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?
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.
There are a lot of "IFs" here. That's the same as taking a nurse who made a med error, even a small one that didn't hurt the patient, and saying "well she needs to be fired because what if next time it is a drug that can kill the patient"
How about this....WHAT IF the nurse is reprimanded, she keeps her job and it never happens again.
I've witnessed a post natal woman almost die because a midwife covered up a 3 litre PPH. When she was reported and an investigation had been carried out all this midwife got was a slap on the wrist.
So far, i have not, which certain does not mena 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.
Working in an OR is totally different from any other part of the hospital. Try working med/surg and having to pass 20 different meds to 7 different patients. What I'm saying is eventually you will make a mistake, probably a med error,it will happen, and when it does you may have a different point of view on this situation.
Working in an OR is totally different from any other part of the hospital
Not necessarily, since you don't know what i do there (and in other depts.)on a daily basis. Just because i work in the OR now doesn't mean that i'm oblivious to what goes on on a med-surg floor, nor does it mean that i'm excluded from making any mistakes.
Not necessarily, since you don't know what i do there (and in other depts.)on a daily basis. Just because i work in the OR now doesn't mean that i'm oblivious to what goes on on a med-surg floor, nor does it mean that i'm excluded from making any mistakes.
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.
You said it for me. I really can't understand why people are unwilling to look at the entire situation rather than just fire the nurse. If she has always been a reliable employee and no one was harmed by her mistake, I think it's incredibly harsh to fire her. It could be handled internally.
I think that a to strict work environment where an exellent nurse do not get a second chance can be unproductive. The nurses become nervous and more mistakes are made.
We are dealing with death and life every single day. There is a lot of responsibility. I need to know my coworkers and bosses support me, then I can provide the best care.
Of course there are occasions where a nurse should be fired on the spot, but based on given information I do not think firing this nurse would do anyone good.
Specializes in Infection Preventionist/ Occ Health.
One important issue that is brought forward by this debate is how difficult it can be to stay alert in the middle of the night. I had a colleague on third shift (in the lab) who would start to nod off the second she sat down at the computer or at the microscope. This nurse seems to be having a similar problem staying alert. She either needs to find a way to get more rest during the day, or she should switch to the day shift.
I do not have an opinion as to whether this particular nurse should be fired. In general, however, I think that it is much more effective to figure out the root cause of the issue, instead of just punishing or firing people.
WOW!!!! It amazes me how many perfect nurses we have here.
How many of you have had to sit with a patient on night shift, with the lights low.....I don't care who you are, you start to nod off. Been there done that...Humans are not nocturnal creatures, I have seen studies that show that 8 hours of sleep in the day are equal to about 4 of real sleep. I worked night shift for years and you always feel like a zombie. It isn't natural for us to be up then. I don't know one night nurse who hasn;t caught him/herself nodding off from time to time, especially on a quiet night. But when it hits the fan, they are right on top of things. Unless you have been in that kind of a situation, don't judge her. I am sure she feels terrible about it. No harm was done.
Talk about judgemental.
ckh23, BSN, RN
1,446 Posts
There are a lot of "IFs" here. That's the same as taking a nurse who made a med error, even a small one that didn't hurt the patient, and saying "well she needs to be fired because what if next time it is a drug that can kill the patient"
How about this....WHAT IF the nurse is reprimanded, she keeps her job and it never happens again.