Dangerous nurse on floor

[rn undisclosed name]

I work on a busy unit with a decent nurse to patient ratio. I work oncology/tele and generally have 3-4 patients. If you haven't worked oncology, these patients are some of the sickest patients I have ever dealt with and can turn on you in the blink of an eye. It is very rare to have 5 patients (happens maybe once every 3 months). We have a nurse who has been a nurse longer than me (I have been doing it 2.5 years) and recently started at our hospital. Several staff have expressed concern and we really hope she doesn't end up killing someone. I am really scared for the patients. While I hate for someone to lose their job she is just really unsafe. I think this just may not be the area for her. While she was on orientation many things were said to our manager and all she says is I know but she let her go off of orientation to be on her own and didn't do anything. I precepted her a couple of times and would just make a list of things for her that she needed to work on. She gets the easiest assignments and still complains it is too hard.

In a situation like this, what would you do? I try to help her out as much as I can but I have my own patients and if I don't get out on time at the end of my shift I get in trouble. I do get tired of always complaining to my manager but I feel like she could care less about her department or her employees. She hardly ever talks to any of us.

[litbitblack, ASN, RN]

I was in this situation as a charge nurse. the lvn consistently couldnt handle her assignment and i spent the majority of my time with her. I ended up missing stuff either becasue i was involved with her or missing her pts stuff becasue she couldnt handle it. She never informed me of new orders, granted I looked all the time, communication with her was always botched as she was behind. One time she was so overwhelmed with a transfer TURP that was clotting that even after education on how to take care of it she still freaked and recieved a new admit who she didn't see for an hour and a half. The nurse manager charged that nite and ended up having four blood transfusions on the whole floor. I finally went to the manager and said look, I can't handle this anymore something has to be done or I have to leave, i feel like my license is on the line. She was sent to admin review soon after. And I believe she was the reason I was terminated. If you can't do your job becasue someone is using up your resources then its time to take it to the next level. Get with the other nurses. Take a list of certain incidents that concern you guys. If nothing gets done by the manager take it to the next level until something is done.

[VORB]

Know that anything you do will create waves. And when it comes to dept mgrs and nursing administration, we are talking politics... big time. Tick off the wrong person and you will lose your job before the 'dangerous' nurse will, with nary a reason. [if you ask the nurses at my hospital who the worst dept mgr is, they will all answer the same; if you ask administration who the best dept mgr is, they will single out the same mgr in their answer.]

So the real question, assuming she IS a danger to patients, is whether it is worth possibly losing your own job (or puting you in an even more uncomfortable work environment) by taking the high road and proceeding with this situation. You cannot ignore the politics of healthcare. There is honor in being a whistleblower -- especially if it saves a life -- but only you can answer how you should proceed in this matter.

Needless to say, if you do proceed, put it in writing and try to get at least one other nurse familiar with the situation to sign it with you and make copies.

[Rabid Response]

You have not detailed any examples of how this nurse is unsafe. If she is merely slow and falls behind, then maybe there is hope for her. You could have your manager meet with her and try to pinpoint what aspects of her job are giving her the most trouble and how she might work on improving. Maybe she is overwhelmed and needs focus.

If that is not the case and you truly believe that she is "unsafe," then you need to document the behavior that is leading you to conclude this about her. I'm sure your hospital has some kind of responsible reporting forms for this. In order for your charge of "unsafe" to hold up with management you need to be able to point to a series of documented incidents as proof. Otherwise, it may look to them as if you simply don't like this other nurse, and they may not have sufficient grounds to take action.

I hope that you can work this out somehow as I know how it feels to work with someone in whom you have no confidence. Nursing is challenging even with dependable, competent co-workers.

[seasonednrs123]

I recently went through a similar situation and it also cost me my job. The "dangerous nurse" for me was a new graduate and she was older, close to 50 like me. I had problems with her when I precepted her, she acted like she didn't know anything about patient care at all, and would thus slow down the rest of the staff with her insane questions like I'm not sure how to flush this IV, I need you to go with me. I know I am good nurse, but when the truth is no longer the truth, and bad nursing care is acceptable, it is just better to move on. I still am looking for work, and this site is helping me keep my perspective that not all health care facilities are run the same. ANd there are good nurses in this worlk, thank God. God Bless and good luck, I don't know if this will help or not.

[gonzo1, ASN, RN]

Tragically nursing has come to the point where we have to choose between protecting our jobs by keeping our mouths shut, or risk losing our jobs by speaking up about unsafe things (doctors, nurses, practices).

Hospitals talk endlessly about safety and speaking up, numerous forms to fill out etc, but when push comes to shove they really don't mean it or want to hear it.

[RN1982]

If you follow her and you pick up mistakes that she had made, document them in an incident report, make a copy and turn in the incident report. At least there will be documentation.

[listry]

as others have mentioned, the key is documentation of unsafe practices you have noted and documentation of having eported these to the appropriate persom, presumably an incident or hazard form.

To quote you: "Several staff have expressed concern and we really hope she doesn't end up killing someone" You must discuss this with your peers and, together, decide upon a plan of action, as should she harm a patient and you are aware of her shortcomings and found not to have acted on your concerns, they (management) will get you that way. Can your union help?