Sleeping Nurse = No Agency?

[HisTreasure, BSN, RN]

We have (my husband and I on separate occasions) caught one of our night nurses sleeping. The first time it happened, DH saw her on the baby monitor (I was already knocked out!) and he didn't say anything. He just got up to the hall bathroom (even though we have the en suite) and made a lot of noise so she would wake up. I guess she got the hint, because the next morning when I relieved her she told me about how she was coming down with something and may not be back that night. Being a PDN myself, I understood and respected where she was coming from, and just told her to call the agency in enough time for them to find a replacement since I had no day nursing that day and would be exhausted. She ended up calling in sick, we got a new nurse and all was well. We never reported it, and asked her back because we assumed it was an isolated incident. We watched her, and the other nurses on the monitor as indicated for the next few days, and had no real concerns. I trust most PDNs are honest and do a good job. I know I've always tried to do a good job and I never want to be one of "those" parents. I try to see it from the nurse's POV.

Weeks later, I woke up with one of my other children and happened to glance into the room and see the nurse sleeping. Not just dozed off (which I admit, I have done in the past- but not on purpose- and never comfortably) but LAID OUT on the floor (off camera) with Gem's Minnie Mouse throw blanket over her! I took care of my other child, put her back to bed, and when I walked past again, the nurse was sitting up in the chair (red eyes, groggy looking, obviously just woke up). I offered her a cup of coffee, and asked if she wanted to sit in the living room with a monitor to have better lighting. She declined, so I kindly reminded her that there is no sleeping and Gem can turn on a dime, so we needed full eyes on at all times. I don't think I was nasty about it, and I told her I wouldn't report her because I understand sometimes it's hard to stay awake.

Third incident, two night ago (3 days later), on my birthday. I came in from my celebration and went straight to bed. I had been the night nurse the night prior and my family had my birthday full from morning to night. I was EXHAUSTED! Because I fell asleep around 9, I was awake again by 2. I got up to get a drink, looked at the monitor, and didn't see the nurse. When I went downstairs, the nurse was on the couch with the other video monitor, lights low, TV off, curled up on the chaise lounge. At this point, I woke her up and sent her home. I did the rest of the shift and called the agency Monday morning. They said they would take care of it, apologized profusely, and arranged to send more nurses out later this week to interview.

Well, yesterday I get a call from them telling me they would no longer be able to staff my case! We are foster parents. These children aren't mine legally, and I HAVE to have nursing coverage 60% of the week as part of my placement contract. I have 6 kids total. They are not going to allow a medically fragile child to stay in a home with limited nursing coverage! When I asked the nursing director for an explanation re: canceling our contract, she simply said because I overreacted with the nurse and it would be difficult to find nurses who are NEVER going to doze off on night shift. I advised her there had been other incidents, and it was NOT dozing off in the traditional sense. It was sleeping. She told me that being a nurse myself, I was already a harder case to staff because nurses don't want to work in homes with other nurses, and this was proof that I heldthe staff to a higher standard than most parents would. Whatever. I moved over to PSA full time, and some of the best nurses I've had are from there. I just wanted two agencies to try to keep my case fully staffed, which didn't work as planned, anyway.

OK, fellow nurses. Please help me improve. Did I overreact?

[rdsxfnrn]

They are getting paid to work, not to sleep. How would that fly if everyone that was at work decided they were going to sleep on shift? No, You did not overreact.

[eatmysoxRN, ASN, RN]

I'd be angry as well. I'd be fired on the spot for dozing off at work. I don't think you overreacted whatsoever

~ No One Can Make You Feel Inferior Without Your Consent -Eleanor Roosevelt ~

[JustBeachyNurse, LPN]

Grounds for termination and even action on a nursing license. You are not being unreasonable. You wouldn't be able to sleep on shift in LTC or hospital and HH/PDN is no different.

[elkpark]

I don't think you're unreasonable at all. In all the hospitals at which I've worked nights over the years, you would be fired on the spot for even appearing to be dozing. I don't see someone's home as any different -- the nurse is there in a professional capacity, to work. On night shifts, that means being awake/alert throughout the shift. Yes, it's harder at night -- but that's the job.

[nursel56]

OK, fellow nurses. Please help me improve. Did I overreact?

Absolutely not. Your experience is a bit of a twist on the more common phenomenon of agencies selling the nurse down the river over the family who makes capricious demands. Not only that, but I believe they are required to give you a 30-day notice.

What I have observed in the past was that the staffing crunch in many agencies was so bad that night nurses frequently had a full-time day job as well. They considered their presence as a sacrifice on their part, and expected to be suitably accommodated for that, including an acceptance of them sleeping on the job and from the patient's standpoint, hoping to God they hear alarms or cries. Often they didn't. There are some lawsuits knocking about as a result of the consequences of when they didn't.

I have always felt that the PDN job is every bit as important as the day job. If they receive taxpayer funds, I would report them to the state. That agency dismissed you for expecting standard-of-care, when they are supposed to be providing standard-of-care. Gemma's patient rights are being compromised imo.

HUGE like and kudos for being such a concerned and dedicated mom/foster mom.

[Alex Egan, LPN, EMT-B]

Sleeping of any kind results in immediate termination of employment from EVERY agency I have ever worked for. You are being completely reasonable. I appreciate that you understand nodding off happens, it's not acceptable but it is completely different from laying down with a blanket! I would recommend you call your states compliance number and report the agency. They are required to give you notice before discharge and the fact that the director admits his staff routinely sleep is awful. If it is a national chain call corporate compliance as well. It won't make a difference but it at least puts your issues and positions on record.

[LadyFree28, BSN, LPN, RN]

No, in fact you do the RIGHT thing!!!

As a former PDN nurse, nurses who sleep give off the horrible MYTH that we don't give proper care, and "all night PDNs sleep"-seems like the supervisors drink from the same fountain!!

I enjoyed night shift, and did it WELL...some kids have worse nights than others, and being able to make them comfortable and be prepared if ANYTHING happens is a top priority. I am pleased you are able to find more consistent nursing care with one agency.

It is laughable that your were "overreacting." Curled up on a floor or someone's couch was something I was too uncomfortable even to THINK to do. My clients home was the unit to me, and I was assigned to one pt! :)

[poppycat, ADN, BSN]

You absolutely did not overreact! I've been doing private duty for almost 6 years & I would never think of sleeping on the job. ( I'm at work as I write this!) Kids who have private duty nurses have them for a reason & for a nurse to sleep on the job puts the child at risk. This is no different than any other nursing job & I don't know any where it's ok to sleep on the job. I hope PSA works for you. That's the agency I work for & I love them.

[lauriefulcher]

You most DEFINITELY didn't overreact, especially since this wasn't an isolated incident! I am a private nurse but I work through a company. I am trying to go independent because my patient needs more hours and my company will not give her over 30 hours nad she needs more care but I can't seem to find any information on it. Getting back to you, sorry I got off subject, I have 2 kids at home that are in all kinds of programs and my patient needs lots of care so yes I get tired but that gives me NO EXCUSE TO SLEEP ON THE JOB! There are lots of other GOOD nurses begging for work and wouldn't sleep but take care of her patient!

[CloudySue]

I also believe that you did not overreact. I agree with the sentiment of what all other posters have expressed here regarding sleeping on the job.

However, I am curious as to why you have an A/V monitor with the nurse in your field of vision. Don't you trust your licensed nurses, even before this happened? Perhaps the agency cannot find any nurses for you who are willing to work with a camera in the room. My agency has one known case who uses a camera like that. EVERYBODY knows about them and they have a hard time staffing them. Working with a camera trained on me like that would make me highly uncomfortable. I don't even like seeing my image on monitors when you walk into grocery stores, or seeing myself on home videos. I hate the feeling of being watched in department stores on security cameras. I've never stolen a thing, but I feel like Big Brother is always there behind me.

I am an adult and a professional with a license and would appreciate not being spied on throughout my workday. I do my job and I have nothing to hide, but I would refuse to go back to any case where the family wants to watch me in secret. I want to be able to eat my lunch, scratch my boob or pick my wedgie without feeling spying eyes on me. Families check on me occasionally by sticking their heads in the room at any time without warning, and that's perfectly acceptable to me. I had one case once where the camera was angled towards the baby in the crib facing away from where I sat and that didn't bother me. I don't mind an extra set of eyeballs on the baby.

You were interested in another nurse's POV, so this was mine! If I'm misunderstanding the situation, I'm sorry. But just going on what you wrote, if I were a nurse in your home I would probably not stick around, no matter how nice and understanding you are. I simply would never feel comfortable or welcome. Just my two cents. That said, put the camera away or angle it differently, and I'd be the best nurse you ever had. Pour me some of that coffee!

[joanna73, BSN, RN]

I can understand occasionally closing eyes or nodding off. However, actively sleeping on the job for extended periods is dangerously unsafe. What's the point of paying someone to care for a child if they are irresponsible? Too bad if they're tired. Don't work the night shift then. You aren't paying someone to sleep.