Overweight nurse unable to physically manage her responsibilties

[Nascar nurse, ASN, RN]

Advice please..

We have a very heavy nurse that works in our SNF. She is very pleasant to both residents & coworkers, she is very reliable and always comes to work, picks up extra shifts when needed, etc. Her actual nursing knowledge is average at best (does need some guidance with appropriate decision making skills related to resident clinical needs). She has been employed by the facility for several years now.

The problem.. she has always been very heavy and as she has aged (probably around mid to late 50's now) she is having increasing difficulty moving about the facility and being able to manage physically providing care. She requires a cane to walk on the the unit, leans heavily on the handrails for additional support. Takes an office chair with her on med rounds so that she can sit as she is gathering meds for each resident, leans on resident beds to support herself for treatments (think both elbows on the bed propping herself up and only using her fingers) and I can't imagine she could ever do CPR.

We admittedly have been turning a blind eye to her for some time because she is really a nice lady with a big heart. Not only do we not want to "hurt her", we also have to take the whole disability act into consideration. We also know she is probably the only working adult in her family and they rely heavily on her income.

The ugly.. We can't keep ignoring this. We have had 2 family complaints within the past week. Both families saying, "although we really like Nancy nurse, we are afraid if Mom had a medical emergency Nancy Nurse will be unable to physically care for Mom." Once said her physical disability is impairing her ability to provide safe care (it takes a very extended period of time just for her to get down the hallway).

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For all you experienced managers, how do we best handle this?

[caliotter3]

I would seriously consider finding an administrative type position for her to transfer to. Otherwise, you might have an unpleasant task ahead of you as I don't see her being able to change herself to be able to meet standards. Maybe have her be an assistant to the MDS coordinator as well as an assistant to the DSD, with a smattering of other duties as necessary to make eight hours worth of work for her. That would be very accommodating as I see it.

[Nascar nurse, ASN, RN]

Thanks for the reply. We tried that with her last year as we could see this day coming. She has no computer skills and at the time I was the MDS coordinator. I sat with her for several days and tried to teach her to fill in for med-rec as med-rec was out on medical leave, but after that amount of time, she was still not able to accurately get one order in the computer in less than an hour .

Unfortunately, we are also under intense corporate review for our budget, which = no extra time for anyone. We keep sending staff home early as it is.

[caliotter3]

Well, you've tried.

[VivaLasViejas, ASN, RN]

This is probably not what you want to hear, but I think it would be wise to ask yourselves how you would handle it if Nancy Nurse were in a protected class of workers under the Americans With Disabilities Act. (She is already protected because she is over 40 years of age, but I don't believe her age is at issue here.)

You can't really get rid of her because of her weight, or because she needs a cane to walk down the hall, or because some family member doesn't think she's competent just because she's fat. You certainly can't get rid of her because her nursing knowledge is "average at best" if it's been satisfactory enough to keep her employed with your facility for a number of years.

I think your best bet would be to bring this nurse in and share your concerns with her in a non-judgmental tone. This is also the time to be creative: you need to offer her an alternative position that would utilize her skills and reward her loyalty without jeopardizing her wages/benefits. My guess is that she would jump at the chance of doing a job where she can continue to be useful but not have to work so hard physically...........I know I would, being 50+ and seriously obese myself (although I'm still in pretty decent shape for some reason).

Believe me, this woman is completely aware of her age, size, and physical difficulties. It's impossible not to be. However, she doesn't deserve to be 'put out to pasture', and you know this or you wouldn't be asking for advice.:)

Good luck, and thank you for advocating for this employee despite her "issues".

[psalm, RN]

Yes...she may be able to fill a different position. But if she can no longer do the job she was hired for R OR patient care is compromised, she may need to find something else.

[Havin' A Party!, ASN, RN]

Agree with psalm.

She needs to be relieved of current duties ASAP, as she poses health / safety risks to residents, families, other staff and herself.

Of course, this should be handled with the appropriately.

Good luck!

[achot chavi]

I like some of the ideas so far, esp being creative to find her work that doesn't require a dependence on her having to run and do CPR.

As to the idea of calling her in and having a talk---, to what purpose- if she wanted to lose weight or get in shape, she would do it on her own, it is doubtful that she will do it if threatened by you, I wouldn't call her in without a witness and prior guidelines as to what you are permitted to say and what not,

The bottom line is she hasn't been absent because of her physical limitations, the downward spiral has been gradual and will probably continue. She might eventually develop complications that will make it difficult for her to work and then she will decide to find work more suitable to her physical situation.

In my country (Israel) we would send her to an MD who specializes in rehabilitation and work related accidents for an OK from him that she is phusically fit for the work load that she is hired for, if she is deemed unfit to physically do the work, she gets workers comp etc.,

As for being a risk to others, only you can decide that. Has she dropped patients, failed to administer care, takes too long to answer call bells etc.

In our facility our staff are not allowed to lean on patients beds as that is personal space- just as they are not allowed to sit on pts beds, I would ask her and all other staff ( in a public memo- not as a personal rebuke) not to physically support themselves by leaning on the pts beds.

You will have to involve ur adm, I would also involve your SW (I am sure they already have an idea that a problem is developing and are waitng for you to deal with it) keep copies of all memos of all correspondences.

If there is any way to find a position for her that will please everyone that would be best!!!

Good Luck & keep us posted!!!

[BabyLady, BSN, RN]

To avoid a possible discrimination suit, you have to make reasonable accommodations.

However, it doesn't require you to make to many accommodations that it compromises patient care.

If you offer her other positions and she cannot perform other positions, such as lack of computer skills and unable to obtain those skills, then you have done all you can do.

Telephone triage, maybe working in a doctor's office, case management, well-baby nursery, etc...may be more suitable for her.

[Nascar nurse, ASN, RN]

I appreciate all of your responses. Unfortunately, I/we can't just create a new position (desk job) for her. Our budget is so tight right now, we are constantly sending even CNA's home for low census - can't image them letting us create a position of an additional nurse wage!

[SuesquatchRN, BSN, RN]

I don't have an answer. We had one such employee and she was let go when there was an incident with a resident. Once someone eloped - she was hired back after that- and I don't know what happened this last time.

[achot chavi]

I can relate, I would ask the Adm to get legal advice on what to do with this nurse.

You sound like you really empathize with her and maybe you can help her find an appropriate position in another facility perhaps as school nurse or in a Dr.'s office...