I think I have an ethical dilemma here... - page 2

We have a situation at my hospital that someone MUST do something about and no one seems willing to tackle. Help! Laura... Read More

    And just whose cousin is this person.....
    What sentinal event do they want? They have already had one isnt that One too many???
    She doesnt even quailify as a warm body in my opinion.
    Document it all and Personally I would have had the DrX write her up because its apparent she didnt notify him as well and if they wont take advise from the charging nurse They will from the Dr, because its his patient that she put in jepordy.
    I would however have a heart to heart with the floor manager and explain the situation again and I would request a peer review on this person .. She isnt worthy of patient care in my opinion and if she thinks RN is anybetter she needs to have a Come to Jesus Meeting, because it is more than she apparently wishes to work for. I would write her up on any and everything she does even leaving the floor for smoke breaks , I am a smoker and I can tell you , Yes we get breaks but patient care comes first or it has always with me.... If she hasnt passed her patients off to another nurse you can get her for patient abandoment... If the other nurses on the floor feel as you do it wont be any problem to have a nurse refuse to care for her patients unless its for a 15 minute break or a lunch break , maybe then she will begin to realize what patient care and responsiblity is about. As far as the phone, if push comes to shove hang up her calls , Rule of thumb, Personal time is to be handled on personal time, not hospital time.... yes there are incidences that you can and will adjust for but other than that you can be a stiff one on that issue .... and the hosptial will stand behind you on that matter
    Good luck to you
    Man Im glad Im off the floor..... she would be a causality
  2. by   Jenny P
    I totally agree with Zumalong here; if your administration isn't listening, go to the Board of Nursing; being sure you DOCUMENT everything objectively and factually.

    Has Risk management been involved with this? I can't understand why they are turning a blind eye to this situation.
  3. by   DJrn
    I agree with everything everyone says about documentation. Don't let anything slide. I would also look into if LPNs can give blood in your state. In my state, they cannot. She may have functioned outside of her scope of practice and if so, could lose her license because of that. You can always report her to the state board if you are not getting results elsewhere.
  4. by   Sodie
    I would also document when I spoke with management about her including who was present. It would be better if a few of you go together to management. Then there will be more witnesses that were present in the meeting. If necessary set up a meeting ahead of time with your manager and director, etc. I would also include the Risk manager as others have suggested. Take minutes of the meeting. I would definately get all my facts together and documented (keeping copies) because if this nurse kills someone and it is uncovered that her coworkers knew she was giving poor care, it could get nasty for all employees !!!

    Good Luck !!
  5. by   Youda
    I would think that a complaint to the BON is a good idea. The only problem I see in that route is that many BON's are so overloaded with complaints that it could take months and months and months before the BON could do anything to relieve your current problem. So, I have to agree with Russell. Refuse to take the keys. She isn't worth your license.
  6. by   Cathy Wilson, RN
    what everyone else said is good. however: my concern is for the patient who needed the ffp and prc's. i truly am not trying to be mean or inflammatory here, but why did you, as the charge nurse, not get right on the blood draw, the type and cross, and go ahead and give the aquamephyton? the patient is the primary concern here, and the nurse is of secondary concern. yes something should be done about her, and now. however, the patient needed help stat! why did the patient have to wait for night shift to give the aquamephyton? i'd have trotted myself down to lab to get the stuff, if you don't keep it on the floor, drawn it up, and given it. obviously, this pt. had a "leak" somewhere that the doc was trying to slow with the vitamin k. the sooner they were injected, the better. i'd have drawn the blood myself, and made sure that the lab knew it was a hyperstat order, so the blood could be hung, as quickly as they could match it.
    i understand you, and the other nurses, not wanting to do the work for this woman, but patient care comes first.
    also, this woman might well have a mental disorder known to administration, and they may be trying to accomodate her under ada. changing clothes in the middle of the nurse's station is not normal, under any circumstances! substance abuse may be another problem. bang the drums loudly enough to be heard to the state bon, if thazt is necessary (as others have said). you and the others may get writers' cramp before the situation is rectified, but it will be worth it.

    one other thing: be sure that the ward secretary knows that a blood or blood-product order and labs are to be given highest priority, even if it means taking the chart to the charge nurse to be sure that the orders are carried out, in a timely fashion. also, make sure that she understands that stat meds are just that, and need the same kind of attention. leaving such orders to be carried out by another person or shift is indefensible!
    Last edit by Cathy Wilson, RN on Aug 21, '02
  7. by   caliotter3
    Question for CW, RN. I am "relatively" new to nrsg, w/limited experiences. Wonder can there be a prob w/taking over a situation (another nurse's pt)? I would have hesitated, in the absence of a supvr to ask first. You can really tell that I've been around long enough to get paranoid about stuff. But I do agree that the pt's need should have been addressed a lot earlier. Even if I would not have taken charge of doing what needed to be done, it seems to me that I would have been trying to get some help from someone.
  8. by   Cathy Wilson, RN
    caliotter3, you are absolutely right! First, if you were aware of the stat orders, and felt that your charge person wasn't, I would've talked to him/her first. If they were covered up, or seemed uninterested, I would've called the house supervisor. I seriously doubt that you would've needed to make any more calls!

    No, I would never just take over the care of another nurse's patient, unless I was the charge nurse, or unless it was an emergency and none of the other a"chain of command" stuff worked.

    You keep right on asking quetions, caliotter3! That is how we learn!
  9. by   caliotter3
    Thanks for the info! I find it so much easier to get good info on this board. Lots of times, in my first jobs, it was like pulling teeth to get info from co-workers. You would have thought they were guarding classified secrets instead of orienting a newbie! Also we don't have to worry about getting embarassed. Again, thanks!
  10. by   Anaclaire
    Document, document, document. Just the facts... no emotions. Include dates, times, people present, patients involved. Stamp your documentation with the patients stamp plate or place a patient sticker on the documentation when patient care is involved. Fill out "Incident Reports" when a patient is involved and send it to Risk Management. Make copies of everything you document and keep it forever... you never know when you may be called to defend yourself in court. Also, you may consider keeping a personal journal at home of your experiences.

    Take your documentation to your floor supervisor. Tell her/him that if they feel there is nothing they can do that you will have no choice other than to contact their supervisor/director. Go up the channels one at a time!!! I've seen nurses get in trouble for not following the chain of command!!! Even when you are correct, hospitals insist you follow their rules.

    Take it all the way to the Director of Nursing Administration and then the Hospital Administrator. Administration listens when Risk Management speaks to them about a situation.

    Then, contact the State Board of Nursing.

    God bless you all!!! Been there and it's a nightmare!!!
    Last edit by Anaclaire on Aug 22, '02
  11. by   LauraRN0501
    Thanks to all of you for your advise. I did actually round up a group of us to go to management together. When I went to the asst manager to request a meeting, we talked and she said she would get in touch with our DON (or whatever they are called now) and let us know when we could see her. As I was leaving the office, the Risk Manager walked in. The next time I saw the A.N. she said Risk Management was there ABOUT THE SAME NURSE, with all the pink sheets in hand and wanted to know what was going to be done about this nurse!!! We never did get to have the meeting as this nurse was called in right then. I'm not sure what happened, but they were in there for a while then she left in a bit of a huff. We shall see. I am going to make sure everyone documents everything here on in, well I will encourage them to, and if I feel things have not changed I will call the integrity hotline the hospital has and then the BON. Hopefully this has has been taken care of.

    And to whomever asked about why I did not see that it got done sooner: when I was noting off the order, I did get the draw done immediately. I don't feel too terrible about that as I had only been charge since 3pm. As for the Vit K, you got me on that one. I should have done it myself, but she said she was going to do it and we were extremely busy and I had my own patients to care for. No excuse, but that's what happened. I think the main problem there was that I'm still a new nurse (1 year) and I've only been charge once before and was just thrown to the wolves. But that's another story.

    Thanks again for everyone's help. I will keep you all informed as to what happens.

  12. by   imenid37
    i think you are right to stick together. unless you document and really turn up the pressuere on management, you won't get anywhere.personally, i think you owe it the public to report this chick to the board of nursing. i once worked w/ a nursing asst. who pinched and slapped one of the nurses (rn). now this rn was young and a bit of a "snot", i will freely admit. however, no one ever should be px'ly threatened or assaulted at work. how many pt's. are real jerks? you just have to handle it . oh well, management slapped this na on the wrist and then hired her as an rn several months later when she graduated from school. after that, the slapped nurse went to another unit. sad, but true!
  13. by   renerian
    Here is my two cents. Follow your chain of command as high up as you need to go. You always have the option if you witness something negligent or unsafe to report her to the board. Be prepared though for a possible backlash......not supposed to happen but it does. What is your discipline policy? If none of this works transfer to another floor.......or get her to. Hard call

    Usually ethics committee cover things not covered by P & P ie)disciplinary measures should be handled by a P & P.

    Does that help at all?