Nice coworker but I'm concerned

[LibraNurse27, BSN, RN]

Hi all, posting on behalf of myself and my coworkers. We work with a super nice nurse, in her 50s and been a nurse for a while. She's in the float pool but has been working with us more lately. She always helps out when asked with turns, cleaning, etc and is really friendly. But we've been noticing some scaryish stuff. Whoever is resource nurse and offers to help people finds that all her 1000 meds aren't given, and it can be 1200 already. Vitamins I get it, but these are timed meds like antibiotics, cardiac meds, heparin, etc. I also found meds scanned but not given, sitting on the cabinet next to a pt's bed, including Norco and IV valium. Pt was in etoh withdrawal and needed the valium, but it was just sitting there, scanned at 0900 but it was 1100.

I have also seen her do a lot of things without gloves. For example yesterday I started an IV on her pt and the saline lock in the kit was broken, so she held it in place while I got a new one. A little blood came out of the catheter, and she wasn't wearing gloves. Once she also put paper tape on my pt's open wound instead of the ordered dressing, and it took me forever to get it off. It was painful for the pt and ripped off more of her skin. IDK what the rationale was. One doctor has it out for her and writes her up every chance she gets. Our manager doesn't like her and floats her whenever she can. My question is, should we report this stuff? Or talk to her in person? Or... keep watching in horror and trying to catch up her work and remind her to wear gloves?

[Jedrnurse, BSN, RN]

The examples you gave are of unsafe practice. Lord only knows what she's done that people aren't aware of. Her med errors and unsafe practice should be documented. The ship has sailed for "talking" to an experienced nurse for things like that.

Frankly, she should be out of a job.

[JKL33]

Rather than everybody reporting back to each other about the latest outrageous aspects of her practice that have been discovered, you each have the responsibility to handle this in real time. For example:

 

9 hours ago, LibraNurse27 said:

I also found meds scanned but not given, sitting on the cabinet next to a pt's bed, including Norco and IV valium. Pt was in etoh withdrawal and needed the valium, but it was just sitting there, scanned at 0900 but it was 1100.

This was one such opportunity, and I could argue that it was a duty you had. I'm not sure how you handled it, but this was a direct observation by you, was not gossip or judgment, just fact.

I would argue that there are a couple of things I might have done if I came upon this scenario, not everyone will agree with me but my actions would depend upon context. The context you are talking about is one of multiple questionable practices that are unsafe. I would have reported this in real time.

I'm not sure how your group of coworkers is dealing with this, but as a basic statement I will say that IMO it is never right to "collect stories" or have this person's scariness be a de facto topic of conversation as if it's secretly everyone's daily entertainment. These are ongoing patient safety issues and need to be reported. Neutrally.

[Been there,done that, ASN, RN]

" My question is, should we report this stuff?" Of course. You are witnessing unsafe practices. It is your duty to report.

If you have personally witnessed narcs at the bedside, it's time to inform the charge nurse, possibly up the chain to the nurse manager. Review the policy on narcs being left unattended.

 

[LibraNurse27, BSN, RN]

1 hour ago, JKL33 said:

Rather than everybody reporting back to each other about the latest outrageous aspects of her practice that have been discovered, you each have the responsibility to handle this in real time. For example:

 

This was one such opportunity, and I could argue that it was a duty you had. I'm not sure how you handled it, but this was a direct observation by you, was not gossip or judgment, just fact.

I would argue that there are a couple of things I might have done if I came upon this scenario, not everyone will agree with me but my actions would depend upon context. The context you are talking about is one of multiple questionable practices that are unsafe. I would have reported this in real time.

I'm not sure how your group of coworkers is dealing with this, but as a basic statement I will say that IMO it is never right to "collect stories" or have this person's scariness be a de facto topic of conversation as if it's secretly everyone's daily entertainment. These are ongoing patient safety issues and need to be reported. Neutrally.

Yes, I agree. In that case with the meds I just talked to her in person and reminded her to give them. I wanted to tell her to be more careful because leaving narcotics/benzos unattended could be really bad for her, but I feel uncomfortable telling someone with much more experience than me what to do. And I don't like reporting people behind their backs, so I guess if I ever find it necessary to make an incident report I'll at least let her know that I'm doing it. so awkward

[LibraNurse27, BSN, RN]

1 hour ago, LibraNurse27 said:

Yes, I agree. In that case with the meds I just talked to her in person and reminded her to give them. I wanted to tell her to be more careful because leaving narcotics/benzos unattended could be really bad for her, but I feel uncomfortable telling someone with much more experience than me what to do. And I don't like reporting people behind their backs, so I guess if I ever find it necessary to make an incident report I'll at least let her know that I'm doing it. so awkward

Yes, I do feel I should have done more than remind her to give the meds and to not leave meds at the bedside. I feel we are being too lenient because she is nice/helpful, but we need to prioritize patient safety over not hurting feelings. I am definitely not a perfect nurse and I do make mistakes, but I think I'm qualified to recognize basic nurse/patient safety issues and infection control risks.

It is difficult and feels disrespectful when someone is more experienced than me, but avoiding awkward situations should not be prioritized over patient safety. We did have to speak to an MD about some of the timed meds that were not given on time to see if future doses needed to be re-timed as to not give too close together, and the nurse who did that did let this nurse know. She didn't seem upset, MD was annoyed but is a first year resident and didn't take it any further. Sighhh I think we all need to work on speaking up!

[turtlesRcool]

So there were controlled substances pulled from the Pyxis, brought into the patient's room, scanned, and then not given?  Why on earth not?  Unless there was an emergency that called her away (which still doesn't justify leaving controlled substances unattended), it seems really strange to do most of the work and then stop short of actually giving the meds.  Something isn't adding up here.  Is there a chance she's "losing it" in some way?  Has she always been like this or is this new?  If she's such a seasoned nurse, it seems like such egregious breaches of procedure and safety should have been dealt with before now.

Speaking up isn't petty. I have colleagues who rub me the wrong way.  Colleagues who are not particularly nice.  Colleagues who are not team players. But they are good nurses. I don't enjoy spending time with them, but they know their stuff, and their patients are in good hands. I would never lodge complaints against them. What you describe is different.

If you have to question if you should say something, consider this: would you want this nurse to take care of you or a loved one?  If not, then how can you justify letting her take care of others this way?  Even if she's super nice, she's not safe.  Could you live with yourself if her negligence seriously harmed a patient and you had said nothing?

[LibraNurse27, BSN, RN]

2 hours ago, turtlesRcool said:

So there were controlled substances pulled from the Pyxis, brought into the patient's room, scanned, and then not given?  Why on earth not?  Unless there was an emergency that called her away (which still doesn't justify leaving controlled substances unattended), it seems really strange to do most of the work and then stop short of actually giving the meds.  Something isn't adding up here.  Is there a chance she's "losing it" in some way?  Has she always been like this or is this new?  If she's such a seasoned nurse, it seems like such egregious breaches of procedure and safety should have been dealt with before now.

Speaking up isn't petty. I have colleagues who rub me the wrong way.  Colleagues who are not particularly nice.  Colleagues who are not team players. But they are good nurses. I don't enjoy spending time with them, but they know their stuff, and their patients are in good hands. I would never lodge complaints against them. What you describe is different.

If you have to question if you should say something, consider this: would you want this nurse to take care of you or a loved one?  If not, then how can you justify letting her take care of others this way?  Even if she's super nice, she's not safe.  Could you live with yourself if her negligence seriously harmed a patient and you had said nothing?

All good points. I'm not sure what happened with the meds left at bedside. She doesn't seem "off" or confused or anything, but you're right that it was really strange. And I would not want her to be me or my family member's nurse, so I agree I need to speak up if I see anything else. Thanks for your reply!

[Ambersmom, BSN, RN]

On 11/6/2020 at 11:41 AM, LibraNurse27 said:

Yes, I agree. In that case with the meds I just talked to her in person and reminded her to give them. I wanted to tell her to be more careful because leaving narcotics/benzos unattended could be really bad for her, but I feel uncomfortable telling someone with much more experience than me what to do. And I don't like reporting people behind their backs, so I guess if I ever find it necessary to make an incident report I'll at least let her know that I'm doing it. so awkward

But in the case where you found meds, including IV meds at bedside and still not given 2 hrs later that is a med error and a time change would need to be done, as well as an incident report. So if blood was found at the bedside 2 hrs later, would she have been told to just give it? I would take the opportunity to ask her (when you are charge or resource) what she is struggling with, if she feels overwhelmed or totally stressed out. and I'd inform her that any future occurences will result in notification to the NM. Perhaps, you're unit is super busy and she just cant keep up? Perhaps she is overwhelmed on the unit? Maybe she'd prefer not to float to your unit. 

[hppygr8ful, ASN, RN, EMT-I]

In reading the scenarios and responses I feel that the whole picture is not being looked at. The op states this is an older nurse (50s) and has been in nursing for a while. She's has been repeatedly written up but has made no significant change in her practice.  Has anyone considered that something may be medically wrong here. Perhaps we are looking at a sleep deficiancy, Metabolic imbalance or even early onset dementia. Maybe what she needs is for someone to take a more caring approach and sit down with her a say something like "I'm concerned that you are making a lot of mistakes and am asking if everything is all right with you?" I agree that you all cannot just each point left as if it is not your responsibilty. To do so does a diservice to her and the patient's under her care. Plus simply failing to act does not absolve the rest of you from liability if something goes wrong with her or one of her patient's.

Just my 2 cents 

Hppy

[Guest219794]

On 11/6/2020 at 12:31 AM, LibraNurse27 said:

One doctor has it out for her and writes her up every chance she gets. Our manager doesn't like her and floats her whenever she can.

The manager knows she is unsafe, but lacks the competence or motivation to deal with the problem.  That is exactly what the manager was hired for, and failure to deal with this represents gross incompetence comparable to the nurse in question.

So, in the entire work environment, only one person has the chief concern of patient safety, and is trying to fix the problem.  

What if, instead of what was quoted above, it said:

At this point, only one doctor is concerned enough about the welfare of our patients to confront the issue.  By doing this, the manager may eventually be forced into doing his/her job.

BTW- part of the manager's job is to solicit information from you to resolve this problem.  And part of your job, as a professional is to help with this.

And- You cannot fix her.  No amount of reminders about gloves, or whatever, will make her safe.

It is a crappy position to be in.  Do whatever you would want a nurse to do if your loved one was entrusted to this nurse's care.
 

[Workitinurfava, BSN, RN]

So the manager keeps floating her but won't keep her on her unit more and address the issues. She will say it's been reported to me by a coworker of yours to the lady  that she has been working unsafely. Hopefully she won't sit back and watch the fight after you guys say something to her.

Well something needs to be done regardless,  and the shame is  the manager won't address it before you guys.