when to report to the bne?

[pkmom]

There is a nurse I work with who just about everyone considers to be unsafe. 3 big time offenses I can think of right away are: dc'ing a central line and starting a peripheral IV for TPN, feeding a patient who just had a heart cath, still had a sheath in place and wasn't supposed to be fed, and pulling an rn who was sitting in a room with patient who was a very high need for a sitter to do admission assessments and "cover the desk" while she was at lunch. the nurse she pulled to cover the desk also had absolutely zero training at the desk. The manager has made her a full time charge nurse and everyone is furious, most have left or are looking elsewhere for employment. Somewhere along the line, it occured to me that maybe she should be reported to the bne before something really bad happens. the occurrances listed above all occured in the last month with other less serious concerns added. Our administrators are aware of the big occurrances, but nothing has happened. I need some advice please, what would you do.

on a differet note, one of our nurses requested a schedule change because she was having oral surgery and didn't want to work while still taking lortab. our manager told her she could work while taking the lortab as long as she had a prescription, but she refused. Is that really safe? I'm too cautious to drive while taking lortab after surgery, I certainly wouldn't want to risk anything at work.

[Dolce, RN]

The first rule of conflict management is to always approach the individual first? Have you done that? Before you involve management (or the BON!) you need to speak with her about your concerns. Then speak with management. It sounds like there is a personal problem that you have with her rather than a strictly professional problem.

[LakesideRN]

What's the real deal? And what is the rest of the story that she dc'd a central line and started a peripheral to start TPN?

Having a nurse that's not trained to work the desk watch the desk for 30 min. SO DANGEROUS. Answering the phone and answering questions for people who come to the desk.

Feeding a POST procedure pt. My God, the HARM that could have been done.

Sounds like there is a lot more to this story than you are telling.

I would hate yo work with you.

[heron, ASN, RN]

I recently found myself in a very similar situation to the OP's. A new nurse on my hospice inpt unit just did not have the clinical assessment skills or judgement needed to care for our terminal pts. Furthermore, she became angry and hostile when any of us tried to point out the problems to her and come up with a solution ... problems were always someone else's fault.

Situation was complicated by the fact that she had an unfortunately bizarre personality style that made it hard to respond to her positively, at least for me ... she tended to disregard boundaries, which makes me back way off.

She was a bad hire from the get-go ... but the manager very properly pointed out that she could not fire someone for "personality issues". The nurse in question finally dropped the last straw on the camel's back by leaving during report (showing signs of a psychotic break), leaving me alone with 9 patients and one tech to help (he was absolutely fabulous - the only reason I and my pts made it thru the nite ).

During the loooooong 2 1/2 months I worked with her, I often spoke about the problems I was having with a colleague who also worked with her regularly. Were we gossiping? Or were we getting a reality check on our perceptions by finding out if someone else is having the same issues?

My point is ... it doesn't take a toxic work environment for staff to have serious reservations about the safety or competence of a worker. In these days of the isolation of nurses by the "primary care" model, just how are the concerned staff supposed to document unsafe care, if they don't "check up" on her?

Why should I care? Well, aside from the obvious patient advocacy angle, there's the fact that, when problems came up, I or my colleagues were the ones who had to deal with them: complaints from family, dissatisfaction from our referring MDs, general chaos on the floor, being unable to depend on this nurse to "have my back" when things got hairy ... on and on.

So ... here's my advice for the OP:

Check yourself very carefully ... are your negative perceptions about this nurse affected by anything other than professional considerations? Is she getting written up for things everyone else gets away with? If yes, you might want to look at your own hidden agenda. Mobbing is an ugly and destructive process. If that's what's going on, you have much bigger problems than one marginally competent nurse.

Be sure your incident reports are for specific incidents that clearly violate institutional P&P or standards of care. Make it complete with dates, times and pt. names, so your info can be checked.

If your institution does not automatically send incident reports to risk management, you may consider sending a copy yourself. If the manager who is "shutting down" complaints is the same one who promoted the nurse in the first place, she may be very defensive re this nurse. In this case, risk management is your friend.

Meanwhile, be patient and CYA. The best you can do is all you can do.

I would hold off on reporting to the Board unless you are personally involved in an incident that's clear and undeniable malpractice: falsifying documentation, drug diversion, practicing outside her scope, etc.