What punishment should this nurse get?

Nurses General Nursing

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  1. Should THIS nurse be fired from her job

    • 24
      Yes, this nurse should be fired...no matter how excellent.
    • 372
      No, this nurse should NOT be fired, it happens...even to excellent nurses.

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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 ICUs, Tele, etc..

If I am that nurse I will cash out all my PTO get a new position and get a position somewhere else. She should not come back, her talents would be better served somewhere else where she would be appreciated.

Specializes in Case Mgmt; Mat/Child, Critical Care.
If I am that nurse I will cash out all my PTO get a new position and get a position somewhere else. She should not come back, her talents would be better served somewhere else where she would be appreciated.

Amen to that!!!! That is exactly what I would do! I hope this is a wake up call for her....and her co-workers as well. Just remember...it could happen to you....:stone

punishment? i have to assess that you are the nurse manager of the unit? how many patients are assigned to your staff when you have patients that are requiring ventilatory support? has your hr department any concept of the physiological toll it takes on anyone working the night shift? does hr have any concept of the mental, intellectual, physical, emotional, and psychological drain caring for patients that saps every "excellent" rn? does corporate policy and those who make it include mental health and restorative time off to regenerate the nursing staff? any time i have been to hr, the secretaries are chatting on their personal calls, never miss their lunch hours, get holidays and weekends off, work days, and have time with their families and for a personal life.

i would think that "sleeping on the job" refers to slackers that try to find a quiet and obscure spot so they can perform their "tasks" minimally and beat the boss.

i think that an "excellent" rn probably succumbed to exhaustion, rather than an attempt to shirk her responsibilities.

as her nurse manager you would be well advised to stand up for your staff to the don (who hopefully has some concept of the clinical arena) and to hr who has no reality whatsoever.

report her to the bon? i am certainly thankful that i do not work in your punishment directed facility. it would be wise for your entire policy regarding professional staff was revamped by those who have hands on experience in the clinical setting.

an "excellent" rn is an asset to our profession and to "punish" one is anathema to what a "profession" is.

counseling, a 30 day probation with a warning is more appropriate than the unconsionable approach you are pursuing.

Specializes in ICU, CCU, Trauma, neuro, Geriatrics.

I work in LTC, we have agitated vent patients here. Where do you think all those closed head injuries ICH's, SDH's and CPR-saved arrests go when they leave your ICU's? As a supervisor I have had to address this issue a few times. I wrote each episode up and had others working along with that employee write their version of what happened. One staff member was a frequent flyer with the dozing off....that one got fired. Two were reprimanded, one with 2 days off without pay and a class in legalities in nursing or 'something like that' was required. The third one was advised to fill out paperwork for FMLA which she did. The two reprimanded are still employees.

Quote from scampi710..."I think that an "excellent" RN probably succumbed to exhaustion, rather than an attempt to shirk her responsibilities. An "excellent" RN is an asset to our profession and to "Punish" one is anathema to what a "profession" is.

Counseling, a 30 day probation with a warning is more appropriate than the unconsionable approach you are pursuing."

we're human, we make mistakes...we're not robot! where's the charge nurse while this was happening????

Specializes in Critical Care, ER.
It actually isn't the hospital that is union . . . .the nurses have to vote to be represented by a union. We voted no.

Actually we voted . . . .

NO!

steph

Well, that doesn't change the fact that, had the hospital of the OP been a union shop, the outcome would have been standardized and different. What if the manager didn't happen to like her and go to bat for her? She would have been fired. I am glad that at your non-union hospital/utopia everything would have been taken care of justly; however in this hospital clearly a union would have helped.

Specializes in M/S, OB, Ortho, ICU, Diabetes, QA/PI.

the sleeping issue aside, I can't imagine working in a unit apparently so strapped for cash that they can't afford to pay someone at a tech or aide level to sit with a patient to keep his hands from wandering up to his trach!

Also, I'm not sure that I would be happy to have to take time away from my personal patients to sit with someone else's restless vent patient - it wouldn't matter to me that other nurses were "watching" my patients - that's not the same as me taking care of them! I guess since I wasn't there, I can only wander why this patient wasn't sedated in some way (you don't need to snow people, just a whiff to keep them from getting restless), soft wrist restraints weren't being used (although I know some institutions are trying to get away from that - it's absolutely the last resort at mine - the documentation is a pain!!) and RN's were being used as high-priced babysitters.....................

ok - the hand holding to keep the patient calm is nice but honestly, if that's what worked, any staff member, not just RN's, could do that. Vents have alarms for a reason if something goes wrong - if the rest of the staff was deemed competent enough to manage the equivalent of 2 nurses' patient loads at a time so everyone could take turns watching this guy, surely they could respond appropriately to alarms or if someone yelled for help, no?

I'm glad the OP posted an update to this story - I thought that the punishment was appropriate but, honestly, I think your whole system is flawed to have allowed this to happen in the first place (IMHO)

and, since this seems to have become an important thing in this thread, I just want to let everyone know that I am an RN and I actively work in an ICU :-)

It's not like she has suddenly been proven to have narcolepsy. If documented that she was counseled and suspended, the hospital would not be at fault if this were to happen again. I sincerely doubt that it will -- she is not somehow more predisposed to it than anyone else. I have woken several nurses up with "Hey SO-AND-SO, NEED ANY HELP WITH ANYTHING?! *clears throat loudly*" Then they wake up, realize they were dozing, and get to work. We gotta help each other out here, not jump down each others throats and ensure even worse staffing. In my unit that patient would have been placed in restraints. So, I think it was nice that the nurses were trying to avoid that approach. Like someone else in this thread joked, "no good deed goes unpunished." :)

it is unfortunate that rn's do not truly grasp the concept of the protection a union affords them. i have worked in union and non-union hospitals. i can tell you that the $30/monthly that is paid is a bargain by all standards. in a union hospital rn's have influence on patient/acuity/staff ratios. in a union an rn is represented fairly rather than being scapegoated for the hospital's reluctance to adequately staff.

it is fine to say "change to days" but has anyone actually tried to change to days? i can guarantee that the excuses such as "we need you on nights" "you are our strongest night rn" "that isn't possible because we have days fully staffed" etc.

without a union rn's become the victims of the corporate mentality. there is no legal contract that protects them. hr may give you an "employee handbook" but you can be sure that when push comes to shove, it is the rn who is treated unfairly.

it is indeed sad that rn's accept the anti-union propaganda generated so successfully by the hospital administrators.

when will we ever learn that to stand together is what makes us strong?

we consistently succumb to the stratedgy of divide and conquer.:o :o :crying2:

without a union rn's become the victims of the corporate mentality. there is no legal contract that protects them. hr may give you an "employee handbook" but you can be sure that when push comes to shove, it is the rn who is treated unfairly.

i just wanted to reply to comments about unions. i've worked in a hospital where the nurses were in unions (one for the rns and another for the lpns). while they may protect someone's job they will side with the employer when a rule has been broken. they really have no choice. a nurse where i worked filed a grievance with the union for being written up and disciplined for being found taking a break off our unit without telling anyone and then not coming back when a code blue was called. on her side she complained that she had the right to a break. however, she said that when she went to the meeting with the union steward, the union representative and someone from the human resources department, she said that both the union steward (who was another nurse working in the hospital) and the union rep sided with the hospital and the written complaint was going to stay in her file. they told her she had clearly broken a rule that she was to notify the charge nurse when she was going on her break and that when she heard the code blue announced for her unit she should have come back to her floor right away.

i think the concept of a professional union is not understood. the situation which you describe is in fact a default to professional responsibility.

an rn who refuses to return to her unit in the circumstances described is violating the professional ethic to which we are commited.

being represented by a union does not go hand in hand with being allowed to ignore our professional responsibility.

being represented by a union protects the rn from unfair decisions made by the administrations in attempting to scapegoat an rn.

being represented by a union provides rns a voice in their professional arena. it also provides rns with the opportunity to negotiate for economic compensation (money and benefits) that is consistent with a professional status, education, decision making, assessment skills etc.

a professional union is not there to protect those who are not professional.

Specializes in Case Mgmt; Mat/Child, Critical Care.
I just wanted to reply to comments about unions. I've worked in a hospital where the nurses were in unions (one for the RNs and another for the LPNs). While they may protect someone's job they will side with the employer when a rule has been broken. They really have no choice. A nurse where I worked filed a grievance with the union for being written up and disciplined for being found taking a break off our unit without telling anyone and then not coming back when a code blue was called. On her side she complained that she had the right to a break. However, she said that when she went to the meeting with the union steward, the union representative and someone from the human resources department, she said that both the union steward (who was another nurse working in the hospital) and the union rep sided with the hospital and the written complaint was going to stay in her file. They told her she had clearly broken a rule that she was to notify the charge nurse when she was going on her break and that when she heard the code blue announced for her unit she should have come back to her floor right away.

Actually, it sounds like this nurse should have been disciplined! First, she left the floor w/out telling anyone.....so who was watching her patients? The charge nurse or another nurse at the very least should be informed when you are going off the floor. As for the code, OMG, I would be running back to my unit for fear it was one of my (in this nurse's case, neglected) patients! :rolleyes:

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