Discipline Question, Help Please

Ok, so think about if this nurse is experienced or not. If this is a brand new grad, there may be a chance to resolve this. Additionally, if this is an experienced nurse, change some habits.

I would think about a written warning for both incidents, with some goal oriented, timelined improvements. And one of the improvements could be an inservice on the basics of patient identification. It is a lesson that lots of nurses need to hear--as a lot of us get very lax in checking the identification rights of the patients. Also to be sure that each patient has a ID band, that doesn't get cut off until they are out of the facility.

For this instance, I would also have this nurse check in with the charge nurse with all of the discharge paper work, and is observed as they are discharging the patient and making sure all is correct. I would also make sure that same nurse is scanning meds and arm bands as they are dispensing meds, just to be sure of accuracy. I would also think that a spot check that the nurse is actually ID'ing each patient during the course of the day would also be helpful. And in an inservice, I would teach all nurses that they need to vocally identify patients, DOB, make sure they have the right chart up, the whole 9. As joint commission has made this a goal for some time, so getting back into the habit is not a bad thing.

You are invested in the success of each of your nurses, I am sure. If the nurse in question declines to follow your plan for improvement, you may not have a choice but to let them go. But be sure that you give ample opportunity for re-education.

Good luck and best wishes.

Thank you for the response, I will re-educate as you suggested.

remember this is long term care.

Ok, so think about if this nurse is experienced or not. If this is a brand new grad, there may be a chance to resolve this. Additionally, if this is an experienced nurse, change some habits.

I would think about a written warning for both incidents, with some goal oriented, timelined improvements. And one of the improvements could be an inservice on the basics of patient identification. It is a lesson that lots of nurses need to hear--as a lot of us get very lax in checking the identification rights of the patients. Also to be sure that each patient has a ID band, that doesn't get cut off until they are out of the facility.

For this instance, I would also have this nurse check in with the charge nurse with all of the discharge paper work, and is observed as they are discharging the patient and making sure all is correct. I would also make sure that same nurse is scanning meds and arm bands as they are dispensing meds, just to be sure of accuracy. I would also think that a spot check that the nurse is actually ID'ing each patient during the course of the day would also be helpful. And in an inservice, I would teach all nurses that they need to vocally identify patients, DOB, make sure they have the right chart up, the whole 9. As joint commission has made this a goal for some time, so getting back into the habit is not a bad thing.

You are invested in the success of each of your nurses, I am sure. If the nurse in question declines to follow your plan for improvement, you may not have a choice but to let them go. But be sure that you give ample opportunity for re-education.

Good luck and best wishes.

You are correct, Morte, but most especially in LTC, it is really hard to identify residents. Especially when you have a bucketload of them. And no one/very few wear name bands.....

I wouldn't terminate yet. Is the nurse a newer employee or one who has been there for a while? Does she have any corrective action in her personnel file? I would look at that, and then sit down privately with this nurse to ask why she thinks she is making these mistakes. It could be that she is overwhelmed and rushed, or is distracted by personal issues, etc., which of course is no excuse. However, if it's brought to her attention that these are major concerns, and you are willing to work with her, (if your organization's policy and her employment record allows that), you may gain a loyal employee in the long run.

On the surface, it sounds like she is rushing to finish her work, and needs to use some tools to make her slow down and concentrate on what she is doing. Maybe another nurse could review her discharge process with her and watch for teaching moments to slow down and double-check her work. Also, is the patient's signature required on the discharge forms?

I would at the very least, give a verbal counseling unless she has other corrective action that would force you to move farther ahead in the corrective action process, and in that document let her know that any further violations could lead to termination of employment to make sure she takes it seriously.

I have worked with some nurses who rush through and "call it good". With some, it's just their personality and somebody has had to wave a red flag to say, "No, it's not good enough! Slow down." Good luck!

I would educate the nurse, and put her on probation. Like someone else stated, I would have the Unit Manager or Charge nurse supervise her for about 90 days. During the 90 days, 1-2 weeks should be dedicated to observing her medication administration, making sure she is correctly identifying the residents. Make sure your facility has updated pictures, or whatever your company use to be able to correctly identify the resident. Stress the importance of correct patient identification. After the probation period, if she is still having problems I would then seek further disciplinary actions. Good luck with the situation!