Working with angry unstable incompetent RN

[pedsRN121]

I have read a couple of previous posts regarding incompetent and unstable coworkers. I have worked the night shift on a pediatric unit with this one other nurse for over 3 years now. She got her nursing license in 1980 and then practiced for a few years as a visiting nurse in Alaska. She then went into the corporate world until 2004. She took a refresher course and my NM hired her instantly to fill a void.

The problem is she has no recollection or retention of information. Every night she asks me a basic nursing question. She has asked me recently how to assess bowel sounds, she wanted the CNA to hang her meds and do her assessments, she did not know if a post inguinal hernia pt would have an incision!! This is only the tip of the iceberg. Her lack of knowledge is only compounded by her attitude. She was surly for years. She makes no effort to retain or learn nursing information.

Her attitude has recently become very manic. She is calling the unit at all hours to see what is going on, she has become very animated and uses loud foul language on the floor (it is a peds unit). She has a terrible temper and recently went off on a secretary to the point the witnessing nurses on day shift paged the manager out of a meeting. Unfortunately, the manager arrived after she was gone.

I have reported many instances to my manager and little is ever done. For some reason, she has a soft spot for this individual and does little to correct her behavior. On learning of the recent tirade she did on the secretary, my manager gave her 10 days off -- and since it is the holiday season, she got to be off her required holidays and have a lovely week off at a time the hospital restricts vacation. This is also paid time off.

Upon learning this I went to my manager and her manager with a documented list of this nurse's proffessional and employee lackings. She is chronically late for work and has not been giving meds because she said she was too busy at 5am, so the day shift could do it at 0730 or 0800. She was not busy and all my meds were given.

I know I now need to continue to document all her incidents. I do not know if any further action will be taken. But now I have to work with her when she returns later this week and I am sure she will have it out for me. I know she is aware many of the accusations came from me. I am nervous since it is just her and I on the night shift. What can I do?? I am nervous she will confront me in her raging anger and I am also worried she will just continue on her way without much repercussion since I don't think my manager wants to be bothered with filling this position. Should I leave or transfer?? Continue documenting or go higher up the chain-it is a large metropolitian city hospital?

Help!

[misschelei]

Doesn't take much to make a parent nervous when it comes the care of their child. Parents of chronic kids can sniff an incompetent nurse out of the parking lot. And those complaints rarely fall on deaf ears. Just a thought.

[llg, PhD, RN]

Arrange a private sit-down meeting with your manager to discuss the situation. Ask her if she is going to address your concerns or not. She may be addressing them in ways you are unaware of. For example, the "10 days off" that you consider a vacation may actually be a 10-day period during which your coworker is expected to seek counseling for her problems. It may have been presented to her as a "last chance" to get her head on straight. You don't know that.

Managers cannot the details of their interactions with other staff members. Personnel matters are confidential. So don't expect to be told what is happening behind the scenes. However, a calm professional and private meeting with your manager should give you a clue as to whether or not she is sympathetic to your concerns and making an effort to address them. If she is sympathetic to your concerns, I would give her a chance to work things out. Ask her for specific advice on how to handle things and schedule another meeting to follow up in a couple of weeks.

Also, remember that it can be harder to "get rid of someone" than you think. The firing of someone is usually a process that takes time. Work WITH your manager to facilitate the process -- if she is sympathetic to your concerns. If she is not sympathetic, then you may have to look for a new job -- but I wouldn't rush into that as a first or even a second choice.

[pedsRN121]

This nurse has gotten many many complaints from parents especially at the beginning. They have died down, but many times parents would request that I be their nurse instead of her. The NM's reply was that the nurse was just different and perhaps people didn't quite get her style.

She also stated to me recently that the # of complaints are down on her, to which I replied that it didn't mean they weren't there, just that everyone unhappy doesn't always make the effort to complain. To the last outburst the RN had recently with the secretary, my NM said she believed it was from the stress of the holidays, our unit being more busy lately and recent tragedies for our staff (including my father who passed away suddenly several weeks ago- but I am glad my manager feels this is a good reason for this nurse to act crazy)

[AliRae]

I have expressed this since the beginning when she told me it didn't matter if her insulin dose was a couple units off!!

WOAH! And she thinks she's a peds nurse?! :angryfire

[subee, MSN, CRNA]

This sounds like a mentally ill person. She needs to have a behavorial evaluation and referral for help. Some state boards will be helpful to the nurse as well as to the person who is doing the reporting. Don't wait. Sounds like this has been going on far too long.

[grammyr]

Your manager has a boss also and if you have documented proof that nothing is being done to address the situation, then go above her head. Sometimes the chain of command seems awfully long, but take from someone who has been there, it eventually works.

[webbiedebbie]

My first thought was maybe substance abuse. I agree with "llg", there may be circumstances that your NM knows about that she can't discuss with you. I would continue to document when things happen and report to your NM. I wouldn't get defensive with her either. I just hope nothing bad happens because of her comment about the amt of insulin she should give. That is very scary!

[pedsRN121]

I do think there may be some substance abuse-more along the lines of prescription drugs, especially since her odd behavior and more manic symptoms really increased in the last month or so-she went from being dark and depressing to wound up and laughing hysterically about nothing. But underneath it all, she was always an incompetent nurse which I hoped would get better. Since it never did and I continued to update my manager with the bigger issues, I just kind of hoped it would work out with her quitting or hanging herself. Since she has been guarded by my manager, I stopped bringing things to her attention. My manager just kept sweeping things under the rug.

I dread working with her again, but I feel better getting alot of the issues on paper and in the hands of my managers supervisor. Maybe you are right and something will finally happen.

The worst part is the impaired nurse thinks she is funny,(she has even made racial comments to another nurse, which she thought were totally appropriate) and a great nurse even though she realizes she doesn't know much! She has spoken of going to work in a PICU at one of the major Childrens hospitals in our area. Atleast there she would be discovered and dealt with.

I thank everyone for all the good advice-document, go farther up the chain, and even look elsewhere- they are all good ideas.

[Virgo_RN, BSN, RN]

I'm with the others who say document, document, document.

[HM2VikingRN, RN]

I think she is bipolar or otherwise impaired...

[Mulan]

So if she's that incompetent how come something hasn't happened with a patient?

[StacieRN, RN]

You should report her to the Board of Nursing.