Impaired Nurses...what should you do...

Keysnurse2008 · Dec 28, 2005

I still stand behind the idea that you need to document care issues, not the possible why's of the problem. Personally, a blood sugar of 500 doesn't mentally impair everyone, especially someone that is consistently noncompliant. Now, if his legs start to fall off, then there is a problem. I would not want to be too personal here. Pretty soon, we'll get to the point where we say obese nurses compromsie care, people that need eyeglasses to see compromise care because they have to have their glasses to read, etc.. I agree with llg - document behavior and patient compromises only.

TraumaRus...omg...last time I checked obesity doesnt impair mental acquity...but......from what she has told me of his behavoir.......it is affecting his mentation....and the fact that levels above 500 will not impair someone is debateable.Do you even work in a hospital? If ya do...tell me what happens to patients that roll thru the Ed doors with BG levels reading "too high to read"...do we just discharge them and pat them on the back and say "you will be ok".....we dont ...do we? "WHY" is it that they are immediately hospitalized? If you truly work in trauma is this the person you want to look up and see making adjustment on your Neosyn,Levophed, dopamine and vasopressin drips?I can see her dillema...when they are symp[tomatic.....she really wanted me to tell her to turn away and ignore it......but....what do you do? I think it will be hard for her to not take this personal....bc...this guy...was her preceptor when she started 3 years ago...they have always been pretty close...and he is only 37.

Keysnurse2008 · Dec 28, 2005

i am a type i diabetic and i know personally how he feels. bad glucose control can effect your ability to provide proper patient care. the only problem with diabetics is we do not like to be labeled as freaks. if you are really a true friend talk to him away from work. do not make it seem you are trying to correct a wrong.talk too him like you are concerned about hishealth away from work. maybe catch him on a off day and treat him too lunch and express it as a concern to his health not like a punishment. do not and i repeat do not talk to him about his diabetes control at the nurses station around other people even though he brings it up. it makes him feel like he is neglecting himself and this makes his control even worse. i have been in his situation and nothing makes me madder than a non-diabetic talking to me about glucose control even if they are right. try to express concern for his health and see if this will help. hopefully this may help you. please do not tell him that his glucose control is impairing his patient care he will feel handicapped and not able to do his job and this hurts. beleive me i know. just try it from a concerned friend perspective and tell him you would like to be able too work with him for many more years and help him through this. he may have personal problems that may be causing his glucose control neglect. this is a very hard thing to talk too a diabetic about it is much like walking on thin ice there is a thin line between helping and hurting in this case. best of luck

jsixxrn...i think you kinda understand where she is coming from.their is not a malicious bone in the childs body. she said she did try to talk to him again 2 nights ago...i will have to ask her about "where" that conversation took place.thank you for sharing your insight. i always get the "what do i do?" calls from her...and this time.....there wasnt a clear cut answer.the last thing ...i think anybody wants to do.....is cause more stress to someone that is suffering from health problems...whether it be this ...or cancer...or chf.....you cant help your diagnosis. she said what alarmed her was last week he had came in and was sweating profusely...and had taken a verbal phone order from a physician that had called ....and when he hung up he sat down and his back was soaked.he tried to write the phone order down on the physicians order sheet...and couldnt recall what the physician had called over.he tested his bg and it was "too high to read" .he gave 18 units or reg insulin and went to lie down in a vacant room. she had to call the physician back....and his order was for a nipride gtt to be started immediately.she said it took about 30 minutes for him to retest and it then showed bg level of 465. so....what do you do? during the conversation ...it came up that this happens "frequently"...and she didnt elaborate on what "frequently" meant.

sjrn85 · Dec 28, 2005

This is second hand information? Then you really don't act on it...you're hearing someone else's version of a conversation.

You really don't want to make an allegation of "impairment" unless you can substantiate it. And most BONs consider impairment to be r/t drugs or ETOH, not what you're describing.

jsixxerrn · Dec 28, 2005

That is a little deeper than I first thought. This is a hard subject for anyone. It is hard to tell a fellow nurse their personal care is effecting patient care. She needs to talk too management but she has to keep her name out of it or risk her friendsip with him. this is a hard situation and there is no easy answer but in his specialty it is no place to be impaired I wish I could offer better advice.

sjrn85 · Dec 28, 2005

Your friend should have reported what happened to the supervisor, not discussed it with a third party later. She allowed pt. care to be compromised by not doing so; if a pt. were harmed because this happened again, she could be held just as liable because she had knowledge of the situation and failed to act.

But again, taking this to the BON is not the appropriate response. I get the impression sometimes from reading this board that people are willing at the drop of a hat to call the BON and "report" co-workers. You really need to have substantial evidence to call the board, and really, you should follow the chain of command unless it's an extreme situation. (Not you personally, I mean "you" in the general sense.)

Keysnurse2008 · Dec 28, 2005

sjrn....yeah it is second hand.But I know she will be calling back tomorrow.

So...when health problems intervene in a practitioners ability to SAFELY do their job...what do you do? Do you remain quiet...and say nothing?If you do that...how will you feel if a sentinel event occurs and you remained silent. As the poplulation...and we ...age.....health problems that impair our ability to safely do our jobs is an issue that we will all see eventually. Lets use another scenario....a nurse is 59 years old and has 80% occluded cerebral arteries...coworkers see strange behavoir....she has difficulty staying on task...and is often.irritational at times.Do you leave her working in a ICU over very critical pateints..and say nothing?You dont address it at all? You just sit back and pray for divine intervention on the patients behalf?

...Hmm......there isnt an easy answer is there? Anyone else have any ideas on how she should handle this? If not......

JaneyW · Dec 28, 2005

We had this situation at my last job except it was a low BS problem and the night shift and someone who was retirement age and had other health problems as well. We all loved her--she had been there FOREVER and had trained most of us. Some nights were fine, but some were downright scary. When it started to compromise patient care, it was brought to the attention of the nurse manager who spoke with her. She went on medical leave for a while and then retired. We gave her a party and she was so much healthier without the stress of work.

I would take the advice to have your friend speak to him privately.

sjrn85 · Dec 28, 2005

sjrn....yeah it is second hand.But I know she will be calling back tomorrow.
So...when health problems intervene in a practitioners ability to SAFELY do their job...what do you do? Do you remain quiet...and say nothing?If you do that...how will you feel if a sentinel event occurs and you remained silent. As the poplulation...and we ...age.....health problems that impair our ability to safely do our jobs is an issue that we will all see eventually. Lets use another scenario....a nurse is 59 years old and has 80% occluded cerebral arteries...coworkers see strange behavoir....she has difficulty staying on task...and is often.irritational at times.Do you leave her working in a ICU over very critical pateints..and say nothing?You dont address it at all? You just sit back and pray for divine intervention on the patients behalf?
...Hmm......there isnt an easy answer is there? Anyone else have any ideas on how she should handle this? If not......

You follow the chain of command. You let the supervisor know, and let him/her act accordingly. You do not just go and call the BON, and you do not let the situation go and then call your friend and tell your friend about it.

Go back and reread my second post. I said very clearly your friend should have called the supervisor, and that she is putting her own license in jeopardy by not taking this through the chain of command at her facility.

Her co-worker has a right to privacy as well, and I doubt he'd be happy to know that not only is his condition being discussed by his co-worker with her friend, but her friend is posting his medical information on a public BB. People have been "outed" here many times for posting detailed info.; the individual being discussed could easily be ID'd by other co-workers, or he himself could be reading what's being posted about him. Not good.

Keysnurse2008 · Dec 28, 2005

you follow the chain of command. you let the supervisor know, and let him/her act accordingly. you do not just go and call the bon, and you do not let the situation go and then call your friend and tell your friend about it.
go back and reread my second post. i said very clearly your friend should have called the supervisor, and that she is putting her own license in jeopardy by not taking this through the chain of command at her facility.
her co-worker has a right to privacy as well, and i doubt he'd be happy to know that not only is his condition being discussed by his co-worker with her friend, but her friend is posting his medical information on a public bb. people have been "outed" here many times for posting detailed info.; the individual being discussed could easily be id'd by other co-workers, or he himself could be reading what's being posted about him. not good.

sjrn85.....i have been a nurse many years.....and i dont think there is anything unusual about a 24 year old nurse...nor the events that i described that diabetics and chf patients go thru.and no...it can not be traced by to the original nurses...bc...a few lil things are different.but kudos to you for being so hippa conscious....but...i already thought of that. just to reinforce you are in the nursing issues and how they affect patient care......however if you had read my post you would have noticed it said the nm was aware...or so she said.

also....i am not so sure who brought up the bon. i think this is a safety issue that should be attempted to resolved within that facility without going to the drastic extreme of going thru the bon.but...it is obviously impairing the diabetics ability to safely pratice ...bc....the staff had to spend time taking care of him...and he couldnt recall the nipride order.

so..if that nm is aware..where do you go? risk management if ..if..it cant be resolved with the nurse?that would be my thought.

as i said....we are all aging...and this is an issue that will come up time and again .there arent easy answers...

as one of the other posts listed above....this is something that she has encountered too.and it was less stressful on all parties after she retired...so i feel this is an issue that we will be addressing more and more again and again and again.

sjrn85 · Dec 28, 2005

If your post was so clear, you should not have needed to go back and edit it after I posted my reply. I know that we are in the "Nursing Issues/Concerns" thread, BTW, but that doesn't mean that anything goes.

In any case, it's nearly impossible for me to comment further because you have altered the contents of your original post, so I can't refer back to it. However, I will say that labeling a nurse as "impaired" carries grave consequences, and usually implies that one is considering reporting that nurse to the BON or taking other serious steps.

And yes, I am HIPAA conscious. And I think it's unprofessional for someone to be discussing this matter in such detail with a third party.

If the nurse manager is aware of the situation but not acting on it, then your friend should take it to the next level; that would depend on the institution's policy. If meds are being missed/ delayed/errors occurring, then your friend should be filling out incident reports every time it happens. Bear in mind that the NM may know more about this than your friend does, and just because your friend hasn't seen immediate action doesn't mean that things aren't in process. Your friend should also be calling the supervisor if her co-worker appears to be too ill to work.

Your friend should use caution in how much information she is disclosing to you; you might want to remind her of that. She may not be as HIPAA savvy. Regardless of what the true details are, it's inappropriate for her to be discussing it with you, and is still a violation of this nurse's privacy when she talks about it with you, whether or not you post the actual details on a BB.

Edited by fab4fan 122705 at 2312 to insert missed word "remind."

Keysnurse2008 · Dec 28, 2005

If your post was so clear, you should not have needed to go back and edit it after I posted my reply. I know that we are in the "Nursing Issues/Concerns" thread, BTW, but that doesn't mean that anything goes.
In any case, it's nearly impossible for me to comment further because you have altered the contents of your original post, so I can't refer back to it. However, I will say that labeling a nurse as "impaired" carries grave consequences, and usually implies that one is considering reporting that nurse to the BON or taking other serious steps.
And yes, I am HIPAA conscious. And I think it's unprofessional for someone to be discussing this matter in such detail with a third party.
If the nurse manager is aware of the situation but not acting on it, then your friend should take it to the next level; that would depend on the institution's policy. If meds are being missed/ delayed/errors occurring, then your friend should be filling out incident reports every time it happens. Bear in mind that the NM may know more about this than your friend does, and just because your friend hasn't seen immediate action doesn't mean that things aren't in process. Your friend should also be calling the supervisor if her co-worker appears to be too ill to work.
Your friend should use caution in how much information she is disclosing to you; you might want to remind her of that. She may not be as HIPAA savvy. Regardless of what the true details are, it's inappropriate for her to be discussing it with you, and is still a violation of this nurse's privacy when she talks about it with you, whether or not you post the actual details on a BB.
Edited by fab4fan 122705 at 2312 to insert missed word "remind."

If you dont want to discuss healthcare issues and things that may affect pt care/safety then please find another forum. The only edit I made...was to clarify what I was asking...which is.....when health issues....such as uncontrolled diabetes, cancer, chf, and altered cerebral flow impairs a healthcare practitioners ability to perform their job safely how do we as nurses intervene when it is coworkers that we care about. How can you ensure patient safety and not hurt your coworker that is ill?Also...When does "impaired" have to mean "drug addict"?No one mentioned that topic...we are talking about HC Issues that we will all begin to see as the baby boomers age and progress. Many things can impair our bodies ability to function as we want them to.Nursing administration ...is reluctant bc of HIPPA laws to intercede.So....since this is the Nsg Issues/Concerns and how they affect pt care forum....and since this is an issue that will either directly or indirectly affect patient care and will become more of an issue in the future I am asking for additional comments if anyone has them on any special pointers anyone can offer the nurse placed in this position. Simply knowing the Nurse manager was aware still does not absolve any nurse of responsiblity if a sentinel event occurs and risk management was NOT aware...so it could be a liability issue for the coworkers too...if the situation was bad enough....and risk management was aware.Thats just my thought.

sjrn85 · Dec 28, 2005

Sigh...again, I said that the NM should be informed, and that, if necessary, concerns should be taken further up the chain of command. I also said that incidents should be documented, and that if a nurse found a co-worker to ill to be working and thus a threat to pt. safety, the supervisor should be paged to address the situation. Measures can be taken to ensure pt. safety while upholding HIPAA regulations.

As I said before, the general context of calling a nurse "impaired" implies substance abuse problems.

I don't know what other suggestions you're looking for. I hope someone else can help you.

And I still think that it is inappropriate for a nurse to discuss detailed personal information about one of her co-workers with a friend.