When should negligence be reported?

[pulmlpn822]

I work in a very busy, very fast paced pulmonary office. We have 6 MD's, 1 PA and 1 NP. The MD's and NP do rotations in the hospital so they're not always there but on any given week we have anywhere from 4 - 8 providers seeing anywhere from 20 - 100+ patients per day (just an example, last Wednesday we had 120 pts, 4 nurses and 6 providers...in an 8 hr shift). We have 3 full time LPN's, 1 full time CMA and 1 part time CMA when its busier. The full time CMA we have has been there double the amount of time I've been there (I'll be there two years in February so she's been there roughly four) yet she can't seem to manage the volume of pt flow we have. She can't stay on task, she doesn't get orders submitted in a timely manner, she can't multi-task and she has completely "forgotten" to document things in pts charts or will document in incorrect charts (to the point of not documenting vaccines she's given - I've caught this now twice). My concern is that, because we're in a pulmonary office, we deal with a lot of pts who require O2 and meds to tx disorders like pulmonary hypertension and COPD. Most recently the problem I caught was that a pt was started on PAH meds, given samples in office and told we would submit the paperwork to get her started stat. The paperwork was filled out, signed and placed in the MA's "to be faxed" folder where it sat for two weeks before the pt called to check the status. (Mind you, she is the only one who has a "to be faxed" folder, the rest of us just fax orders as we receive them to avoid a situation like this). I then had to jump through hoops to get the pt her meds as the MA already sent a d/c order for her other PAH meds and because PAH meds are specialty meds, they always require a prior auth. The pt got her meds, was not harmed in the process but very well could have been.

The issue I'm having is that this has been an ongoing issue with this co-worker for over a year now. She "forgets" to do tasks, she is unorganized and loses orders or other things that need to be done, whether immediately or not, she documents samples of meds in the wrong pts charts or neglects to document at all (including vaccines). I started by bringing this to her attention (again, over a year ago) and then had to involve my office manager who then involved our human resources representative. They keep saying "we're giving her 30 days" (to fix her errors) or essentially she'll be terminated however, in the process of all of this over the last year so much of her responsibility has been taken away (because she's just not competent enough to do it) and given to the other nurses. This in turn makes our work load heavier, doesn't allow for the best pt care and could potentially put someone's life at risk.

I'm not trying to cause anyone to lose their job, especially in today's world and this time of year, but something has got to give. My question is: since my office manager and human resources representative have been involved her file of complaints and improper follow through is well over an inch and a half thick. I don't see anything happening to her because now, majority of her responsibilities have been taken (I'm not really sure how you can "mess up" if you have no job duties). I'm not quite certain why my office is holding onto her the way they do or why she has stayed as long as she has but this is causing severe nurse burnout for myself and my other co-workers and the people who suffer the most are our patients. I've done some research and Medical Assistants don't report to the board of nursing but I did find who she reports to. Should I file a grievance? Should I just wait and "trust" HR will do the right thing (even though they've dragged their feet for over a year)? I don't want to find a new job because I really love my office and love what I do but this has absolutely stressed me to the max and I'm so lost.

Please help.

[iluvivt, BSN, RN]

Your employer could be worried about this person filing a wrongful termination lawsuit and want to make certain they have rock solid evidence before they let her go. All you can do at this point is to continue to report to the appropriate person(s) when she fails to perform up to standard. This way you are providing them with further evidence. I personally would ask your office manager and human resources representative what exactly is the hang-up. I did this recently with a coworker that is a troublemaker and poor clinician and I did find out what the hang-up was. They want to build more of a case so legally they are in a better position because they are certain this employee will sue.

[jadelpn, LPN, EMT-B]

Present to the powers that be to stop allowing her to do any patient care at all. Use her specifically for faxing, filing and/or other office work. Cut back hours to part time. Perhaps a few hours in the early a.m. before patients arrive, and evening making sure that everything is where it should be. Suggest hiring a part time LPN.

Yes, it could cause more burnout. But no more than having to be behind her checking her work on top of your own.

What has been the thought process of why she is so unorganized and forgetful when you have pointed it out/corrected her? "We are too busy and I can't handle it?" If so, a way that she can retain her job part time during hours that there's no patients present doing things that have to be done but can't be done easily when there's 100 patients on the books?

She is a huge risk to patient safety.

[pulmlpn822]

Thank you, very much, for your responses. To answer some questions: my previous career (before nursing) was restaurant management so I can understand wanting to cross your t's and dotting your i's when terminating an employee but my office manager has made excuses for her over the last year. She has said, on more than one occasion, "I just have a soft spot (for this nurse) because she was hired when the office was doing really poorly and she helped me fix a lot of things." The problem with this is that this was four years ago. My office manager then said "well I can't write her up for being behind if everyone else is behind also because then I'll have to write everyone up." The problem with this is that we wouldn't be behind if she would have better time management. So now the complaints I've started rewording the complaints I've been submitting to say specifically "this is negligence" rather than "because she's so far behind we had to do this." The nurses in my office are responsible for taking calls and she's been so far behind before that she's left voicemails unanswered for two - three weeks.

The other two LPN's and myself have requested another LPN in the office rather than CMA but the problem is that she will need to either relocate or be terminated first. I've mentioned to my boss suggesting to the CMA to transfer to a smaller, less hectic office because I truly don't believe she means harm but she just can't keep up with the work. Her excuse is usually just simply "I forgot" or "I was going to get to that today." I do know she has a dx of ADD but truth be told she's more unorganized since starting her medications (which have now been "adjusted" several times) than she was before that.

She has basically been put on a "30 day probation" and is going through an "intense re-orientation" but now so many of her responsibilities have been stripped from her that I don't see her even having the opportunity to mess up. We have also discussed changing her main role to trusting pt's as they come in but she never med recs correctly and when she has a pt with elevated vitals she doesn't make the doc aware nor does she re-take or anything. For example, we had a pt whose BP was 250/117 a few weeks ago and sent on her way. The pt then filed a complaint that we're not giving her proper care. So I understand the facility not wanting the employee to sue but wouldn't they not be more concerned about a lawsuit from a pt or even worse, a wrongful death suit?