Lack of nursing "common sense"?

[joanna73, BSN, RN]

Ok first off, I would like to mention that I am a new grad, with A LOT to learn. Secondly, I am not in the habit of policing or judging or reporting any other nurses. And of course, we all have off days.

However, after working with this person for 3 consecutive days recently, I have to wonder. She is also a recent grad, but she has several years experience (IEN), and she has been working at this facility longer than me. Well, several instances just made me shake my head. When I attempted to nicely explain the rationale, this coworker just argued. So, in the end, I mentioned a couple of things to one of the senior nurses, because our supervisor is away.

For example:

Allowing a family member to feed her mother cake. This pt has been on only IV fluids and thickened juices for over a month. She barely tolerates the thickened fluids. When I mentioned this to my coworker, she stared at me blankly.

Arguing that the IV tubing does not have to be replaced every 72 to 96 hours as per protocol, even after I explained the basics of infection control.

Failing to do a pain assessment in a 12 hour shift with a 91 year old pt. Dx: dementia and recent stroke. Because the pt did not ask or say anything about pain. It's our job as the nurse to be proactive with our pts.

Forgetting to sign meds. Yes, I have done this also. We all do. But I'm talking MAJOR holes. Not just a few.

Leaving a dressing in place for 3 days because it looked intact. However, we have all been instructed to assess the skin every 2 days at least.

....Among several others. Now again, I am by no means perfect and we all get busy. However, in my opinion, these things are part of basic nursing. When we were discussing the care, this coworker looked at me like she had no idea. And in the end, I ran around the three nights fixing and following up on all her stuff.

Frustrating! And mind boggling, given that she has experience.

[ceridwyn]

I feel your pain and been there.....I tried to discuss the problems (as I do with any nurse, from any country, including my own)...she could not see what the problems were, tried to explain that there may be differences in culture and gave her my support if she needed any help, but she told me I was being racist.....I just did not want patients' to suffer anymore and did not want to keep taking the blame for dressings not being done and pain relief not being given, anymore when we were rostered on together.

This went on for 2 YEARS (I transferred out within weeks of first incident) until there was enough complaint forms filled out from doctors, patients, incident forms by fellow nurses, patients relatives until there was enough evidence before they terminated her employment and reported to the nurses board.

[RGN1]

There is no excuse for bad nursing, period, be you a new grad or not.

It's very hard to follow a nurse like that and I can probably, safely say that we've all been there! There is no easy fix either - we can all shout report her but how many of us, hand on heart, have done that when we really should have. It's the culture of blaming the messenger instead of listening to the message.

I think that if her care has put pt safety at risk you need to take it higher, otherwise just speak to her, no matter how blankly she may look at you it may well be sinking in at least a little bit.

Even better - do you have a clinical nurse educator you can speak to? I found ours invaluable in a similar case, as she approached it form a learning perspective rather than seeming to be management responding to a tattle tale (which is NOT what it is but is what our society often chooses to think of it as)

I hope you get it resolved both for yours and your patients sakes!

[joanna73, BSN, RN]

Thanks for your support. The thing is, I work in LTC, and the one RN on duty is the charge. So it's almost dangerous to have a careless person working alone like this on a shift. At least on a unit, you have other nurses around for support. And these three shifts...well, this was not the first instance of this nurse's substandard care.

The problem is, when the next nurse comes on shift after someone like this, you're basically playing catch up and putting out fires. Ultimately, the patients suffer. And when I tried to talk with this person and explain the rationales, she was oblivious. I don't get it. As the caregiver, we're supposed to monitor our pts and take initiative. When I spoke with the senior nurse about some of these things, she said, "yes, we have concerns."

Oh...and failing to chart. Me having to explain that documentation is a legal responsibility. Geeze! I'm thinking, "where did you go to school?" These are basic principles. Fortunately for everyone, she doesn't have many shifts.

[joanna73, BSN, RN]

We don't have a nurse educator. I have another shift with this person in 2 weeks. If I notice the same patterns, then I will document and bring my concerns to the head nurse.