Preceding Nurse Never Completes her work

Anna Flaxis, BSN, RN · Feb 17, 2012

I need to know a little more about the situation before I can give a thoughtful response. For example, how long has this been going on? Weeks? Months? Years? How long has this nurse been practicing? Is she a new grad? Is she a new hire? Have you spoken directly with this nurse about your concern? What is her explanation for this behavior?

KelRN215, BSN, RN · Feb 17, 2012

More information would probably help, but if I'm working a day shift and see when I'm looking up my patient that there are meds timed at 0600 or 0700 not signed off, I will simply ask the off-going nurse "did you give that 6:00 Decadron?" If the answer is yes, the question has reminded them to sign it off. If the answer is no, I know to give it as soon as I'm done getting report.

If her charting isn't finished, I don't see why that would mean I couldn't take report. She should simply tell you, "I gave Mr. S morphine at 0640 and haven't had a chance to chart it yet."

bsnanat2 · Feb 17, 2012

This person has been a nurse for nearly 10 years. When I say no charting has been done, I mean 0 charting has been done for the day. When I've worked on the shift with her, she stays on her iphone all day with her family. She marks all her meds on an index card (we have scanners) and literally charts her begin of shift assessments along with everything else after her shift. Even the new nurses on her shift leave before she does. One or two meds or the last rounding or two is one thing, but she actually charts nothing all day and can not give a decent report. She rarely even knows what day the person had surgery. She is BFF with the manager.

bsnanat2 · Feb 17, 2012

There have also been several instances where "now" doses were ordered due to critical labs and she didn't give them. She will often claim ignorance of new orders and it will often be hours before she has even seen all her patients. When on shift with her, most of us would have done assessments, passed meds and have begun charting before she even assessments. No joke, she actually told a MD that the pt was doing well ambulating when the pt was a new double amputee. She had not seen the patient that day and it was near lunch. I guess management is waiting for a death or critical event before doing something.

allnurses Guide · Feb 17, 2012

document, document and document.

Incident reports about late meds/meds pulled & not charted/missed doses; these are all medication errors and therefore reportable.

Same with labs and blood, check your policies on time limits; our hospital has policies that define that amount of time you have to do orders, over the time limit, incident report.

Be very factual, put only the time the order was written, and when the lab/blood trx etc. actually happened. Leave out anything personal that could sound like a vendetta.

If you don't trust the immediate manager, start handing them to the nursing supervisor or the DON. Incident reports are supposed to be the private communication between you and the legal department as well as management, do you have a hospital lawyer on the premises?

Some places have an ethics hot line that is anonymous, ask HR if there is one.

Anna Flaxis, BSN, RN · Feb 17, 2012

Wow, this nurse sounds like a sentinel event waiting to happen. I agree with JBudd that it sounds like the incident reporting system is your best bet, as well as some kind of organizational integrity hotline, if one exists in your facility.

VICEDRN, BSN, RN · Feb 17, 2012

I'd refuse it. If you administer a med and its already been administered but not charted, its actually your med error and you will be the one talking to the manager about it. Thus, I would refuse politely. Would say something like, "Oh, I will wait till you finish. Otherwise, its confusing and I don't want to get written up for med errors." and then smile gorgeous! ;-)

luckynurse_1234 · Feb 17, 2012

That sucks. I work with two or three nurses like that...The textbook answer is to tell them to do all those things before they go home, but you do get tired of having to say that over and over again. Unfortunately, the "norm" on our unit is always leaving stuff for the night shift to do "Oh, I didn't give that med. Oh, I didn't get that lab drawn. Oh, it says the order was put in at 1600 but I didn't see it until just now (1900)." I used to think that was ok until another more experienced nurse pointed out even on night shift, "you ONLY have 12 hours." I agree with Stargazer and VICEDRN; I have written people up a few times. Sadly, it does seem like management doesn't want to do anything until there is a sentinel event.

RNperdiem, RN · Feb 17, 2012

Do you do 1:1 report? If so, make going over the MAR together. "Oh I see several meds you have not signed off on, let's take care of that now." Make her go ahead and sign for what she gave.

Bedside report can help if you have to go in and see the patient. Notice the infiltrated IV, the drips running out("Have you ordered another insulin drip from the pharmacy?")

It is not subtle, but sometimes you have to make your expecations known.

This nurse sounds like a chronic case and patients can get hurt.

I once read in a book that if you shine the light of scrutiny on your star players, they enjoy the chance to shine. If you shine light on the low-performers, they disappear.

SHGR, MSN, RN, CNS · Feb 17, 2012

Agreed with most of what is above. I worked med-surg for a long time and the expectation was that you would finish your stuff on your own shift, and stay late if you needed to.

Surely you are not the only one on your unit that is noticing this nurse has (big dangerous) issues? What is everyone else's thoughts? Are you all afraid of your manager or retaliation? In that case, you don't have a culture of safety and you need to go above the chain of command for a. your patients and b. your own license and career as VICEDRN stated above.

bsnanat2 · Feb 17, 2012

Thanks for the replies!

No, I am not the only one who has noticed it. The more veteran nurses on our shift refuse to take report from her and so the new nurses get her patients. We have all made it clear to her that it is unacceptable to us, but management and the others on her shift continue to cover for her. She has done everything from what I've mentioned to even not properly wasting narcs and benzos. One new nurse even saw her pocketing Valium when the patient "refused" - no record of return, waste or med being given. Management: "Oh I'm sure she just forgot to chart it." What's interesting is that some in upper management want her out and we newbies are trying not to get caught up in the crossfire. Some of us think she is diverting and that her friends are covering for her while she 'straightens things out.'

One way they protect her from others is by making her charge, so everything has to go through her. Charge on our unit really does not involve too much extra work, so she should still clearly get her work done. Not uncommon for her to give float pool or newbies 5-6 pts while she takes 3 and won't take any admits.

It's just really sad how she and another bad apple are bringing the whole unit down.

Thanks again.