Seasoned ICU Nurse Lacks Critical Thinking

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Last night shift I worked with 2 of my colleagues one who is one of the units senior staff nurses (SSN). We each have at least 10 yrs experience, she our SSN has about 30 years ICU experience.

we agreed that I would go on break first and our SSN would go last.

I return from break and my colleague goes on break next and gives report on his patients, rooms 7 & 8 to her.

She is notorious for sleeping on the job constantly falls asleep at the desk so when she asks me if she could go to the lounge and take a 15 min break because she is so so tired I shrug and let her go.

The surgical resident then comes by and asks me if I'm covering bed 8, I say no our charge is, but how can I help? He says the patient is more tachycardic and is in pain, could I please medicate him for pain.

As as I go to assess Rm 8 and get some morphine I notice my charge nurse back on the unit, talking with the surgical resident about a medical patient in Rm 7. Curious I go into Rm 7 who looks a bit unstable and the resident asks me to page RT. I go back to desk to page RT (who took forever to come) and then answered a call bell in Rm 3.

I come out of Rm 3 and see my charge nurse sitting down at the desk charting by the tele monitor and apparently the surgical resident went back to the call room. Still curious about bed 7 (who I am technically not covering and know nothing about but hey we're here for every patient ) I ask her what's going on with the patient and she just shrugs and say she doesn't know what wrong with him and let's wait for RT.

I begin to worry and look at Rm 7 on telemetry and his pulse oximeter says 80 and he's still tachycardic to 120s-140s. I go to room and talk to patient asking him if he feels worse, he nods yes, he is diaphoretic, and is using accessory muscles to breath and is also grunting and sounds wet. I immediately increase his fio2 on his high flow to 100 and tell my charge that his saturation is now 75% and that I'm going to page the medical resident who is assigned to him immediately. I speak to the resident and tell him that the patient seems to be deteriorating and will need intubation.

Internal medicine intern comes to unit (with RT running behind him) and debates putting patient on biPap and wants an abg first and I tell him that patient needs imminent intubation, biPap will not help. Back and forth debating with intern while my charge nurse just stands there. Intern decides he wants his seniors opinion. Senior comes to floor and patient ends up intubated within 5 min. I was so irritated at my charge nurse.. how are you here with 30 years ICU experience and leave a deteriorating patient, not call the covering MD and just shrug it off? Couldn't she see the patient was in distress???

This is not the first time she has shown lack of skill or expertise. I had a code recently and she had no clue how to fill out the code sheet and was asking me what to write???

She once had a patient with a subdural hematoma, consistent systolic BP in 200s on nicardipine running at only 2.5 mg!(starting dose) because she didn't know that cardene was a titratable drug. I had to titrate it myself.

She had another extremely critical patient who coded and she was not ready...no defib pads on patient, I ran the code on her patient while she stood by watching. She freezes in code situations.

I feel so unsure now with her covering my patients . I've worked with a lot of awesome nurses with differing amounts of experience but c'mon after 25/30 years how does one still struggle like this? She's a lovely woman but this is so unsafe.

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Time isn't a cure for incompetence.

So, you work with Sleepy and Dopey. Any of the other dwarfs work there?

Other than Doc.

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Specializes in New Critical care NP, Critical care, Med-surg, LTC.

It certainly sounds like a difficult situation to be in. Have you worked with her in past when she didn't have any trouble? Maybe she's dealing with some issues that are making her more tired and that will obviously affect judgment. If you're very concerned about it, maybe initiate a conversation with your manager, it could easily be framed as concern for a coworker. Obviously falling asleep throughout the shift could be unsafe for everyone, especially when covering more patients. I wouldn't jump to questioning competence first, though, that will bring a whole different tone and make you look very accusatory. We all make mistakes, I would hope she can get back on track.

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Specializes in Psych (25 years), Medical (15 years).

I've never worked ICU, enjoyed reading your well-written post, am an Old Dog,and want to convey my appreciation for your concern, All4NursingRN.

Your concerns need to be addressed through the proper channels, and I sense you know this. Given your well-written post, conveying facts and concerns will be no problem for you.

Lastly, I want to say that we Old Dogs and COBs need to be given feedback on our performance. I am not nearly as sharp as I was 15 years ago when I started at Wrongway Regional Medical Center and realize that I have to think and rethink things and involve my colleagues in decisions because sometimes I don't see the whole forest.

When my day comes, I want to be able to gracefully leave my position. But if I am no longer able to fulfill my duties, I want to be informed of that. I've had my time and am ready to retire whenever need be.

If your colleague needs the same, so be it.

The very best to you, All4NursingRN!

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Specializes in Tele, ICU, Staff Development.

Constantly falling asleep at the desk...any chance she is diverting?

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Specializes in Hospice.
Constantly falling asleep at the desk...any chance she is diverting?

Or sick? Profoundly depressed? Hypothyroid? Lyme disease? Inappropriate medication for mental health issues? I agree that the deficiencies you described are totally inconsistent with 30 years' experience in ICU, which tells me that there's an acute problem in the mix somewhere. Have you asked her about it?

Bottom line, whether her performance problems are caused by illness or stupidity, she needs to be away from the bedside until they are addressed. There are many ways to go about this, some more compassionate than others.

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Specializes in Palliative, Onc, Med-Surg, Home Hospice.
Constantly falling asleep at the desk...any chance she is diverting?

Or she could have sleep apnea and narcolepsy. My husband had to go on disability (after being a rad tech for 23 years) because of narcolepsy. He constantly fell asleep also.

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Specializes in Hospice.
Or she could have sleep apnea and narcolepsy. My husband had to go on disability (after being a rad tech for 23 years) because of narcolepsy. He constantly fell asleep also.

Yes. I simply can't believe that this nurse's performance would be that bad for thirty years without anyone noticing.

That being said, if the OP's description is anywhere near accurate, she cannot be allowed to continue endangering her patients.

OP, has anything been done so far to address the situation?

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Personal issues vs. Burn out? Has to be something right? Was she competent before and now she can't stay awake long enough to think or were you so green that it seemed like she knew her stuff? Has there been a change?

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Or sick? Profoundly depressed? Hypothyroid? Lyme disease? Inappropriate medication for mental health issues? I agree that the deficiencies you described are totally inconsistent with 30 years' experience in ICU, which tells me that there's an acute problem in the mix somewhere. Have you asked her about it?

Bottom line, whether her performance problems are caused by illness or stupidity, she needs to be away from the bedside until they are addressed. There are many ways to go about this, some more compassionate than others.

Or just working Nights for too long?

I worked with an older nurse in ICU. She didn't know ICU as well as the younger nurses who had less nursing experience. She didn't really want to be in ICU but had to accept the job when ICU was opened.

Patient safety comes first, so what do you plan to do?

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Thanks Davey! She has admitted that the manager has spoken to her numerous times about her performance issues. She often leaves hours after her shift and the manager has told her she is too soft for the charge nurse position. She said she has cried in his office before and told him if he doesn't think she is fit for the role (after about 10 yrs as SSN) he could demote her but I don't know what came of that discussion.

Honestly I feel like my hands are tied, the manager knows she has performance issues so what else is there for me to do? I feel like a rat, snitching about her work ethic because she does have wonderful bedside manner, but her clinical acumen is very lacking. *sigh*

Thanks for hearing me vent!

I've never worked ICU, enjoyed reading your well-written post, am an Old Dog,and want to convey my appreciation for your concern, All4NursingRN.

Your concerns need to be addressed through th proper channels, and I sense you know this. Given your well-written post, conveying facts and concerns will be no problem for you.

Lastly, I want to say that we Old Dogs and COBs need to be given feedback on our performance. I am not nearly as sharp as I was 15 years ago when I started at Wrongway Regional Medical Center and realize that I have to think and rethink things and involve my colleagues in decisions because sometimes I don't see the whole forest.

When my day comes, I want to be able to gracefully leave my position. But if I am no longer able to fulfill my duties, I want to be informed of that. I've had my time and am ready to retire whenever need be.

If your colleague needs the same, so be it.

The very best to you, All4NursingRN!

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Does she have trouble with finding her words? Has she always been this way?

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