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?
Your presuming this nurse would fall asleep again. Did I say at any point in this thread that it is acceptable to fall asleep on duty, I think you would find that I havent. I dont believe the best way to deal with this situation is to go in and fire this nurse.Have you managed many wards and situations, believe me there are far worse situations occuring on a daily basis and if I sacked them all then we would have a worse nursing shortage than we have right now.
Sorry, there has to be standards. You fall asleep on the job for 2 hours, someone has to wake you up, you get fired. IF, she does fall asleep in the future, and IF harm comes to her pt, THE HOSPITAL is at fault for letting her continue to work. I would not take that chance.
That's a tough one. Being that she is an excellent nurse with I assume no prior disciplinary record, then perhaps everything could be handled internally with a reprimand and no report to the BON. Did the patient or any of her other patient's suffer because of this? If the answer is no, then I don't think it would be necessary to report her to the BON.
If it were to happen again (before anyone jumps on my case i'm NOT saying it WILL), the question could be asked why it was allowed to happen again.
Yep. What if she doesn't get fired??? What responsiblity will the hospital have if the next time she falls asleep harm comes to one of her pts? What if the next time, someone dies? The hospital would surely be at fault for letting someone like this continue to care for pts.
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.
But no one is suggesting that she should be allowed to continue working without some kind of counseling/remediation/discipline, just as occurs EVERY DAY with other errors in nursing performance. 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?
Let the one who has never made a mistake throw the first stone.
We are talking about a good nurse. Everyone and I mean everyone has made a mistake. All the high and mighty need to take notice. No one is perfect not even the ones that think they are.
We are talking about a good nurse. Everyone and I mean everyone has made a mistake. All the high and mighty need to take notice. No one is perfect not even the ones that think they are.
There is making a mistake, and there is sleeping on the job for two hours and requiring someone else to wake you to complete your nursing duties. These are two different things. This isn't high and mighty, this is common sense. I have made my point. See ya!
It could, depending on the situation(s)! In this particular situation, my facility would see this as neglect (we've had it happen before), and i agree with it.
Come on Marie why are you being so harsh? Your not perfect. You can't honestly say you have never made a mistake.
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.
But no one is suggesting that she should be allowed to continue working without some kind of counseling/remediation/discipline, just as occurs EVERY DAY with other errors in nursing performance. 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?
Excellent point. There should be some kind of punishment, but not to fire the nurse. Think about med errors that occur. We have all heard stories of nurses that make med errors that actually KILL patients, but they are not fired over it. As for the hospital being liable if it happens again, I don't think that will be the case if some action is taken against the nurse. It seems like too many people on this board want to burn this nurse at the stake for an error.
We are talking about a good nurse. Everyone and I mean everyone has made a mistake. All the high and mighty need to take notice. No one is perfect not even the ones that think they are.
I agree but lets hope that when we make a mistake we get a fair hearing and support. Every mistake in a hospital has life threatening possibilities and none worse than a medicine error. I bet that every nurse I know and have ever known has done a medication mistake even if it is a minor one like being late giving the medication.
Never said i was. I know that i'm not, and i also don't need to be told this either.
You can't honestly say you have never made a mistake.
So far, i have not, which certain does not mean that it WON'T. The opinion i am posting for this particular thread's subject, i would expect if i were the nurse in that situation.
cardiacRN2006, ADN, RN
4,106 Posts
Sorry, there has to be standards. You fall asleep on the job for 2 hours, someone has to wake you up, you get fired. IF, she does fall asleep in the future, and IF harm comes to her pt, THE HOSPITAL is at fault for letting her continue to work. I would not take that chance.