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Ethics question, risky nurse, reckless behavior

Good evening ladies and gentlemen,

I write to you all in hopes of helping my mind and heart some resolution to an aching situation as of late.

Lets say the describing scenario is an isolation hall  of 4-11 acute care patients getting rehab with 2 twelve hour shift nurses.

During shift change a night nurse consistently tells the on coming nurse she has not seen any of the patients, has not gone down the hall, doesn't know much about them due to a very bad received shift report BUT yet assures the on coming nurse they are well and fine because the med aide never came and got her (a med aide covers the hall during the night shift).  The one coming nurse has asked her not to do this because its unsafe and not quality care, the on coming nurse has asked her to learn her patients and shown her where to get the information if she doesn't feel comfortable asking her discharging nurse for said info, the on coming nurse has encouraged her to know her patients for note support sake and fairness and safety to the patient as their right to quality care. Twice she has left without giving report because she thinks its appropriate that the med aide give report to the on coming nurse.

The buildings philosophy is to not awaken a sleeping a patient. The hall assigned is an acute hall no long term residents. Most of them always receiving a PRN of sorts. This nurse even went as far as writing an order for something without permission.

The chain of command has been used; a nurse (LPN) in a mgmt position (staffing), weekend supervisor RN, DON and administrator and they all shrugged the concerns off. This on coming nurse that has heavy concerns has changed to PRN because unsafe care was too daunting. Now they won't even offer this nurse with concerns shifts and are turning other peoples time off requests down saying they don't have help when they know they can call the PRN nurse.

Lastly, the nurse who isn't checking on her patients or even getting vitals for that matter because she delegates those to a CNA got moved into the day spot for the nurse who left due to ethical constraints. Most patients are ortho but usually 50% respiratory requiring an assessment of sorts.

I feel like I need to inform the BON but I am scared to death of retaliation. I was going to contact Corporate since my local chain of command felt there was no issues. I do not know who to go to for support, advice, counsel.  Am I over reacting? Should I just let it go? I know there are bad nurses everywhere even though there shouldnt be. How can nurses professionally get around other nurses who in a sense breach their duty to care? Thank you for any thoughts and insights. 

Edited by dianah
formatting

BSNbeDONE, ASN, BSN, LPN, RN

Specializes in Med/Surg, LTACH, LTC, Home Health.

So basically the nurse comes to work, does nothing, and goes home. As for not giving report, what would she say? She’s already admitted to not laying eyes on the patients...anything else would be a lie. Management doesn’t see a problem with this? This is not a facility I’d want to be associated with.

Start looking for another job. Take care of the patients assigned to your care until another position comes available. When it does, work your notice and turn the page on this nonsense.

Edited by BSNbeDONE

I actually would quit now, before it comes to bite YOU in the butt for knowing this nurse isn't doing her job.   And I would notify the BON.  And Corporate.  And JC. 

1 hour ago, griffeysnurse said:

Good evening ladies and gentlemen,

I write to you all in hopes of helping my mind and heart some resolution to an aching situation as of late.

Lets say the describing scenario is an isolation hall  of 4-11 acute care patients getting rehab with 2 twelve hour shift nurses.

During shift change a night nurse consistently tells the on coming nurse she has not seen any of the patients, has not gone down the hall, doesn't know much about them due to a very bad received shift report BUT yet assures the on coming nurse they are well and fine because the med aide never came and got her (a med aide covers the hall during the night shift).  The one coming nurse has asked her not to do this because its unsafe and not quality care, the on coming nurse has asked her to learn her patients and shown her where to get the information if she doesn't feel comfortable asking her discharging nurse for said info, the on coming nurse has encouraged her to know her patients for note support sake and fairness and safety to the patient as their right to quality care. Twice she has left without giving report because she thinks its appropriate that the med aide give report to the on coming nurse.

The buildings philosophy is to not awaken a sleeping a patient. The hall assigned is an acute hall no long term residents. Most of them always receiving a PRN of sorts. This nurse even went as far as writing an order for something without permission.

The chain of command has been used; a nurse (LPN) in a mgmt position (staffing), weekend supervisor RN, DON and administrator and they all shrugged the concerns off. This on coming nurse that has heavy concerns has changed to PRN because unsafe care was too daunting. Now they won't even offer this nurse with concerns shifts and are turning other peoples time off requests down saying they don't have help when they know they can call the PRN nurse.

Lastly, the nurse who isn't checking on her patients or even getting vitals for that matter because she delegates those to a CNA got moved into the day spot for the nurse who left due to ethical constraints. Most patients are ortho but usually 50% respiratory requiring an assessment of sorts.

I feel like I need to inform the BON but I am scared to death of retaliation. I was going to contact Corporate since my local chain of command felt there was no issues. I do not know who to go to for support, advice, counsel.  Am I over reacting? Should I just let it go? I know there are bad nurses everywhere even though there shouldnt be. How can nurses professionally get around other nurses who in a sense breach their duty to care? Thank you for any thoughts and insights. 

Who are you in these scenarios? If I'm being honest, you sound disgruntled and not entirely credible.

Report what needs to be reported, but make sure that it's true and not the result of some personal feud or never-ending rumor mill. And you should definitely look for a new job. This one is 100% guaranteed not to work out.

Certainly not disgruntled. No rumor mill. No feud. This is a personal experience of mine and I’m trying to sort thru it without being dramatic. I’m trying to be professional while maintaining my morals and commitment to nursing and patient safety. I give 100 to everyone I know and even those who don’t deserve it. I am a push over. So again I’m trying to learn my voice and advocate for what is right is right or what is safe is safe. Hope that makes sense. 

The facility is concerned about profit and nothing else. You have followed the chain of command and will never get this situation to change. Pick your battles, this one is lost. Do not notify corporate.. they are the ones responsible for this.  Get outta dodge ASAP. In the interview, explain it was not a good fit. Future employers already know the reputation of this facility. 

Edited by Been there,done that

This place has made it clear that they don't care about any of this.

You don't need to report anything to the BON, you need to find a place to work where they are interested in providing good patient care.

Don't become part of the drama. Everything you've written out is just drama.

nervousnurse, ASN

Specializes in NICU, Peds, Med-Surg.

On 7/5/2020 at 6:05 PM, griffeysnurse said:

During shift change a night nurse consistently tells the on coming nurse she has not seen any of the patients, has not gone down the hall, doesn't know much about them due to a very bad received shift report BUT yet assures the on coming nurse they are well and fine because the med aide never came and got her (a med aide covers the hall during the night shift

I used to work on a very busy rehab unit like this, and seriously---NOT seeing any of my patients the entire shift is a nightmare I have once in a while.  When I wake up, I'm sooo happy it wasn't real! I have dreams/ nightmares like that about every 6 months or so---but this ACTUALLY happens where you work?    It is horribly shocking that a nurse wouldn't see their patients AT ALL ? ! ? !   Doesn't your unit require head-to-toe assessments at least each shift ( 12 hours), or every 8 hours (that was the rule when I worked med-surg years ago).   

 

I agree with everyone who said you should leave; however, if it were me, I'd feel an ethical responsibility to report to the the BON, too.  I just cannot fathom a nurse who doesn't check their patients AT ALL?  I feel very sorry for those patients !!  Even though I was on a rehab floor (which some think is "easy"---LOL!)  we'd have patients whose recent hip replacement would dislocate, who were "only" on our floor after a total knee, but then had a stroke, etc.  HOW can this person's boss be okay with this?  


Good luck! 

Edited by nervousnurse
forgot to include a detail ; )

You are right for wanting to report the neglect of your facility.  In my experience in LTC, the culture is to “look the other way”.  The nurses there don’t say anything because they count on that same wall of silence if they weren’t able to dot all their “Is” and cross all their “Ts”.  This is how wounds go unreported, and progress to stage IV without anyone ever having seen it, etc.  It would be in the best interest of your license to leave ASAP, and to not tell anyone you’re leaving who doesn’t need to know, and avoid saying anything negative.  Then, contact the BON and request to remain anonymous.  There is absolutely no hope for this facility if nurse leadership is unconcerned. 

TriciaJ, RN

Specializes in Psych, Corrections, Med-Surg, Ambulatory.

I second the advice to find a new job.  I don't think I could just walk away without at least trying to do the right thing, however.  I would anonymously call the BON and any accrediting body on my way out the door.

Time to move on.  Good luck.

canoehead, BSN, RN

Specializes in ER.

Email the manager with your concerns, be very objective and specific, with dates. Tell him/her how you responded ("I went down the hall and did and immediate visual check on everyone")so they have the opportunity to correct your response. Then they can't come back and say you should have done something different. Make sure you say this has happened repeatedly, and you will leave it with them, but you are available if they need more information.

So now you have covered yourself. If anyone says you caused an unsafe situation or didn't respond to it appropriately you can pull out that email. It's an unsafe situation, but not one you caused, and you handled it as best you could.

Unfortunately, I bet there's more going on, and you won't want to stay there. Get another job, but don't give up this one until you are ready. You don't need to panic about someone going after your license though, because this is not your fault.

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