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?
Think of this as any other disability that would impair physical mobility. We have a disabled doctor who rides around on a little motorized scooter and does her work. That might be a good accomodation for this nurse Seems like a win-win. There could even be help to pay for it through vocational rehabilitation programs.
Specializes in Gerontology, Med surg, Home Health.
Every facility I've ever worked in requires a physical every other year which needs to state whether or not the nurse is physically capable of performing all the tasks required. I send a job description along so the doc knows exactly what is expected of the nurse. If you can't safely push your med cart or help in an emergency, then a staff nurse position in a SNF is NOT for you.
How about Tx nurse? Responsible for some pt care, but not taking a full assignment. And, unless a Tx must be done at a certain time, she would have the full shift to get her job done. just my $0.02
I suspect there must be more to it than slow moving, using a cane or leaning on a handrail or bed.......my DON does these things. When she was a floor nurse and passing meds, she used a chair to sit down to set up each individual's meds too...just as this nurse does.
I have been in LTC for roughly 35 years now....have had 2 physicals when joining a new company and none on annual or semi-annual basis...have had cancer twice. I think an annual physical for all licensed staff would be a good idea (if the company paid for it). She should not be singled out.
The treatment nurses I have seen on the job were busting their butts for eight hours going from one end of their assignment to the other with no time to rest. If this person can not handle normal nursing duties, I can't see her handling treatments.
This is a dilemma that many nurses as they age face, not just obese nurses. You see the same problem in the construction trades which require a certain level of physical ability.
I've also seen nurses with back problems move into management or desk jobs. You have to be qualified for that job, however. I think the person whose body is giving out needs to be proactive and think about their next career move. I don't think that they should be automatically handed the next desk job.
I was talking about this with a nurse who is currently an ICU nurse where I work, and a clinical site instructor. She's now working on her Masters and wants to get her advanced practice license. She is around 50 now, enjoys the mental challenge of ICU but is worried about the physical demands as she ages. She's not in any way overweight btw.
So, I think anyone who depends on their physical abilities for their work, in any field, needs to take responsibility for their own careers, now and in the future.
The OP stated they tried having this nurse work with the computer in the past but she took over one hour to input an admission or something similiar. If I was aware that my physical work days were coming to an end, I would show some initiative to learn something less strenous. It sounded to me that the nurse wasn't motivated, so perhaps her employer shouldn't be so motivated to push her into something she can do. You can lead a horse to water......
Thanks for all your advice from everyone, although I do have to say I highly resent the implication that we just don't like having a fat nurse around. I think if the person who wrote this would READ my initial post it would be very clear that I really like this lady and I care very much about what happens to her. If I wasn't very sensitive to her issue I would have never been looking for advice to begin with - Jeez, give a person some credit!
Bottom line is my FIRST priority is to the residents. We, as management, can not be there 24/7. When we leave we have to have competent nurses that can provide the care each resident is entitled to receive. If it was your Mom in respiratory distress and the end of the hall and you called for help.. and it took the nurse an extended period of time to get there and then because of her physical condition, could not properly perform care what would your reaction be??? How many times have you all been involved in an emergency situation that requires you to go up and down the hallway to get supplies, meds, call dr/family, etc.
As I have said, we do not have any extra $$ in the budget to "make up" a position for her & I find it hard to believe that so many of you do.
My state only requires a physical upon hire and that is all my company will pay for.
We did call this nurse into the office. We explained our concerns and those of the involved families. We gave her examples of our concerns and also all of her great points. Our approach was one of concern for her as well as for our residents. She was at first very defensive and eventually stated that she came in "knowing" she was going to get fired (we didn't fire and hadn't intended to at that point in time). As the meeting continued, she broke down in tears explaining how it really had gotten much harder for her and how bad she hurt everywhere after working just 2 days in a row. In general she was rather defeated and we all ended up in tears before it was over. We did suggest that she see her Dr. about helping with her other physical conditions to see if her mobility could be improved. We also suggested maybe she look into a facililty or other employment with a slower pace (ie: just a calmer ICF unit vs our crazy one or maybe home health - which she admitted she wasn't sure she could get up and down house steps either). We explained again that our first priority had to be resident care/safety and she understands this. We also gently explained that we have no choice but to follow corrective action if further family complaints (justified of course) continue.
This is very disturbing to me that you assume because she is fat uses a cane holds a rail or leans against a bed that she can be a good nurse or that she wouldnt be able to perform CPR how judgemental and ignorant Sounds to me like your facility is just uncomfortable having a fat nurse
I didn't ASSUME anything.. I see it with my own eyes everyday. That is not judgemental and I am not ignorant - Thank you very much!
It probably would be better not to emphasize that the nurse was 'overweight' in your title, but instead discuss more of her physical decline that's interfering with her ability to be a bedside nurse.
Weight and physical appearance are very touchy subjects.
It probably would be better not to emphasize that the nurse was 'overweight' in your title, but instead discuss more of her physical decline that's interfering with her ability to be a bedside nurse.
Weight and physical appearance are very touchy subjects.
I completely understand the politically correctness of the situation, but knowing that I weigh a little over 200 pounds (ie: I'm not skinny either), it would be hard to overlook the fact that this nurse weighs 350-400 pounds and it IS playing a big role in her physical decline. Fact not opinion
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arelle68
270 Posts
Think of this as any other disability that would impair physical mobility. We have a disabled doctor who rides around on a little motorized scooter and does her work. That might be a good accomodation for this nurse Seems like a win-win. There could even be help to pay for it through vocational rehabilitation programs.