What punishment should this nurse get?

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  1. Should THIS nurse be fired from her job

    • 24
      Yes, this nurse should be fired...no matter how excellent.
    • 372
      No, this nurse should NOT be fired, it happens...even to excellent nurses.

396 members have participated

Had an interesting situation that came up and thought I'd throw it out for discussion.

One of our staff RNs was found sitting in a chair and sleeping at the bedside of one of our ventilator patients at 7am. She tells me that the patient was very restless and they had been constantly watching him throughout the night shift because of the fear of him pulling his trach out. They found he would settle down when someone sat with him and held his hand (how basic can nursing care get?). So, periodically during the night different staff members sat at his bedside. The nurse in question says that at 5am she had caught up on all her charting and told her co-workers that she was going to sit down in the room with the patient. She sat down, took his hand and he immediately quieted down. She sat back and the next thing she knew someone was waking her and telling her it was 7am. She jumped up and worked on giving her 6am meds and ended up giving an oral report to the oncoming shift (we tape report).

A very serious decision has to be made here. This is a really excellent nurse and I'm afraid there will be no choice but to fire her and report her to the Board of Nursing. I understand that she did not intend to fall asleep and that she was helping the patient, but rules are rules, aren't they? How I wish this hadn't been reported. Our facility rules clearly state "no sleeping on the job". Our Human Resources Office and the Director of Nursing will make the final decision. What do you all think?

Specializes in Critical Care, ER.

Well, anyway, my vote is for supportive talk with handholding and maybe verbal warning. I have a real hard time beleiving anyone that says that they haven't made a single error unless they have a limited set of responsibilities to perform over a short period of time...

Specializes in Critical Care, ER.
Actually I would feel that I was glad the nurse was in the room whether she was asleep or awake. I have been in the horrible position of having my mother trached with ARDS not once, but twice, in the last year. Give me a sleeping nurse next to the bed over one who does not come in the room for hours on end! At least the nurse would be close when the vent alarmed!

Lu Ann

RN ADN graduate 11/05 :balloons:

So true. Good point, Lu Ann.

Actually I would feel that I was glad the nurse was in the room whether she was asleep or awake. I have been in the horrible position of having my mother trached with ARDS not once, but twice, in the last year. Give me a sleeping nurse next to the bed over one who does not come in the room for hours on end! At least the nurse would be close when the vent alarmed!

Lu Ann

RN ADN graduate 11/05 :balloons:

Count me in as agreeing with you too!!:D

steph

Specializes in Cardiac.
I'm sorry but I notice that you are a nursing student.....ummm excuse me, but in no way, shape or form are you qualified as an RN to answer this question. Even if you are a tech, even working nights, in a million years there is no comparison. You just don't have the knowledge or training, yet, to make a decision about a situation you know nothing about. I am not looking to make this a nurse vs tech debate or anything like that. It's just a simple fact. Once you are an RN, and have worked long enough to "get it"....you may understand what I'm talking about. And if you don't and for any others looking to string this (exemplary) nurse up for this minor error, well, that's why, people, that we can't keep qualified people at the bedside. For those of you in nursing long enough, you know what I mean.....:rolleyes:

A housekeeper can tell you that this is wrong, and yes, I do have a qualified opinion. That is just dumb to say. Its pretty typical to say, oh she's just a nursing student, so her opinion is invalid. Whatever you have to tell yourselves, I gues. Hate to say it, but a bum on the street can say that you don't fall asleep at work. Tech or not. If I walked in and found my husband on a vent a the nurse sleeping in the chair, I would have her butt fired so quick her head would spin. I would be taking to the BON that day, and I would sit down with the pres of the hospital-You bet she'd be fired. To say that you MUST be a nurse to have a opinion that matters is absurd. This attitude that I can't possible know what it's like it stupid. If you need to have the proper training then I guess I'll pass. I would assume that with proper training and experience, that I would know this is inappropriate to do at work. I guess I am wrong. I guess in a few years when I change my job then I will think it is ok to take people's lives carelessly are recklessly. Gees, sorry. Next time I'll think twice before I make a comment in this forum. I forgot it was for experienced night nurses only.

A housekeeper can tell you that this is wrong, and yes, I do have a qualified opinion. That is just dumb to say. Its pretty typical to say, oh she's just a nursing student, so her opinion is invalid. Whatever you have to tell yourselves, I gues. Hate to say it, but a bum on the street can say that you don't fall asleep at work. Tech or not. If I walked in and found my husband on a vent a the nurse sleeping in the chair, I would have her butt fired so quick her head would spin. I would be taking to the BON that day, and I would sit down with the pres of the hospital-You bet she'd be fired. To say that you MUST be a nurse to have a opinion that matters is absurd. This attitude that I can't possible know what it's like it stupid. If you need to have the proper training then I guess I'll pass. I would assume that with proper training and experience, that I would know this is inappropriate to do at work. I guess I am wrong. I guess in a few years when I change my job then I will think it is ok to take people's lives carelessly are recklessly. Gees, sorry. Next time I'll think twice before I make a comment in this forum. I forgot it was for experienced night nurses only.

I think what some of us are surpised about is the lack of understanding about errors in nursing and how that is normally handled.

This situation does not warrant immediate firing and a call to the BON.

As a nurse, I know that med errors, lapses in judgment, fatigue, are all things that may happen to human beings at one time or another. Nursing is set up so that those errors can be addressed in a professional and compassionate manner - it happens every day - someone makes a mistake and it is handled, without talking to the BON. Without getting fired.

There are even programs for addicted nurses to get better.

And the fact that you don't seem to be aware of this aspect of nursing is what bothers me and maybe others when you say fire her and call the BON.

Once asleep, she didn't make the choice to sleep for 2 hours. There was a systems error here where the patient needed a sitter and there was no sitter . . . since this happened and was reported to management, hopefully it will be handled and fixed.

steph

Reading this thread reminds me of the saying....."we eat our young".

Specializes in Case Mgmt; Mat/Child, Critical Care.

Thank you for that very compassionate post. Oh, btw, we don't even know that this nurse was sleeping for 2hrs, perhaps it had been 15 min or so...we don't know.....

I think what some of us are surpised about is the lack of understanding about errors in nursing and how that is normally handled.

This situation does not warrant immediate firing and a call to the BON.

As a nurse, I know that med errors, lapses in judgment, fatigue, are all things that may happen to human beings at one time or another. Nursing is set up so that those errors can be addressed in a professional and compassionate manner - it happens every day - someone makes a mistake and it is handled, without talking to the BON. Without getting fired.

There are even programs for addicted nurses to get better.

And the fact that you don't seem to be aware of this aspect of nursing is what bothers me and maybe others when you say fire her and call the BON.

Once asleep, she didn't make the choice to sleep for 2 hours. There was a systems error here where the patient needed a sitter and there was no sitter . . . since this happened and was reported to management, hopefully it will be handled and fixed.

steph

Specializes in Pediatrics; Camp.

WELL SAID!! I would hope that we as a profession could be fair, compassionate, caring, understanding, etc. Let's face it, we're ALL going to make a mistake, some more serious than others, some causing harm, and some luckily not. We are also going to work along nurses who don't give us a good name. This one infraction is much less than an incompentent nurse working shift after shift. Members of my family have also been on the receiving end of nursing, and believe me, there are some really nasty nurses out there. It sounds like this nurse may work with some, because obviously they weren't concerned about her or her patients, or they would have been looking out for her and her patients. Seriously, you know that there was at least one person who was aware of what was going on. Also, where the heck was Respiratory? Don't they have also have a responsibility to check on a vented patient? In my experience, RT makes frequent rounds on vented patients. Anyway, I'm encouraged that I'm not the only one who feels like it is completely unreasonable to even think about FIRING this person. There are other measures, and if a manager has even basic managerial skills, she will explore other options.

If a lawyer found evidence of repeated instances of any kind of unacceptable performance on the part of a nurse that went UNADDRESSED by the hospital, that would surely support a claim of negligence against both the nurse and the hospital.

But no one is suggesting that she should be allowed to continue working without some kind of counseling/remediation/discipline, just as occurs EVERY DAY with other errors in nursing performance. If we fired every nurse the first time s/he made an error that had the potential to jeopardize patient safety, no one would be left!

Why do we allow nurses to continue to practice following med errors, errors in transcribing orders, errors involving patient identification, etc, if we want to hang this person for a first offense despite a long history of providing excellent patient care? Wouldn't it be more prudent to provide counseling and place the employee on probation as we do with so many other situations involving unacceptable performance?

Specializes in Case Mgmt; Mat/Child, Critical Care.
Reading this thread reminds me of the saying....."we eat our young".

Not just our "young" but our aging, our tired, our weak, our stressed, etc etc. Sad isn't it....:crying2:

Reading this thread reminds me of the saying....."we eat our young".

Which direction are you pointing the finger? Seems like all sides have gotten a bit hot. :)

"nurses eating their young" is an old wive's tale anyway . . . we buried it months ago on a thread and just about everyone tossed a shovel of dirt on it.

I think this discussion, while hot, has not been about anyone eating anyone.

Some are just incredulous that this would warrent firing and a call to the BON while other are just incredulous that it wouldn't.

steph

Specializes in Geriatrics/Oncology/Psych/College Health.

Moderator note:

We value ALL opinions at allnurses - I ask everyone to kindly do not attack other posters for having one. Please keep your focus on the post, not the poster.

Specializes in Vents, Telemetry, Home Care, Home infusion.
To All,

I do not believe that as an isolated incident in a dark room at 0500 should result in termination. As anyone who has ever worked the night shift has fought sleep while charting, taping, talking or driving. I have fallen asleep at RR crossings as I just leaned back for a min.!! Only to be rudely awakened by a blowing horn and an Irate driver.:eek: We all need to watch out for each other as help us realize that we are not perfect. A stern warning as we call LEVEL ONE....which means 90 days, no OT,no occurences, no tranfers...then POOF all gone. I do not believe that over one time sleep that the BON would revoke anyone's license unless it was "The Final Straw" with some horrible out come. Have pity...Have mercy!! We all can become sleep deprived. Boston

Lets look at the salient points from OP:

1. Patient was very restless.... constantly watching him throughout the night shift because of the fear of him pulling his trach out....found he would settle down when someone sat with him and held his hand.

2. Periodically during the night different staff members sat at his bedside.

3. Nurse in question says that at 5am she had caught up on all her charting and told her co-workers that she was going to sit down in the room with the patient. She sat down, took his hand and he immediately quieted down

4. She sat back and the next thing she knew someone was waking her and telling her it was 7am.

5. RN was found sitting in a chair and sleeping at the bedside of one of our ventilator patients at 7am. This is a really excellent nurse.

6. Facility rules clearly state "no sleeping on the job."

I've been involved in similar situation on nights caring for restless vent dependent patient, sitting at a bedside + holding hands to calm patient with heavy eyelids...

Working nights on a unit with vents, patients are rarely left alone for two hour intervals---usually someone is in: RT, aide, lab, primary nurse etc., but those golden moments of uninterrupted time do occur.

When faced with exact same situation I looked at INTENT.

1. Was RN deliberately sitting in chair in the room to catch some sleep (wrapped up in blanket hiding behind curtain as I'd seen a fellow nurse do on more than one occasion)? NO

2. Was the RN providing care? YES

By using "therapeutic use of self" she had calmed a restless patient and prevented trach dislogement, thereby maintaining airway.

3. Where her patients truly abandoned? NO. Other staff were on the floor, she informed them of her whereabouts, most likely expecting they would keep an eye on her patients, as she probably did theirs while they sat with this patient.

I've had as many as 6 vented patients by myself on nights as LPN and RN on Resp/Telemetry unit working 12/12. Sometimes you get busy with a critical situation and don't get to fully assess other patients for 2 hour intervals. Staff on floor are always attuned to listen to the vent sound/alarms and glance at hallway tele monitor (old days). Are those patients abandoned cause I didn't see them for two hours: NO. Same applies here.

When we'd have a patient like this or knew other staff had major disaster brewing, I'd usually stick my head in the room every now and again to make sure they weren't drowning. There could be a dozen reasons why other staff didn't come in room: busy with own patients, maybe this RN was patent's primary nurse so no relief expected.

A lot boils down to who found the RN asleep. The one time I found my partner nodded off sitting with patient after several brutal nights, just woke her up eyes closed only few minutes and she was able to spring into action.

Fifth time I had another RN tell me it she was napping as her patients quiet, had refused to assist restarting difficult IV for me (she was unit expert) and I'm tearing my hair out, well that patients chart I needed to review with supervisor just happened to be on the table in our conference room where she was sleeping and the supervisor observed her that way for over 30 min.

RN was contrite over incident.

For this type occurrence, my recommendation is same:

A stern warning as we call LEVEL ONE....which means 90 days, no OT, no occurrences, no transfers...then POOF all gone.

However, I'd keep report in my personal files for 1-2 years, only send to HR if repeat incident.

If other type staff involved that found patient, I'd carefully discuss with them situation, RN apology and that disciplinary action taken. PERIOD---never tell what that action is.

Hopefully this cooling off interval will bring back focus to the case and not posters and my comments provide food for thought.

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