure you have coworkers/ patients to corroborate your story, and submit it to your licensing body

TriciaJ, RN · Jun 12, 2018

How do you know she gave the wrong Coumadin dose? Because of the way she documented it, right? Then it's not her word against yours. And it requires a call to the doctor and an incident report, just like any other time a medication error is discovered. Don't let it be between you and management. Any time an error occurs there is a protocol to be followed, usually an incident report and a call to the doctor.

When doing your own charting be careful not to throw this nurse under the bus. Just chart your observations and assessments objectively and let the findings speak for themselves. If you start finding yourself with a target on your back, you'll want to start looking for the exits. It's too bad, but this is what happens when management gets too desperate for a warm body. They end up running off their conscientious staff until they're down to barely-warm bodies.

Platypus · Jun 12, 2018

Sigh - just wrote a long post and it never went through. I know about the coumadin issue because I work with this patient 5 of the 7 days every week and was off 2 days and knew exactly how much she gets ( 2- 4 mg tabs) and how much was left before I was off for 2 days (3 -4mg tabs). This Pts INR is usually 2.2 and 2.3. That Thursday, when I returned, it was 1.6 and there was 1-4mg tab left. The nurse in question was on the cart both days.

I have talked to the nurse, suggesting night shift is a slower pace and might help her learn the computer system and how to enter orders better as there are less distractions. She wasn't interested in working night shift. I also suggested that she might want to take notes that she can refer back to if she is stuck on what to do, like for admissions or putting in orders. She didn't feel the need for that either.

caliotter3 · Jun 12, 2018

You are trying to help her with practical suggestions and she won't take the hints. Document carefully and be vigilant around her without letting it look like you are out to get her. You never know what is her real ace in the hole.

allnurses Guide · Jun 12, 2018

I feel my patients lives are in danger due to this nurse's incompetence.

Going out on a limb here but since you say she is an "older" nurse have you considered that the behaviors you are witnessing may be signs of a cognative impairment or even early dementia which would be a different scenario than just plain incompetance.

Still if whatever is going on is putting patients at risk and your administration is doing nothing then you must report her to the BON. Then your conscience will be clear and you will know you have done all you can.

HPPY

Long Term Care Columnist / Guide · Jun 13, 2018

I'm not old (yet), but I had to leave nursing because of cognitive issues that stem from certain medications I take for a medical condition that affects my brain. I'm glad I realized how bad it was getting before I did something awful or forgot a crucial med or treatment. It's a shame this nurse isn't taking the hint, and that administration doesn't seem to be taking your concerns seriously. All you can do at this point is document what you observe, and if necessary escalate it up the chain of command, which may include the BON. I wish you well...sure wouldn't want to be in your place.

TriciaJ, RN · Jun 13, 2018

I once worked with a cognitively impaired nurse. She had no short term memory and wouldn't write anything down. I think she was also lazy, in addition to her impairment. Following her on the next shift was a nightmare. So much time had to be spent cleaning up her mess. Concerns raised with the manager were blown off. Then a union rep tried to raise our concerns with management and was given a song and dance about how was she supposed to know there was a problem when no one told her?

The problem went unabated until a death occurred that she could have prevented. She was given the opportunity to intervene in a situation and kissed it off to the next shift. It was too late by then. I don't know what happened behind closed doors, but she finally resigned. Very sad that it took a death for her to get sent on her way.

This is why the OP needs to document meticulously; you don't want the blame for this person's ineptitude.

caliotter3 · Jun 13, 2018

I once worked with a nurse who was quite a problem in more ways than one. She bragged about her personal relationship with the DON, probably preventing many complaints. I once walked in where the nurse supervisor told me she had quite a time trying to figure out the mess on the problem nurse's med cart. She abruptly left the facility after an "emergency" call, leaving poured meds, doses all over the cart, the med sheets unsigned, and telling no one what was up. Her 'friend', the DON, got rid of her after one of her med errors concocted for another nurse, caused the death of the resident. It is very sad that sometimes it takes an unnecessary patient death for management to do what needs to be done.

Have Nurse, ADN, RN · Jun 26, 2018

I helped to orient a nurse at my facility. She is an older nurse that had many years of experience, but had been out of floor nursing for several years. I was looking forward to working with her because I thought I could learn a lot from her. However, after orienting her for several weeks, it became apparent there were some issues. She was forgetful, did not pay attention to details and often either didn't listen well, was forgetful and/or just didn't understand or "get" what she was being told about the way things needed to be done. I found myself having to repeat the same things to her over and over. I was not the only one with concerns and she stayed on orientation for nearly 3 months. I wrote a lengthy note to HR about my concerns. The nurse said she hated the job and put in her 2 weeks and quit for what she thought was a better job. 2 weeks later she was back and said the other job had one nurse to 40 patients. Our unit might have 1 to 15 ratio, but it is hard work with the acuity of the patients.
Apparently the note I wrote was either ignored or forgotten about. She is off orientation and I have heard that patients have complained about her and do not want her providing care. Recently, I worked after her after my being off for 2 days and saw that the incorrect coumadin dose had been given to a pt for 2 days. I told the unit manager and she said there was no proof other than my word. There have been some more serious issues which have come up and I don't want to detail here in the event someone recognizes the issues. I feel my patients lives are in danger due to this nurse's incompetence. I have made my concerns known to administration and they have seemingly brushed it under the rug. I truly feel they are more concerned with having a warm body with RN than having someone who knows what they are doing. Anyone else see this going on or have any advise?

Yes. It's called the State Board of Nursing. If a nurse is putting a patient in danger and nothing is being done, and you are aware of it, you are REQUIRED to report her. They likely would do their own investigation and you can remain confidential.

psu_213, BSN, RN · Jun 26, 2018

Regarding the Coumadin dose--tread carefully. As other's suggested, she may have an "in" with the DON, so it may be too late to put in an incident report without it seeming like, at least in the DON's view, that you are torpedoing this other nurse.

In the future, write a judgment free, 100% factual incident report: "Pt should had X number of Coumadin tablets remaining had Y remaining. Pt states 'I was given 2 mg last night instead of 4 mg.'" Same thing you would write for any other discovered med error. Be prepared that even this might not work, but it seems like going directly to your supervisor isn't get anywhere either.