Sleepy Coworker... Patient Incident!

[All4NursingRN]

I work in a 10 bed mixed pretty much low acuity surgical stepdown/ SICU. My charge nurse at night who has been there for 30 years is literally no good for her self after about 11pm. After that point she's sitting at the nurses station fighting sleep with her head bobbing up and down and right in front of the telemetry monitor as that we have no Tele tech. I've noticed this for a long time, she's even fallen asleep standing in front of the computer on wheels while giving meds. Even for a nurse with her amount of experience her time management skills seem to be lacking. She routinely is still passing meds nearly 1 1/2 hours after their due time and leaves late every morning up to 3 hours post shift even when most times patient acuity is low and the unit has been quiet.

Well recently there was an incident with my patient. I had a stable 40 year old woman post head injury with a sub dural hematoma. At the time census/acuity was low, about 3 stepdown/med surgish patients so it was just me, my charge, and the PCA on the floor. I insist she goes on break first (which I usually do because like I said she starts falling asleep at the station) and when she comes back I'll go and the PCA will go in between to ensure 2 staff members are on the unit most of the time. So she comes back from break and I say I'll wait until the PCA comes back before I go but she insists that I go. Knowing how easily she falls asleep I just hang around, because earlier on my patient tried to get out of bed calling out for the nurse to use the bathroom and I ran to the room just in time before she got OOB.

My charge sees me hanging around and says" just go the PCA will be back soon". I give her thorough report and tell her please watch my patient she is a subdural, is a chronic alcoholic and is mostly calm, but is impulsive when she wants to use the bathroom. We have cameras in each patient room, so I turn the channel to my patient and tell her to please watch it. 45 min later she is knocking on the lounge door, needing my help because apparently the PCA over stayed his break, wasn't on the floor. I come out and she tells me my patient tried to get OOB and is on the floor. She is practically berating my patient saying that she didn't call and now she has to write an incident report.

The thing is I'm inclined to believe the patient was indeed calling for the nurse as I instructed her to do and when noone came she tried to get OOB, my charge probably fell asleep again in front of the Tele monitor and the camera and didn't hear the patient calling or see her getting OOB and woke up when she heard the thud! When she hit the ground. I was so peeved, this woman was a bleed of all patients to fall!

Her tiredness at work needs to be addressed but how? I've noticed this since I came to this unit, I almost think she has a sleep disorder or is on something. One time she drove me home and she was so sleepy I prayed I'd get home safe.

[jennylee321]

I mean you can't report her for what you suspect happened when you were off the floor because it's just a guess. However you definitely need to report the chronic issues she is having with nodding off and explain to your manager that you don't feel safe leaving her on the floor alone.

[heron, ASN, RN]

Have you talked to her about it?

I have a similar ongoing issue with a co-worker. We are able to talk about it quite frankly and come up with strategies to help him stay alert. He is fully aware that if I find him sleeping, he will be reported and likely terminated, but I'm on his side and willing to help avoid that if I can. So far it works.

[SmilingBluEyes]

So, you're going on what "probably" happened? How about your talk to the nurse about what "REALLY" happened first before you go reporting her for falling asleep. The issue about her nodding off needs to be addressed, yes. But you don't know what really happened in this case. Don't report what "may have happened"; report what you actually have SEEN.