Had an interesting situation that came up and thought I'd throw it out for discussion.
One of our staff RNs was found sitting in a chair and sleeping at the bedside of one of our ventilator patients at 7am. She tells me that the patient was very restless and they had been constantly watching him throughout the night shift because of the fear of him pulling his trach out. They found he would settle down when someone sat with him and held his hand (how basic can nursing care get?). So, periodically during the night different staff members sat at his bedside. The nurse in question says that at 5am she had caught up on all her charting and told her co-workers that she was going to sit down in the room with the patient. She sat down, took his hand and he immediately quieted down. She sat back and the next thing she knew someone was waking her and telling her it was 7am. She jumped up and worked on giving her 6am meds and ended up giving an oral report to the oncoming shift (we tape report).
A very serious decision has to be made here. This is a really excellent nurse and I'm afraid there will be no choice but to fire her and report her to the Board of Nursing. I understand that she did not intend to fall asleep and that she was helping the patient, but rules are rules, aren't they? How I wish this hadn't been reported. Our facility rules clearly state "no sleeping on the job". Our Human Resources Office and the Director of Nursing will make the final decision. What do you all think?
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
Lets look at the salient points from OP:
1. Patient was very restless.... constantly watching him throughout the night shift because of the fear of him pulling his trach out....found he would settle down when someone sat with him and held his hand.
2. Periodically during the night different staff members sat at his bedside.
3. Nurse in question says that at 5am she had caught up on all her charting and told her co-workers that she was going to sit down in the room with the patient. She sat down, took his hand and he immediately quieted down
4. She sat back and the next thing she knew someone was waking her and telling her it was 7am.
5. RN was found sitting in a chair and sleeping at the bedside of one of our ventilator patients at 7am. This is a really excellent nurse.
6. Facility rules clearly state "no sleeping on the job."
I've been involved in similar situation on nights caring for restless vent dependent patient, sitting at a bedside + holding hands to calm patient with heavy eyelids...
Working nights on a unit with vents, patients are rarely left alone for two hour intervals---usually someone is in: RT, aide, lab, primary nurse etc., but those golden moments of uninterrupted time do occur.
When faced with exact same situation I looked at INTENT.
1. Was RN deliberately sitting in chair in the room to catch some sleep (wrapped up in blanket hiding behind curtain as I'd seen a fellow nurse do on more than one occasion)? NO
2. Was the RN providing care? YES
By using "therapeutic use of self" she had calmed a restless patient and prevented trach dislogement, thereby maintaining airway.
3. Where her patients truly abandoned? NO. Other staff were on the floor, she informed them of her whereabouts, most likely expecting they would keep an eye on her patients, as she probably did theirs while they sat with this patient.
I've had as many as 6 vented patients by myself on nights as LPN and RN on Resp/Telemetry unit working 12/12. Sometimes you get busy with a critical situation and don't get to fully assess other patients for 2 hour intervals. Staff on floor are always attuned to listen to the vent sound/alarms and glance at hallway tele monitor (old days). Are those patients abandoned cause I didn't see them for two hours: NO. Same applies here.
When we'd have a patient like this or knew other staff had major disaster brewing, I'd usually stick my head in the room every now and again to make sure they weren't drowning. There could be a dozen reasons why other staff didn't come in room: busy with own patients, maybe this RN was patent's primary nurse so no relief expected.
A lot boils down to who found the RN asleep. The one time I found my partner nodded off sitting with patient after several brutal nights, just woke her up eyes closed only few minutes and she was able to spring into action.
Fifth time I had another RN tell me it she was napping as her patients quiet, had refused to assist restarting difficult IV for me (she was unit expert) and I'm tearing my hair out, well that patients chart I needed to review with supervisor just happened to be on the table in our conference room where she was sleeping and the supervisor observed her that way for over 30 min.
RN was contrite over incident.
For this type occurrence, my recommendation is same:
However, I'd keep report in my personal files for 1-2 years, only send to HR if repeat incident.
If other type staff involved that found patient, I'd carefully discuss with them situation, RN apology and that disciplinary action taken. PERIOD---never tell what that action is.
Hopefully this coolingoff interval will bring back focus to the case and not posters and my comments provide food for thought.
I understand "most" people adjust to night shift, but what about the other's that are in a position in which the facility dictates they work 2 weeks of days and 2 weeks of nights on a continuous basis? Talk about brain dead.
This was the case at a very large hospital I worked at in Ohio as a new nurse. I worked for 2 years, 2 weeks of day shift and then 2 weeks of night shift. I was an absolute wreck (nauseous and mentally fatiqued) on night shift, no matter how much sleep I got that day or how much coffee I drank throughout the night. I begged and pleaded to be placed on straight day shift or even evenings but was told I had to do my time and only nurses with the highest seniority could work chosen shifts. I had to quit in order to regain my life, mind, emotional sanity and health back. THIS IS A TRUE STORY!! I feel it is a facilities responsibility to take care of their nurse's and this may mean looking into ways to restructure work hours or being more sensitive to scheduling needs or desires of individuals.
P.S. when I asked "why" this facility made nurses work these ungodly day/night rotations the answer I got was because that is the way they have been doing it since the 50's... There may have been a reason to start this type of shift work in the 50's but that doesn't mean we need to keep a bad tradition in place does it? AND they still do this today!!
I understand "most" people adjust to night shift, but what about the other's that are in a position in which the facility dictates they work 2 weeks of days and 2 weeks of nights on a continuous basis? Talk about brain dead.
This was the case at a very large hospital I worked at in Ohio as a new nurse. I worked for 2 years, 2 weeks of day shift and then 2 weeks of night shift. I was an absolute wreck (nauseous and mentally fatiqued) on night shift, no matter how much sleep I got that day or how much coffee I drank throughout the night. I begged and pleaded to be placed on straight day shift or even evenings but was told I had to do my time and only nurses with the highest seniority could work chosen shifts. I had to quit in order to regain my life, mind, emotional sanity and health back. THIS IS A TRUE STORY!! I feel it is a facilities responsibility to take care of their nurse's and this may mean looking into ways to restructure work hours or being more sensitive to scheduling needs or desires of individuals.
P.S. when I asked "why" this facility made nurses work these ungodly day/night rotations the answer I got was because that is the way they have been doing it since the 50's... There may have been a reason to start this type of shift work in the 50's but that doesn't mean we need to keep a bad tradition in place does it? AND they still do this today!!
Not everyone can adjust to nights. But if that position is accepted, it's expected you stay awake.
I finally had to leave night shift after 13 years, I finally couldn't take it anymore.
Most people do indeed adjust, several thrive, but there is fatigue on the night shift, I saw it many coworkers all the time.
I used to rotate shifts too...hated it. Count me in as one who didn't adjust to rotating shifts.
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
Gosh, there is making a mistake, and there is sleeping on the job!
If you are not able to stay awake during your shift, then you should not be working! Your responsibility is to be a safe practioner to your pts. If the night is too hard to work, then speak up to your boss and get traded to days. Gees, imagine being the agitated pt: Imagine looking over and seeing your nurse asleep!! And, BTW, this wasn't a little nap-this was a 2 hour nap! Someone had to wake her up! Totally and completely unacceptable...[/quote
Cardiac,
I must share that there are times in a ICU when intubated patients truly want to feel a physical presence in the room so they know they are alive. I am sure that when she first went into the room it was not with the intent to fall asleep. A dark quiet warm enviroment can make anyone doze off. The rhymic soumd of the vent and finally the patient who had been the bane of everyone existance that night is finally quiet. Share if you have ever not known how you got home after working 2 -12 hour shift in a row, made dinner, washed a couple loads of clothes and baked cookies for your 6yo's party. Have you ever been driving after a night shift and had to open the window in a blizzard just to stay on the road! Or don't remember if you stopped at the traffic light? I know I have actually fallen asleep behind the wheel at a RR crossing or at a dead stop in traffic in chicago on the dan ryan or on 128 in boston. Only to be rudely awaked by some irate driver blowing their horn furiously and flipping me off!! Should have been driving? NO! but I also needed to get home to meet the bus! Man is not NOCTURNAL it is not a natural state. I agree it is not "acceptable" but it is not such a grevious act that she should lose her liscence.!! "TO ERR IS HUMAN TO FORGIVE DIVINE" Even as a supervisor when I finally sit down in the morning to do staffing with the staffing sec. We have both closed our eyes, not realized it pencils in hand bolt upright in the chair... to be awakened by the ringing phone. It is the responsibility of the charge nurse to be aware of her staff and to check upon them if they are missing. I will lay a paycheck on the line that the rest of the staff was so relieved that the patient was finally quiet and stopped being disruptive :yelclap: that they never noticed until the nurse who actually had the patient did the one last check and found her...asleep:sleep: (been there done that) I am sure that if she went in after "several staff members" had been ther also her patients were being watched as they would if she went on break or lunch. If I traded everyone to days that c/o of being tired I would never have a night shift!! You will be entering the profession soon and I need you to feel compassion and understanding to your peers because that shows me that you will be able to show compassion to your patients from a diversified background. You WILL encounter things and ways of life or someones decision that you do NOT agree with and goes against your very core of beliefs. ......it is compassion and understanding that you need to have...it's TOLERANCE that is imperative!!!! Serious offenses are serious but it is our job to help change them or help them through whatever it is they need. To help them realise the gravity of what they have done....remorse is huge with me. I agree that there is a level of expertise that we need or a standard that needs to be followed but.....we also need to stop eating each other alive!!!! Just food for thought.....I'll get off my soap box.:chair: Besides if the patient was that agitated I and intubated I bet you that even if he looked over at the nurse he was just relieved that someone was ther holding his hand!!!! :redpinkhe
Not everyone can adjust to nights. But if that position is accepted, it's expected you stay awake.
I finally had to leave night shift after 13 years, I finally couldn't take it anymore.
Most people do indeed adjust, several thrive, but there is fatigue on the night shift, I saw it many coworkers all the time.
I used to rotate shifts too...hated it. Count me in as one who didn't adjust to rotating shifts.
I did a float shift for one year and then switched to nights. I feel for the nurses who do have to rotate shifts, that is hard, I have been there. However, as Tweety says, if the position is accepted then it's expected you should stay awake.
Gosh, there is making a mistake, and there is sleeping on the job!
If you are not able to stay awake during your shift, then you should not be working! Your responsibility is to be a safe practioner to your pts. If the night is too hard to work, then speak up to your boss and get traded to days. Gees, imagine being the agitated pt: Imagine looking over and seeing your nurse asleep!! And, BTW, this wasn't a little nap-this was a 2 hour nap! Someone had to wake her up! Totally and completely unacceptable...[/quote
Cardiac,
I must share that there are times in a ICU when intubated patients truly want to feel a physical presence in the room so they know they are alive. I am sure that when she first went into the room it was not with the intent to fall asleep. A dark quiet warm enviroment can make anyone doze off. The rhymic soumd of the vent and finally the patient who had been the bane of everyone existance that night is finally quiet. Share if you have ever not known how you got home after working 2 -12 hour shift in a row, made dinner, washed a couple loads of clothes and baked cookies for your 6yo's party. Have you ever been driving after a night shift and had to open the window in a blizzard just to stay on the road! Or don't remember if you stopped at the traffic light? I know I have actually fallen asleep behind the wheel at a RR crossing or at a dead stop in traffic in chicago on the dan ryan or on 128 in boston. Only to be rudely awaked by some irate driver blowing their horn furiously and flipping me off!! Should have been driving? NO! but I also needed to get home to meet the bus! Man is not NOCTURNAL it is not a natural state. I agree it is not "acceptable" but it is not such a grevious act that she should lose her liscence.!! "TO ERR IS HUMAN TO FORGIVE DIVINE" Even as a supervisor when I finally sit down in the morning to do staffing with the staffing sec. We have both closed our eyes, not realized it pencils in hand bolt upright in the chair... to be awakened by the ringing phone. It is the responsibility of the charge nurse to be aware of her staff and to check upon them if they are missing. I will lay a paycheck on the line that the rest of the staff was so relieved that the patient was finally quiet and stopped being disruptive :yelclap: that they never noticed until the nurse who actually had the patient did the one last check and found her...asleep:sleep: (been there done that) I am sure that if she went in after "several staff members" had been ther also her patients were being watched as they would if she went on break or lunch. If I traded everyone to days that c/o of being tired I would never have a night shift!! You will be entering the profession soon and I need you to feel compassion and understanding to your peers because that shows me that you will be able to show compassion to your patients from a diversified background. You WILL encounter things and ways of life or someones decision that you do NOT agree with and goes against your very core of beliefs. ......it is compassion and understanding that you need to have...it's TOLERANCE that is imperative!!!! Serious offenses are serious but it is our job to help change them or help them through whatever it is they need. To help them realise the gravity of what they have done....remorse is huge with me. I agree that there is a level of expertise that we need or a standard that needs to be followed but.....we also need to stop eating each other alive!!!! Just food for thought.....I'll get off my soap box.:chair: Besides if the patient was that agitated I and intubated I bet you that even if he looked over at the nurse he was just relieved that someone was ther holding his hand!!!! :redpinkhe
To start off, I am not an RN. (trying though!!) But I keep thinking about humanity. I worked 3am to 11am for 6 months and it was the worst time of my life!! I am not looking forward to doing it again!!!
Here's my question, but since the OP has never replied I won't get an answer. If they were taking turns with the patient, who was caring for each others? They knew where she was, and knew there were 6am meds. Why were her patients not cared for by them??? Why are they not being repremanded? Is it possible to sit with someone for 2 hour "shifts" and be somewhere else at the same time? Shouldn't one of the other nurses gone to her at 6am and relieved her to pass her meds, or done them for her?
I don't know the seriousness of being on a vent yet, but if I walked in at 6am to find a nurse sitting with my father, holding his hand, and "snoozing", I would actually feel touched. Touched that nurses care so much.
Another point is that someone posted about doctors not wanting to be woken up in the middle of the night for "patient care". Boo hoo for them! Sorry to wake your child doctor.... But if we don't do some intervention here, it could b\put the patient at risk, or the staff! Oh, I'm sorry...did I wakey you upey? Never mind, we'll just take turns sitting with him in the dark at 4am and fight our bodies natural urge to fall ASLEEP when it's supposed to.
There's a difference with how you can work when you are on your feet, and how you work when you are sitting down in a dark room for 2 HOURS!
I would probably have dozed off too! Hey, I'm human. Unfortunately, caffiene has nadda effect on me.
Specializes in ER (new), Respitory/Med Surg floor.
If a lawyer found evidence of repeated instances of any kind of unacceptable performance on the part of a nurse that went UNADDRESSED by the hospital, that would surely support a claim of negligence against both the nurse and the hospital.
If we fired every nurse the first time s/he made an error that had the potential to jeopardize patient safety, no one would be left!
Why do we allow nurses to continue to practice following med errors, errors in transcribing orders, errors involving patient identification, etc, if we want to hang this person for a first offense despite a long history of providing excellent patient care? Wouldn't it be more prudent to provide counseling and place the employee on probation as we do with so many other situations involving unacceptable performance?
I agree. Nurses are human. This nurse needs some type of reprimand but I do not feel should be fired. Just as the person here mentioned you'd be firing lots of nurses. Mistakes happen. Yes we are dealing with people's lives but we are people too. You have to look at a person entire job performance. Now if there were other issues going on that nurse should be let go. But if this person as mentioned is a good nurse and this was the only thing...yes a reprimand but not being fired. Has any of you done a one to one? I never fell asleep doing one but I can see how easy it could be. Not excusing this nurse at all just that she made a mistake. Lucky for her patients they were ok yes that was a huge chunk of time. It was very serious and something needs to be done but I don't feel she should be fired at all or loose her license unless there were other examples of poor nursing care.
Speaking of sleeping...my father...relax people he deals with machines in a factory that doesn't harm people unless you stick yourself in them...went to the bathroom fell asleep on the toilet and woke up 3 hours later!!! He wasn't caught and is also an dedicated hard worker.. I AM NOT EXCUSING SLEEPING ON THE JOB!
"Excellent nurses" don't grow on trees. If they make a mistake you work on it, make it better. To keep replacing a nurse with another and with another is asinine. The next one may not fall asleep but might make a worse mistake. Unless someone is guilty of assault and malice I cannot see this pattern of reasoning. The same goes with any other profession.
Right now I am taking my prerequisites toward becoming an RN. When I read some of these threads...it is quite scary and sometimes overwhelming. This is indeed such a tough issue because on the one hand I can understand the need to protect the patients from future negligence and of course to protect the hospital too. I mean, she did neglect her patients no matter how you look at it and I'm sure worse things happen on a daily basis but 2 hrs is neglect. But then you have a good nurse with presumably no priors who has a clean record and makes one mistake. With the shortage of nurses and with the fact that you find one who once again is presumably knowlegable in her field and has the compassion and patience to deal with people, then that's a hard call to just right there on the spot fire her with no if, ands or buts about it. I would not want to be in the person's position who has to make the decision to make or break her career. But whatever it is, she has to accept it. I don't like the fact that nurses are supposed to be superhuman and that there are no faults allowed and one mistake can cost all the years of schooling and sacrifice and dedication. This now if weighing heavily on my heart. It is also giving me much to think about which is why I like this site so much. I am scared right now because I am an accountant but I have so much compassion and patience for nursing(not to mention whenever I mention that I'm preparing to go to school for it, everyone always says I should have gone years ago because that's where I belong). I am paying for all of my prerequistes out of pocket and will have to take out major loans to go to school and have to quit my present job to dedicate time for school and to make this huge sacrifice and make a mistake only to have people waiting to snatch everything away from me is a lot to think about. I am going to pray on this because this is not the first situation on this site that I've read about. I pray that everything works out for this nurse and even if they have to fire her I hope that she can still practice nursing somewhere else and learn a great lesson from this!
Esme12, ASN, BSN, RN
20,908 Posts
Thank you well said!!!!!!!!!!!!!!! boston