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.

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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 Med-Surg, Geriatric, Behavioral Health.

Let the judgement of the board stand as per NRSKarenRN. The bench rests. Case closed. Appropriate judgement has been rendered.

Further discussion is welcome, but disrespectful arguements (as indicated by Nurse Ratched) that plead little towards the benefit of the thread will close it.

(Need a gavel smiley here)

I think it is sadly unfortunate, let alone in a nursing shortage crisis, that we can not make minor exceptions for our hard-working, often stressed-out, sleep-deprived nurses of this country and bend a rule!! This was a harmless incident that definately needs to be addressed but firing will only put you one more nurse short and she will go off and get another job elsewhere.

On a larger scope, I think it's very important to look at how healthcare facilities can unintentially potentially abuse staff sleep cycles. Some of the thoughts I have 1) did the nurse work safe number of hour shifts that week? 2) Was there mandated overtime that evening 3) Does the nurse rotate day and night schedule bi monthly? 4) Was the nurse working an extra shift or traded with someone else? 5) Is the nurse forced to work night shift at the facility, would she much rather prefer a day shift schedule?

When it comes to falling alseep at the wheel (literally sometimes) I think the main cause is the erradic shifts nurses, especially new or traveling nurses, are often forced to do in order to comply with facility schedules.

I am aware sick people need 24/7 care. I don't have the answers to better scheduling but hopefully with continued studies and new

literature regarding sleep deprivation facilities can begin to take scheduling more seriously.

Specializes in Med-Surg, Geriatric, Behavioral Health.

Thank you, horatschki, for pulling the thread back to topic/issue.

Specializes in RN, BSN, CHDN.

I had a troubled nights sleep over this thread and I am glad things have been addressed, I personnally was very concerned re the attitude towards how mistakes are dealt with and feel reassured that Nurses are not fired for their first offence. I am due to emigrate soon to take up a nursing position in AZ and I had nightmares about being sacked. I am a very experienced RN who has been fortunate enought not to make mistakes that I am aware of, but you can never say never.I am going to work nights so I am hoping this unfortunate incident never happens to me and I shall be consuming Red Bull to attempt to ensure I never close my eyes. I worked nights last week and I felt so sick at 5 am that I walked the floors to ensure I didnt.Once again I am thankful for some sensibility to this thread.

Specializes in Med-Surg, Geriatric, Behavioral Health.

At this present moment, there are "13" pages to this thread. Here is the original post in order to refer back to so folks don't lose sight of the issue. Sometimes, longer threads, such as this one, need the original post thrown back up to help members stay on topic.

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?

As I see it, the nurse is described as "an excellent nurse" who fell asleep...for how long in a two hour period?....very hard to say....but, bet you it was not for 2 hours. It happens! If a single occurrence, is it the end of the world?....NO! I bet if anyone was tired enough, or lets say exhausted enough, from rotating shifts or working stretches, it could happen very easily. Let's not forget this nurse was described as "excellent". Let's not lose sight of that fact. Is this reason for a dismissal? Lord, I hope not. The only error she made was not acknowledging that maybe she was too tired to assume this duty. We all have limitations. She simple underestimated. Again, the question begs "why was this reported" in the first place. Also, a judgement error on the one who did the actual reporting.

Well, for what it's worth, no one has really (except in the first of the thread) mentioned the hospital and BON's policies. There is a similar thread about a nurse sleeping on break and the DON is writing her up. Anway, in NC it is almost always a firing offense to be caught sleeping from the Board's standpoint, and our hospital has a policy of firing those found sleeping on the job. That's it. No questions. The stand is pretty much unambiguous. However ,the other issue is BEING CAUGHT or FOUND sleeping on the job, and then being reported to the BON/Nursing Administration. I would be interested in knowing what actually happened to the nurse in question. And by the way, I also work night shift.

Specializes in ER.

I think a great deal of weight should be put on whether it was a willful act or not. Some workers look constantly for a chance and a place to sleep, or watch TV instead of working- any excuse will do. Others work hard and just get caught in a situation where they didn't get enough rest and are trying to make it through the night safely.

If a nurse has a history of tucking away in a quiet corner to avoid work I think a harsher response is called for.

Specializes in Critical Care, ER.
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

Excellent post, Steph. :)

Specializes in Nephrology, Cardiology, ER, ICU.

I received my Emergency Nursing Journal yesterday in the mail and one of the articles talked about the stress of shift work. I know personally, I worked nights for many years and it was often difficult to get adequate sleep. I was very fortunate that I never fell asleep at work - although I did fall asleep driving home from work one morning and drove off the road (15 miles - rural area). I have found in my life that it is better not to judge others too harshly - you never know when you will need understanding, mercy and compassion.

Hey...I gave up reading a few pages of this discusion. When things are debated so quickly, how about trying the chat room? It is great.

Specializes in Utilization Management.

All I know is, at our facility we've had some discussions almost as heated as this thread became, and the Final Answer is: If this happened to me tonight, I would get canned immediately, no questions asked.

Has nothing to do with whether or not the patient pulled his trach out (although I shudder to think what might've happened if he had....)

Do I think the policy itself is right? Well, yeah, I kinda noticed that the docs have this huge fluffy bedroom all to themselves next to the ER, while nurses are NEVER allowed to catch some sleep on the job. However, docs work more than 12-hour shifts and presumably, that's why nurses became nurses--to have a life outside of work.

So it wouldn't matter. Policy is policy and I don't make policy. If I'm in complete disagreement with a policy, the time to fight it is before, not after, it causes a problem. So I hope those of you who claim that this needs to be taken on a case-by-case basis, or that the policy is too harsh, take it up with management and get the policy changed. It can be done.

Specializes in Clinical Research, Outpt Women's Health.

She wasn't hunkered down in the break room with a blankie for heaven's sake! It was an unusual situation, and I think it is understandable that this could happen. If you have ever worked night shift you understand the 0400 crash that occurs. She was doing a good thing, and unfortunately the room needed to be dark and calm for the patient so it is totally understandable that this could occur. Shame on anyone that would throw away a good nurse over this.

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