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Seasoned ICU Nurse Lacks Critical Thinking

Nurses   (6,147 Views | 34 Replies)

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Mavrick has 30 years experience as a BSN, RN and specializes in 15 years in ICU, 22 years in PACU.

1,576 Posts; 24,142 Profile Views

I was having episodes of nearly falling asleep while I was charting. Then I noticed I was having a really hard time falling and staying asleep at night.

Finally connected that with my increased use of Tramadol (for my RA pain). Stopped the Tramadol and now use acetaminophen/naproxen. Narcolepsy-like symptoms have disappeared. It was so weird though, to feel like if I didn't constantly keep my mind active I would fall asleep in the middle of the day.

If this is new behavior for your SSN, I would be concerned for her deteriorating mental function. She needs a medical check up.

If this is old stuff that your unit is just now noticing, your manager needs to do her job and and reassign this nurse to what her skill set can handle.

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1,763 Posts; 20,600 Profile Views

My hospital is pretty strict with making sure nurses get their 30 minute break. If you miss it more than twice it becomes a discipline issue, for the nurse and the charge nurse. Depending on how I'm feeling I sometimes take a lap around the building to get some fresh air, or I take a 27 minute nap. I feel great after either one. I'm fortunate that my facility sees the importance of getting nurses off the floor regularly, I wish every work environment was as committed to ensuring their nurses get proper breaks. It benefits my coworkers and our patients.

I bet the nap does help a lot. I have a really hard time falling asleep during the day and usually just get about 4 hours of sleep before a shift, but once I'm on my shift I feel way too wound up...there's no way I would even be able to fall asleep. That's great that you also work at a facility that makes sure nurses get their breaks! My charge nurse and manager will come up and ask nurses if they've had it and encourage them to take one once 0200 is rolling around. Pretty happy with my hospital! I feel lucky.

(Sorry OP for that mini-hijack!)

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Been there,done that has 33 years experience as a ASN, RN.

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My management actually encourages night nurses to take a 15 minutes nap during the shift because studies have shown (according to them) that this improves outcomes. Now, not a single nurse in my short career thus far has taken a nap during shift because nobody has time for that lol.

I agree nurses should be allowed to sleep on their break. That does not apply in this case.

"she is notorious for sleeping on the job constantly falls asleep at the desk ".

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230 Posts; 2,835 Profile Views

Maybe she is not a night shift person? I worked nights for 2 years and always stayed awake, I worked with others who would fall asleep because they were night sleepers. Maybe a switch to days would help the sleeping on the job issues but mist likely would highlight her performance issues while the powers that be were watching.

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SafetyNurse1968 has 20 years experience as a ADN, BSN, MSN, PhD and specializes in Oncology, Home Health, Patient Safety.

12 Followers; 56 Articles; 356 Posts; 19,008 Profile Views

I have worked in this icu for 2 years and she has always been like this. The culture of my facility is very lax and people just cover things up until something happens.

At first I thought maybe she was working multiple jobs or had little kids but she doesn't have multiple jobs and her son is a pre-teen??

I thought perhaps she is diverting as well but i don't know but I believe she's either on some medication that makes her sleepy or she perhaps she has a disorder like some have stated.

I have spoken to my manager about the work ethic of a nurse without naming names out of months of concern, he kind of shrugged it off eluding to the that some just have better experience than others??? But that he understands my concern.

For now I'm just keeping a paper trail of everything.

I applaud your concern over patient safety. My concern is also for your safety. If you work in a facility that is "lax" (has your facility ever taken a safety attitudes or safety culture survey? If so, what are the scores?) you are putting yourself and your license at risk. Error can happen to anyone at any time, and is even more likely to happen when there aren't adequate systems in place to support patient safety. The impact an error can have on not only the patient, but the nurse can be devastating, and I would hate for you to experience the loss of self-confidence and shame that can go with being involved in an error. One thing you could do that I haven't seen mentioned here is contact your board of nursing. The board can be a huge support to you in this situation, and contacting them is yet another proactive thing you can do if issues come up in the future. Please contact them and let them know all the details, and please consider looking for work elsewhere. Until you can get out of the situation, documenting everything in great detail is your best defense.

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377 Posts; 13,564 Profile Views

Wow you're really lucky indeed! I wish my facility showed some care for our break times.

I bet the nap does help a lot. I have a really hard time falling asleep during the day and usually just get about 4 hours of sleep before a shift, but once I'm on my shift I feel way too wound up...there's no way I would even be able to fall asleep. That's great that you also work at a facility that makes sure nurses get their breaks! My charge nurse and manager will come up and ask nurses if they've had it and encourage them to take one once 0200 is rolling around. Pretty happy with my hospital! I feel lucky.

(Sorry OP for that mini-hijack!)

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377 Posts; 13,564 Profile Views

Thank you your suggestions are very good. Yes our hospital culture is very lax with very high administrative and unit manager turnover. I plan on leaving in another 2-3 years because I'm in school and have other obligations. I may change units within another year or so, probably PACU or cath lab. Im ready to step away from bedside honestly but that's another issue lol.

They send out employee surveys every year but I don't ever remember getting the results.

I applaud your concern over patient safety. My concern is also for your safety. If you work in a facility that is "lax" (has your facility ever taken a safety attitudes or safety culture survey? If so, what are the scores?) you are putting yourself and your license at risk. Error can happen to anyone at any time, and is even more likely to happen when there aren't adequate systems in place to support patient safety. The impact an error can have on not only the patient, but the nurse can be devastating, and I would hate for you to experience the loss of self-confidence and shame that can go with being involved in an error. One thing you could do that I haven't seen mentioned here is contact your board of nursing. The board can be a huge support to you in this situation, and contacting them is yet another proactive thing you can do if issues come up in the future. Please contact them and let them know all the details, and please consider looking for work elsewhere. Until you can get out of the situation, documenting everything in great detail is your best defense.

Edited by All4NursingRN

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247 Posts; 5,490 Profile Views

30 years of experience that's an awesome feat.

Something obviously is not right just as others pointed it out. From my perspective, I see her as being burnt-out and has had enough. Thus, losing control.

I hope this RN you're describing gets the help she needs before something truly bad happens to her patients and upon herself!

You can be a big help by notifying the head honchos in your department!

Easy Fix! Easier said than done, cause it is.

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377 Posts; 13,564 Profile Views

Update: Turns out she is leaving the ICU before the end of the year for a clinic position (very sudden departure) she doesn't seem happy though and is a bit withdrawn lately. She has been getting called in to the managers office quite a bit as of late so I don't know if her departure is any result of that.

I'm surprised she is taking a position where she will lose her seniority and title so I believe she maybe was forced out or at least felt that way and sought greener pastures. Sad. It must be hard to leave the people you have worked with for 20+ years, we are planning a little party for her, I wish her the best.

Edited by All4NursingRN

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132 Posts; 3,527 Profile Views

It could also be she no longer wants to be there and is doing any and everything to not be involved. Someone needs to bring the sleeping on the job, her not be involved in her own patients critical care needs to the attention of the Managers and Administration before someone actually dies under her care. People usually know when they become a hindrance rather than a helper on any job. Being brave enough to acknowledge that takes courage.

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HazelLPN has 54 years experience as a LPN and specializes in Adult ICU/PICU/NICU.

487 Posts; 17,977 Profile Views

The great Bette Davis, one of my favorite actresses when I was a little girl, said once "Getting old ain't for sissies!"

There's nothing good about getting old once you realize that you can't do what you used to do as well as you used to do it.

You get to the point where you know that you can't do the job as well as you used to. I worked in the ICU for over 40 years before I bowed out. In my case, it was my knee that was the problem. I didn't move as fast as I used to. I began dreading when I had to travel off unit with a patient to CT or MRI with a bunch of pumps.... or even transferring them to the floor with very little. I am happy to say that my care never suffered, right up to the end but I knew that If I continued for much longer that my care would not be up to MY standards. Facing knee replacement surgery and a long recovery period...not to mention that I was 75 years old at the time...I knew I wouldn't be back after my surgery. They all said I would be back...I'm not sure if they really thought that or they wanted me to feel good about myself. When I went in for my last shift I said to myself "This is it....soon it will be finished."

I feel for your coworker. However, I don't think it was that she lacked critical thinking. You don't work in ICU 30 years without being good at it. She has some kind of problem. Heath problem, family problem, burn out problem....we don't know. That's why she's leaving....not because she simply lacks "critical thinking." I'll be you anything she knew there was a problem long before anyone else did. That's how it usually happens.

In time, she will learn that there is life after critical care nursing. After I retired, I immediately had my knee replaced. I still have to walk with a cane occasionally when I go up stairs or when I have to walk a long way...so I could never return to the hospital again. However, I am STILL active as an LPN. Not in the ICU or a hospital...but as a substitute assistant school nurse caring for special needs students. I love it. I work very little but am glad that I can still work at an age when some people can't even tie their own shoes.

I hope she loves her job in the clinic and finds happiness in nursing again and whatever ails her will be taken away from her.

Best to you both,

Mrs H.

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