What constitutes a bad nurse?

allnurses Guide · Apr 3, 2019

There is black, there is white and there is the continuum in between. The only truly bad nurse is the psychopathic nurse that does bad things to vulnerable people on purpose. Ie: the nurse in Tyler, Texas injecting air into arterial lines of people. That's a bad nurse guilty of murder.

I think most nurses are somewhere north of that by quite a bit. Those who are without good self assessment skill and/or willingness to self assess are further gone than those who are willingly taking a look at their practice, their mindset, their weaknesses, their prejudices, etc. Lack of self assessment still doesn't make them a bad nurse, but it may make them someone who ought to be doing better. It could make them pretty close to a bad nurse if not doing self assessment is purposeful. I would add that not staying on top of best practice is probably also not ideal.

Snatchedwig, BSN, CNA, LPN, RN · Apr 3, 2019

9 minutes ago, not.done.yet said:
There is black, there is white and there is the continuum in between. The only truly bad nurse is the psychopathic nurse that does bad things to vulnerable people on purpose. Ie: the nurse in Tyler, Texas injecting air into arterial lines of people. That's a bad nurse guilty of murder.
I think most nurses are somewhere north of that by quite a bit. Those who are without good self assessment skill and/or willingness to self assess are further gone than those who are willingly taking a look at their practice, their mindset, their weaknesses, their prejudices, etc. It still doesn't make them a bad nurse, but it may make them someone who ought to be doing better.

Wow @ air in the line

I like how you mentioned self assessment. I am in a point in my professional and personal career where i am just constantly second guessing myself. I have 1 month to go until i graduate with a ASN. I am struggling with that fact right now.

allnurses Guide · Apr 3, 2019

Second guessing is definitely not the same as self assessment. One is anxiety driven. One is an objective/subjective gathering of data to reach nonjudgemental but honest conclusions that impact patient safety and safe practice.

Snatchedwig, BSN, CNA, LPN, RN · Apr 3, 2019

Heres an example that stuck with me for a little. A few weeks ago i came to work and my patient blood pressure was 60/40. Consulted with the dr to get IV fluids and labs on board, ran it wide open. No significant increase in blood pressure. Albumin ordered--- no significant change. Labs came back hgb 6.1 or something like that. 2 units of blood transfused and patient stabilized. I went home stressed and proud at the same time. Next week i had an exam on similar hemodynamic instabilities and didnt do so well on the exam considering (barely passed). This really messes with my mind and emotions. Im competent enough for practical use but not theory?

Totally didnt want to derail thia thread into a therapy session. Still wanna know peoples own definition of good/bad nurse.

Mr. Murse · Apr 3, 2019

I think what defines a good/bad nurse should probably be divided into two main categories: clinical and social.

I've known a lot of nurses over the years who were not very clinically savvy nurses. In other words, they had poor critical thinking skills, often made questionable decisions and sometimes were just downright scary. Yet often these same nurses have a great bedside manner and patients love them.

So clinically, while I hate to call someone a bad nurse, they were at the very least not the most competent and confidence inspiring nurses, but the patients may have loved them and thought they were great nurses, being blind to the risks the nurse may have been posing to them.

On the other hand, I've known super smart nurses who had terrible rapport with patients and other staff. These were the kinds you might want around during a code or complicated situation, but they might say something inappropriate or embarrassing while cleaning up a patient. Often they might have run ins with patients and other staff, but you would rarely question their clinical judgement.

In the first example, said nurse might be a bad nurse clinically, but a good nurse socially. In the second, they're a bad nurse socially but a good nurse clinically. Then, of course, you have those occasional nurses that are good at both or bad at both too.

Either way, there's a large degree of subjectivity in defining this kind of thing, but I personally worry most about clinically lacking nurses. It doesn't matter if Granny in room 12 loves you if you don't understand how to keep her alive or why she's even in the hospital.

Snatchedwig, BSN, CNA, LPN, RN · Apr 4, 2019

On 4/3/2019 at 9:00 AM, Mr. Murse said:
I think what defines a good/bad nurse should probably be divided into two main categories: clinical and social.
I've known a lot of nurses over the years who were not very clinically savvy nurses. In other words, they had poor critical thinking skills, often made questionable decisions and sometimes were just downright scary. Yet often these same nurses have a great bedside manner and patients love them.

So clinically, while I hate to call someone a bad nurse, they were at the very least not the most competent and confidence inspiring nurses, but the patients may have loved them and thought they were great nurses, being blind to the risks the nurse may have been posing to them.
On the other hand, I've known super smart nurses who had terrible rapport with patients and other staff. These were the kinds you might want around during a code or complicated situation, but they might say something inappropriate or embarrassing while cleaning up a patient. Often they might have run ins with patients and other staff, but you would rarely question their clinical judgement.
In the first example, said nurse might be a bad nurse clinically, but a good nurse socially. In the second, they're a bad nurse socially but a good nurse clinically. Then, of course, you have those occasional nurses that are good at both or bad at both too.
Either way, there's a large degree of subjectivity in defining this kind of thing, but I personally worry most about clinically lacking nurses. It doesn't matter if Granny in room 12 loves you if you don't understand how to keep her alive or why she's even in the hospital.

So in your terms would you rather be considered good by social or clinical terms?

ruby_jane, BSN, RN · Apr 4, 2019

On 4/3/2019 at 7:24 AM, Snatchedwig said:
Wow @ air in the line
I like how you mentioned self assessment. I am in a point in my professional and personal career where i am just constantly second guessing myself. I have 1 month to go until i graduate with a ASN. I am struggling with that fact right now.

I think this feeling's pretty normal until you have some experience under you. You're already an experienced LPN. You're now dealing with the additional duties that come as an RN. No amount of "LPN-ing" is going to prepare you to RN. That comes with time. And sometimes that comes with doing the best you can until you learn how to do better. Good luck!

Sour Lemon · Apr 4, 2019

19 minutes ago, Snatchedwig said:
So in your terms would you rather be considered good by social or clinical terms?

You really have to be both. There's that really annoying saying ...they don't care how much you know until they know how much you care.
Anyway, if you're worried about yourself, I would say you're one of the good ones. That's the impression I get, at least ...and I'm not one to be encouraging for the sake of protecting anyone's feelings.
Another great quality is knowing what you need help with. Ask someone diplomatic to join the conversation if you have a difficult patient and things seem to be going south. Ask for guidance with regard to clinical decisions when you're not 100% sure, too.

TriciaJ, RN · Apr 4, 2019

On 4/3/2019 at 5:44 AM, Snatchedwig said:
Heres an example that stuck with me for a little. A few weeks ago i came to work and my patient blood pressure was 60/40. Consulted with the dr to get IV fluids and labs on board, ran it wide open. No significant increase in blood pressure. Albumin ordered--- no significant change. Labs came back hgb 6.1 or something like that. 2 units of blood transfused and patient stabilized. I went home stressed and proud at the same time. Next week i had an exam on similar hemodynamic instabilities and didnt do so well on the exam considering (barely passed). This really messes with my mind and emotions. Im competent enough for practical use but not theory?
Totally didnt want to derail thia thread into a therapy session. Still wanna know peoples own definition of good/bad nurse.

From this post alone, I feel confident that you are a good nurse. You care about learning your theory, you care about properly assessing the patient and acting on what you know to achieve the best outcome. You care enough to question yourself and look for ways to improve. You really have it covered.

As far as doing less than stellar on an exam - there are a lot of reasons for this, none of which has to do with your knowledge level. Sometimes the questions are just worded stupidly. The questions are also based on the assumption that you don't have more than a certain knowledge base. So you have to answer based on what a novice would know. If you are already practicing, you know in reality you would need more information than the questions provide. So when answering, you have to second-guess what they're probably looking for, rather than what you actually know. Clear as mud?

Forest2 · Apr 4, 2019

Interesting thoughts here. I would rather be taken care of by a highly competent and knowledgeable nurse than someone that puts on a good bedside show. I once worked with a nurse that had fantastic bedside manner, the patients loved this nurse, but this nurse was near incompetent.

I also know of a doctor that if I ended up critical in ER he would be the one I want to take care of me. However, he is obnoxious to nurses.

A good nurse is competent and has a pleasing demeanor. A bad nurse is incompetent and has a terrible attitude. If you have concerns about yourself, then I would say you either are a good nurse or have great potential.

On a funny note, I was working with an aide once, she was a great aide, great personality and a very hard worker, team player. We were taking care of a female with a foley catheter and the patient needed to separate her legs, this patient was well known, knew us well and we knew her well. Said aide says to patient, "spread your legs, you know how to do that, you've got kids". I nearly chuckled and I might have, the patient laughed and I said "_______ don't say things like that." But thinking back on it and it has been a few years. I smile.