What else can be done about a nurse sleeping on duty??

I work as a charge nurse in an ICU. I am having a problem with a nurse sleeping while on duty. I'm not talking about sleeping while on her 30 minute, unpaid break but rather, sleeping for hours at a time, every single shift. She doesn't let anyone know, she just disappears into the computer room at the back of the unit or into the family conference room and sleeps. Her patient's end up being horribly neglected all night as a result and the other nurses on the unit end up picking up her slack by having to answer her call lights or silencing her pumps. Not too long ago, one of her patient's coded and, while I have no proof of this, I strongly suspect she was sleeping just before it happened. 

I have spoken directly to her about. I wake her up every time I find her sleeping. I have went to management about it. Nothing works. It seems like management couldn't care less about the situation and, since she keeps getting away with it, the behavior continues. I have no idea what to do about it now. I just feel like eventually a patient is going to be harmed and/or will die as a result of her sleeping. What would you do in this situation? 

Management may need more proof. If they aren’t willing to come in, call the house supervisor when she is sleeping. In their position, they may have more pull if they catch it and see themselves what is happening. If an employee is in a specific shift and can’t perform the duties they should be moved. A night shifter should be moved to days. Many places employees can be fired for sleeping on duty and reported to the board for negligence. It sounds as if your management doesn’t want to deal with it so I personally would escalate. 

Specializes in Rehab/Nurse Manager.

At first I was thinking that this nurse probably needs to be fired but then realized you probably aren't in the position to do so.  She also may have health conditions that you likely wouldn't know about that may be causing continuous episodes of sleeping during her work shift, or isn't getting enough sleep at home for various other reasons.  Regardless, it is a safety issue, especially considering the unstable patients she would be working with, and should be pursued.  

Is it possible to have a witness with you the next time you find her sleeping? Maybe a second person would help in that they could write a statement, etc and verify that this person is, indeed, sleeping during her shift.  Or call the manager right away when you find her the next time.  If all else fails, I agree with some other posters that discussing the situation with your bosses' managers may be the next step. 

Good luck

Specializes in ICU/ER/Med-Surg/Case Management/Manageme.

I'm really not clear on all the comments about videotaping, calling her each time her patient needs something, etc.  I can overlook many things - judgement errors, decision errors,  need for additional training, coaching or education - but this is none of those. You say you've gone to management but they've done nothing.  Not intending to be offensive, but have you "whined" to management or have you actually submitted a serious complaint?  An occurrence report?  

First, as charge nurse, you have a great deal of responsibility to all patients in the unit as well as all other staff in the unit.  But especially her patients!  You are placing everyone, including yourself, in jeopardy by not making necessary waves to get this situation immediately corrected.  Personally, I would immediately provide the nurse manager with written documentation and forward a copy to the DON.  You need specific dates/times.  If other staff are aware they may or may not join you in signing the letter.  I'm not an attorney, but I really think you would have some liability if something tragic happened while you were aware but not pursuing every avenue to have this resolved.  Could be misconstrued as you trying to protect her.  Sleeping could be the result of simply not getting enough sleep at home, caring for children during sleep hours, a medical condition, or even drug use.  No matter the cause.  Protect your patients, your other staff, yourself. 

7 hours ago, RN2B21 said:

I would handle it as much as you can if she is nowhere to be found and then document in the chart “this nurse handled situation, patients primary nurse made aware of situation once found. Primary nurse was sleeping in conference room (or wherever you found her sleeping)”.

Absolutely not. This is not an appropriate use or function of a patient's chart.

I am surprised at some of the replies.  Creativity is not required for this situation; it needs to be immediately forwarded to house supervision at each incidence. Don't even look for her--let house sup go on the hunt for her and find her sleeping. Call them back next time you can't find her, too.  If they argue I would go as far as calling the executive/admin on-call, who would be the person above house sup. Fill out incident reports PRN.

A charge nurse typically is not given the authority to discipline coworkers. So go straight up the chain of command without delay when a coworker is this negligent. That is all.

 

I'm amazed she still works there and is comfortable enough to sleep AFTER a patient coded while she was away sleeping. I'm also amazed at having enough time to sleep in the ICU where alertness is a must because patients are already super high risk and can go left at any given moment. Is this new behavior or you being fed up with the usual behavior? She's super comfortable with sleeping and has even appeared to have a routine. How has this gone on for so long? What are the other nurses on the unit saying? People have to be fed up with the constant need for coverage while she sleeps.

Some people who get away with things become aware at some point that they are fair haired, their situation is golden, or both. Many will flaunt their behavior, to include the illegal. Get away with it today, do it tomorrow.

I have been a house supervisor and an ICU manager, and a legal nurse consultant. Report her to the house supervisor. Also, follow up with an email, cc'ing the CNO. This is patient abandonment, pure and simple. It is grounds for immediate termination. The hospital is legally responsible for the actions of this nurse if something happens to the patient. The offending nurse, charge nurse, manager can also be sued separately and as employees of the hospital if something catastrophic happens. Having a paper trail helps you defend yourself. 

Specializes in ED, Tele, MedSurg, ADN, Outpatient, LTC, Peds.

Wow! That's crazy!

Page the night supervisor, "Tell them you can't find the nurse" and follow up with an email to the nurse manager as part of shift report.

Request for a meeting of the manager and all night staff to discuss this issue.

 If this continues, bump it up to compliance  as a safety concern. Make sure everything is documented.

 Has anyone sat down with her and asked her why she is sleeping when she is supposed to be working? Is there a family issue that she's up all day, is she working 2 jobs, is she on drugs or having a medical issue requiring meds that make her sleepy? Does she have a friend there who can talk to her honestly about this issue?

It is grounds for instant termination in many institutions.

 Hope things get straightened out soon!

Specializes in Geriatrics, Dialysis.

I agree with those that say it's time to aggressively move this up the chain of command, with fair warning. Next time you work with sleeping beauty let her know you need to be updated if she leaves the floor and if at any time she can't be can't be reached you will be contacting your supervisor. Then do so.  Every time.  Let it become the house supervisor's job to hunt her down and find her sleeping.  I can't imagine why your manager has allowed this to continue as long as it has. It's time to get other people involved and calling in the house supervisor seems to be the logical next step.

On 12/16/2020 at 12:38 PM, cynical-RN said:

I am not sure about videotaping her. I doubt that is in your job description as charge nurse. I heard a story of someone who did that and the person being videotaped said she was praying and sued for violation of privacy or something akin to that. America is a highly litigious society. Be cautious with some of the unthinking advice you might be given herein. You have reported it. Let the buck stop where it should appropriately stop. 

I recall that case.  I thought then, and still do, that she ought to pray on her breaks.  If I remember correctly, she was sitting on the hallway, visible to all, with her eyes closed, maybe even covered up with a blanket, appearing for all the world to be SLEEPING.  It was at a VA facility, yes?

In this current case, I really wonder what is wrong with the Manager.  If I were the Manager, I would get this wench gone as fast as I possibly could - maybe transfer her to Days so I could keep an eye on her.  No doubt she has some horrid trouble at home and I would feel some compassion for her, but not nearly to the extent that now exists.

Maybe she and the Manager are sleeping together?  Or they are related or something like that?

I do like the idea of an anonymous letter to the Board and maybe first to the Manager's boss.  These people can turn on you and grind you up, so protect yourself.  Does it bother your coworkers enough to get them to speak up, even if anonymously?

If the possibility of patient harm didn't exist, I would say stop titrating her drips, answering her lights, etc.   Please don't let anything bad happen. 

I don't know what to advise in a case like this except get the House Sup and the Manager's boss and Admin and the Board involved ASAP.  Anonymously or as a group.  

Talk to a couple of lawyers about the legality of videotaping this person sleeping on duty.  

I really wonder why your Manager isn't jumping on this.  Could you possibly be mis-perceiving it?  Of course, your Manager would have no way of knowing that, as she isn't there on your shift.  So back to my previous advice.  Good luck. on your shift involved the minute you find her missing in action or see her somewhere appearing asleep.

You could crash some cymbals behind her.  Or blare Reveille on the trumpet.  Just kidding.  She'd probably sue you for assault or something.  Just involve the House Sup, your boss again, and maybe the CNO for starters.

Good luck.  This will end, you just have to be persistent.

On 12/26/2020 at 10:52 AM, RN2B21 said:

Since management refuses to step in and protect the patient, next time a patient of her experiences an adverse event (codes, falls, etc), I would handle it as much as you can if she is nowhere to be found and then document in the chart “this nurse handled situation, patients primary nurse made aware of situation once found. Primary nurse was sleeping in conference room (or wherever you found her sleeping)”. Then leave it at that. Let management see that documentation in the legal chart and see if they change their tune. 

No, no, no, and no.  The chart is not the right place to fight this battle.  

And do you actually want there to be a code, fall, whatever type of pt harm? 

No.  Sorry, your advice is totally wrong.  Not only are you "hoping for" terrible harm to the patients, but you are also suggesting that there is no more immediate, safer way to approach this.

Hopefully, you see that your suggestion is not right.

2 hours ago, amoLucia said:

You're kidding, right? This would DEFINETLY be 'the kiss of death' for OP.

Kiss of death could be her not doing it because her boss could say you should have let me know when things go south.. This is serious. At this point she is left no other choice. Either this or do nothing at all. Moving things up the ladder will require her to say I informed my boss but nothing happened. If she let that nurses pts crash she would be fired with the quickness and the boss would act like she didn't know of the situation with sleeping beauty. Trouble is bound to find her if she lets her manager allow this behavior and yes it will get out that she reported her even if it"s anonymous. There are other hospitals or healthcare facilities if she needs to find another job but only 1 clean nursing  license.

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