It's sounds like you have covered your bases as far as alerting your superiors, documenting the poor nursing care etc. I too, would say your next move is to alert the board of nursing...but before you do this, have you sat down and talked to this "50 year old nurse as a friend, not a colleague and really communicated how upset you are with her alleged incompetence? Soemtimes you will hear another story if you befriend someone and really act like you care about what's going on with her. Maybe she's in pain, or having troubles at home, or quite possibly she's noticed she's having trouble remembering things (could be early alzhemimer's?) May I encourage you to risk it and try talking to her 1:1 and really caring instead of just being ticked off about her not carrying her load. So many times there is a reason for poor care if only we would communicate better. If you are not satisfied with her answers, go ahead and write the board. Before the board though, I would also notify the county commissioner and your legislators as to the incomptetent administrators of your health dept. since they appear to be looking the other way on this nurses performance. Oh well, just a thought. pdxrn