I want to do the right thing...

[KuteNurse]

Hello all,

I had a dilemna at work this week that was very hard to deal with. A coworker whom I love dearly has been going through a difficult time for about 2 months+ now. She always had a little bit of depression over the years, which she dealt with well. It was not until recently that problems have occurred.

She had the gastric by-pass surgery a little over a year ago. As some may know, after this surgery, vitamins are no properly absorbed especially B12. She gives herself her monthly B12 shots and she takes multi-vitamins.

Her behavior has changed dramatically including her looks. Her hair is falling out because of lack of vitamins. I will find her sleeping at her desk and she forgets her passwords constantly. I actually caught her with her eyes closed and sucking her thumb at her desk. She cannot handle her doctors schedule in a timely manner and she asks for help. Don't get me wrong, I do not mind helping, but when it affects my own work, then it is a problem. This past week, 2 doctors she was working for complained to our supervisor about her. One parent actually said she did not want this coworker touching or doing anything to her child because she was not competent. My other coworkers have also been worried about her behaviors. Evidentally she was standing at our med counter drawing up a shot and she fell asleep at the counter with the needle in the vial of medicine. On Monday, I really felt she was out of control and that her behaviors were unsafe for patient care. I decided it was time to talk to my supervisor. (My supervisor at that point did not know anything that was going on in the nursing station because we were all afraid to say anything to get her into trouble.) I guess we were afraid she would be fired or something in the like.

I truly do not want to see her in trouble, but she really was not safe to be working with patients. My supervisor said she had a plan in mind. That my coworker would work with one of us. We would take care of patients together and she was not to give any shots or medical treatments. My coworkers and I really do not think this is going to solve the problems at hand. She needs medical treatment for her mental illness and she needs to see a physician about regulating her diet and her medications so she can function normally again. (Medications are not absorbed the same after having this surgery.) I do not want to see her fired. But at the same time, I am not being her friend if I am her co-dependant and not helping her. I believe what is in her best interest is to take a medical leave of absense to get the medical attention she needs. How do I suggest this to my supervisor without causing more waves??? My coworkers and I have talked about my supervisor not doing her job well...We thought of going higher up in management to get this problem dealt with. But if we do this, do we have to worry about repercussions??? What does everyone think?

 

[sedoniaraqs]

It sounds to me like the true solution to the problem is for your friend to address her health problems. Is she aware that her work is erratic and endangering to the patients? Is she aware that her appearance and behavior have changed for the worse since the surgery?

Surely being in the healthcare work, she can find a highly competent doctor who can run tests and pull together info from her GI, psychiatrist, endocrinologist, dietician, etc, and try to troubleshoot and solve her problems?

Can she get any sick time off to get medical care?

 

[teela]

This is a hard decision. For the safety of all involved, it is best to report it to your hospital. The reason being is that if some emergency happens and she has to work alone, she could make a mistake which would hurt the hospital. She is dealing with human life and she should be getting treatment no matter what. I"m taking a leadership class right now as part of my Masters. In the discussion, they said you sometimes have to make those hard choices so people will listen. In this situation, you might be covered by some sort of whistleblower type laws. If you are afraid of loosing your jobs, do you have a union you could have a representative with you as a group of you present your concerns? Or maybe you all could send something annonomously to the hospital.

 

[KuteNurse]

It sounds to me like the true solution to the problem is for your friend to address her health problems. Is she aware that her work is erratic and endangering to the patients? Is she aware that her appearance and behavior have changed for the worse since the surgery?

Surely being in the healthcare work, she can find a highly competent doctor who can run tests and pull together info from her GI, psychiatrist, endocrinologist, dietician, etc, and try to troubleshoot and solve her problems?

Can she get any sick time off to get medical care?

Thanks for replying Sedonia. I do not believe she is aware of her medical problems because she is so out of it. She stated after she was called to talk to my supervisor that she is tired of tattle-tales. (Even though they were medical doctors who reported her in the first place.) So I do not think she see's the whole picture. I do not believe she sees herself endangering others. I am not certain what she thinks about her appearance. She does have a good doctor she sees because she talks about him. However, my supervisor has suggested she seeks psycological help and she chooses not to. I also believe she is elligible for a medical leave of absense. If this helps, to understand the story better. It really is a touchy one.

 

[KuteNurse]

This is a hard decision. For the safety of all involved, it is best to report it to your hospital. The reason being is that if some emergency happens and she has to work alone, she could make a mistake which would hurt the hospital. She is dealing with human life and she should be getting treatment no matter what. I"m taking a leadership class right now as part of my Masters. In the discussion, they said you sometimes have to make those hard choices so people will listen. In this situation, you might be covered by some sort of whistleblower type laws. If you are afraid of loosing your jobs, do you have a union you could have a representative with you as a group of you present your concerns? Or maybe you all could send something annonomously to the hospital.

I truly believe there could be dangers to patients here if they have not already occurred. I do have a union, whom I have not dealt with much in my career. However, they are there for representation. As a last resort, we could always contact the Minnesota Board of Nursing and they have to act on it and investigate the situation. However, this could get her disbarred from her nursing profession. I do not want to see that happen to her, I just want her to get the help she needs so she can function once again.

 

[Amanda (was Aziyade)]

Take it up a level. For your supervisor to just have her work with YOU or someone else is ridiculous and not addressing the real problem. I would imagine this could possibly even open you to up to some kind of a lawsuit if something bad happened, you know? Can you talk to your supervisor's supervisor? Or talk to someone in the union who can get something done without directly naming you?

I'll bet if this woman gets the help she needs she would thank you for it later. You may be hurting her feelings now, but she's obviously mentally ill right now. And mentally ill people hardly ever think THEY are the ones who need help. Until they get it. I've had to fight with loved ones to take their depression medicine, because when they're deep inside depression they don't realize that they truly NEED the meds to function.

Think of it this way -- pretend something terrible happens as a result of her negligence. How would you like to go through the rest of your life knowing you MIGHT have been able to do something about it, but didn't? Do you want to live with that kind of guilt?

The fact that patients are aware of this woman's problem and want to avoid her is evidence that it is a SERIOUS problem. Don't wait for someone to get hurt, or drugs/tests/records switched around, or something mistranscribed or whatever. Can you talk to other doctors in the office? Maybe get one of them to do something about it? Would a doctor's complaint be more effective than a nurse's?

I'm sorry you're in this position. It's got to be rough. Sending you positive thoughts and a virtual HUG!!

 

[Aniseteph]

You have to follow your organisation's policy for raising these concerns, and possibly there are responsibilities that your professional registration puts on you too. I'd do what I am obliged to do for my registration and as part of my contract with the hospital, tell my supervisor that that is what I am obliged to do, and document EVERYTHING. If you don't act, the bottom line is you are part of the patient safety problem and your careers are on the line. And I imagine she'd lose her job/registration if she makes a serious error, so getting her stopped now when some medical attention could get her back to normal would be doing her a favour.

Does your supervisor have a timescale for this plan? IMO if you and your co-workers are basically having to carry your friend's workload because she is not able to do her job (really lame plan IMHO) then you are entitled to know how long for, and it's entirely reasonable to ask your supervisor to agree a review date with you all. And you can make sure it is documented that you all have concerns about carrying her workload AND her well-being AND patient safety, so very short term would be better. Can you say OK we'll do this for a day or so and report back? That way you are being positive about the plan (even if you know it's hopeless), and then you can bring your experiences of the trial period, whether it is helping, AND your professional/contractual obligations along, and the ball will be back in your supervisor's court. And if a much better plan doesn't materialise ASAP I'd think very seriously about taking it higher in the interests of patient safety.

If anything happens to a patient it would be terrible but you would have done all you could. You can only do so much from the bottom of the management heap - it's your job to report what needs reporting but it's theirs to act on it, that's what they are paid for.

Risk manangement story I heard - a nurse in charge of a chronically understaffed ward at night had a patient die because basic checks weren't done, they were going to throw the book at her. But she had been filling in clinical incident forms every time the ward was dangerously short staffed, they had all gone up through the system to management... who had done nothing. She was completely in the clear, management in very deep doodoo indeed. It doesn't make it any better for the patient, but the buck stops where it should, where someone can make a decision to stop it happening again.

I hope it all gets sorted out OK.

 

[Mosaic]

KuteNurse do you know her family and her doctor? Maybe approaching both and putting them in the picture could be a solution. They could then talk to her. Also as her friend maybe try to talk to her directly, yes she may be angry but maybe she is frightened deep down and afraid to face the escalating problem for fear of losing her job or friends etc. Self denial
as you will know is a coping mechanism and it sounds like she may be in this mode.

I understand how difficult it is to go over one's supervisors head but maybe 2 or 3 of you need to do this together, better to lose her friendship than have her injure a patient or herself <sigh> a very difficult situation.

Do hope you are able to resolve this quickly.

 

[KuteNurse]

Take it up a level. For your supervisor to just have her work with YOU or someone else is ridiculous and not addressing the real problem. I would imagine this could possibly even open you to up to some kind of a lawsuit if something bad happened, you know? Can you talk to your supervisor's supervisor? Or talk to someone in the union who can get something done without directly naming you?

I'll bet if this woman gets the help she needs she would thank you for it later. You may be hurting her feelings now, but she's obviously mentally ill right now. And mentally ill people hardly ever think THEY are the ones who need help. Until they get it. I've had to fight with loved ones to take their depression medicine, because when they're deep inside depression they don't realize that they truly NEED the meds to function.

Think of it this way -- pretend something terrible happens as a result of her negligence. How would you like to go through the rest of your life knowing you MIGHT have been able to do something about it, but didn't? Do you want to live with that kind of guilt?

The fact that patients are aware of this woman's problem and want to avoid her is evidence that it is a SERIOUS problem. Don't wait for someone to get hurt, or drugs/tests/records switched around, or something mistranscribed or whatever. Can you talk to other doctors in the office? Maybe get one of them to do something about it? Would a doctor's complaint be more effective than a nurse's?

I'm sorry you're in this position. It's got to be rough. Sending you positive thoughts and a virtual HUG!!

Thankyou for your well wishes. I do not work again until Tuesday of next week, so it will be hard to deal with the issue when I return. However, it is definately on my mind. I thought of calling my supervisor or my co-workers to see if the problem is being dealt with. I also thought of calling my supervisors supervisor and telling her what is going on. I think all the docs would be supportive of getting her the right help she needs. Many of them are just so busy to see the real issues at hand. But if we tell them what has been going on, I think they would be supportive. I definately feel like I am in a tight spot with some very tough decisions ahead of me.

 

[KuteNurse]

You have to follow your organisation's policy for raising these concerns, and possibly there are responsibilities that your professional registration puts on you too. I'd do what I am obliged to do for my registration and as part of my contract with the hospital, tell my supervisor that that is what I am obliged to do, and document EVERYTHING. If you don't act, the bottom line is you are part of the patient safety problem and your careers are on the line. And I imagine she'd lose her job/registration if she makes a serious error, so getting her stopped now when some medical attention could get her back to normal would be doing her a favour.

Does your supervisor have a timescale for this plan? IMO if you and your co-workers are basically having to carry your friend's workload because she is not able to do her job (really lame plan IMHO) then you are entitled to know how long for, and it's entirely reasonable to ask your supervisor to agree a review date with you all. And you can make sure it is documented that you all have concerns about carrying her workload AND her well-being AND patient safety, so very short term would be better. Can you say OK we'll do this for a day or so and report back? That way you are being positive about the plan (even if you know it's hopeless), and then you can bring your experiences of the trial period, whether it is helping, AND your professional/contractual obligations along, and the ball will be back in your supervisor's court. And if a much better plan doesn't materialise ASAP I'd think very seriously about taking it higher in the interests of patient safety.

If anything happens to a patient it would be terrible but you would have done all you could. You can only do so much from the bottom of the management heap - it's your job to report what needs reporting but it's theirs to act on it, that's what they are paid for.

Risk manangement story I heard - a nurse in charge of a chronically understaffed ward at night had a patient die because basic checks weren't done, they were going to throw the book at her. But she had been filling in clinical incident forms every time the ward was dangerously short staffed, they had all gone up through the system to management... who had done nothing. She was completely in the clear, management in very deep doodoo indeed. It doesn't make it any better for the patient, but the buck stops where it should, where someone can make a decision to stop it happening again.

I hope it all gets sorted out OK.

Thankyou for you great points and yes...I feel like our jobs could be on the line if something happens. Even when we are full staffed, we are so busy that we are understaffed. When someone calls in sick, it means taking over someone else's schedule which puts us at risk of being unsafe. I also feel that putting my coworker to work with someone else is not correcting the problem. Talking with my supervisor, she said she had lots of information that she could not disclose. But I do not know what info that was or what it means. The reason I do not see having my coworker work with another will work out is because she has had this problem now for 2+ months. She goes for like a week of having bad days, then she is find for like 2 days...then back again continuing the cycle. Everytime she goes downward, it seems to get worse and worse.

 

[KuteNurse]

KuteNurse do you know her family and her doctor? Maybe approaching both and putting them in the picture could be a solution. They could then talk to her. Also as her friend maybe try to talk to her directly, yes she may be angry but maybe she is frightened deep down and afraid to face the escalating problem for fear of losing her job or friends etc. Self denial
as you will know is a coping mechanism and it sounds like she may be in this mode.

I understand how difficult it is to go over one's supervisors head but maybe 2 or 3 of you need to do this together, better to lose her friendship than have her injure a patient or herself <sigh> a very difficult situation.

Do hope you are able to resolve this quickly.

I know of her doctor and she talks of her family, but I do not know them personally. I do not think her family would help her out much. She has a bad marriage where they do not share a bedroom and her husband locks himself away in a room with the computer doing God knows what. Her son is in his mid twenties living at home...My coworker told me that when asked to think about moving out, he threatens to commit suicide...So she lives with a very dysfunctional family. It is really sad actually and I am certain it is playing into her bad work performance.

 

[gisela]

It makes me sad to read aout you co-worker and it's certainly a big problem for you as well as the hospital. Strong of you to react. I cannot see how this can go on. It could end in disaster for her as well as others. If she's so fragile and weak now how would she manage if something went terribly wrong?
I really hope for you to figure out how to do this. If I prayed, I would pray for you, but I don't, so I will keep you in my thoughts, ok?

In Sweden there have actually been formed two new laws after nurses stood up to some bad situations in nursing homes. The laws were named Lex Maria and Lex Sara after the nurses that reported the incidents.

I'm not saying that everything will turn out well with certainty, just that there are still people out there who see what's right and wrong and credit the ones who deserve it.

 

[adiemus]

Hi there - what a difficult situation you're in...
I agree with what you've done so far - ethically you're responsible to her to raise the issue, which you've done. You've also recognised the ethics around her patient care - and dealt with that the way that is correct in your work place. The next step is to go up the management ladder if you believe patient safety (and her personal safety) is being compromised, and then if that is unsuccessful, go on to the next layer of management - or the professional body.
In the end, it's your responsibility to notify but not yours to carry the responsibility which is what you would be doing if a patient was harmed in this process - I bet you'd feel terrible knowing that you had the opportunity to act but didn't do so.
What you're really doing is offering her and the organisation an opportunity - one to prevent harm, and another to offer her help.
I wonder if you could ask her what she thinks she needs to do - and she's probably ambivalent about doing anything, but actually knows the options.
Another thought is to suggest Employee Assistance Programme if you have one - they may help her choose to do something for herself.

In the meantime - YOU need to look after YOURSELF! We're here to listen and help as much as you need!

 

[Yasmine Bint Al Nubia]

Hi KuteNurse, I'm a RN and I've seen this more times that I can count. We think we can save a person by hiding their 'disability' and because we don't want to get them in trouble. Well let me tell you...she's already in trouble! And so are her patients and co-workers who cover up for her. As nurses, we need to police ourselves. She needs an intervention plain and simple, she must be brought to the realization that it's dangerous to work under these conditions, besides it creates more work for you.
Discuss this with your supervisor. Relate details and not personal, emotional reasons.
Most employers have an employee assistance program. She needs to be directed to one. Usually it's the supervisor's job.
Also most employers have FMLA. She can take advantage of that as well.

As a nurse it's hard enough to take care of patients much less an impaired co-worker!
Yasmine

 

[nightdancer]

Personal and Patient safety, first. If you need to escalate it to HR, you need to do that. They will not fire her for health reasons, SEIU would have a fit, especially if her work to this point was good. Document, document, document. If its not charted, it didnt happen. Putting her to work with you is only to get around the staffing issue, and to show some sort of "corrective behaviour" on paper, which again, may or may not be documented elsewhere. Write it down, take it to HR. It is not safe for your license if she makes a mistake, and that is unfair to you.

 

[KuteNurse]

It makes me sad to read aout you co-worker and it's certainly a big problem for you as well as the hospital. Strong of you to react. I cannot see how this can go on. It could end in disaster for her as well as others. If she's so fragile and weak now how would she manage if something went terribly wrong?
I really hope for you to figure out how to do this. If I prayed, I would pray for you, but I don't, so I will keep you in my thoughts, ok?

In Sweden there have actually been formed two new laws after nurses stood up to some bad situations in nursing homes. The laws were named Lex Maria and Lex Sara after the nurses that reported the incidents.

I'm not saying that everything will turn out well with certainty, just that there are still people out there who see what's right and wrong and credit the ones who deserve it.

Gisela,

You are exactly correct in saying she is fragile and weak right now. That is part of why it is so difficult. I don't want it to feel like I am going for the jugular, when all I want to do is for her to get better so she can get back to her job and function in society again. I appreciate and respect the fact that you will keep this in your thoughts...Thankyou for that. Minnesota does not have laws for reporting incidents like yours, but I believe I could report it anonymously if need be.

 

[KuteNurse]

Hi there - what a difficult situation you're in...
I agree with what you've done so far - ethically you're responsible to her to raise the issue, which you've done. You've also recognised the ethics around her patient care - and dealt with that the way that is correct in your work place. The next step is to go up the management ladder if you believe patient safety (and her personal safety) is being compromised, and then if that is unsuccessful, go on to the next layer of management - or the professional body.
In the end, it's your responsibility to notify but not yours to carry the responsibility which is what you would be doing if a patient was harmed in this process - I bet you'd feel terrible knowing that you had the opportunity to act but didn't do so.
What you're really doing is offering her and the organisation an opportunity - one to prevent harm, and another to offer her help.
I wonder if you could ask her what she thinks she needs to do - and she's probably ambivalent about doing anything, but actually knows the options.
Another thought is to suggest Employee Assistance Programme if you have one - they may help her choose to do something for herself.

In the meantime - YOU need to look after YOURSELF! We're here to listen and help as much as you need!

Thankyou Adiemus for your help and support. I have a feeling when I return to work on Tuesday, that if things have not improved, my coworkers and I will have to move a step up to get this resolved. We do have an employ assistance program...I believe it covers 3 free appointments with mental health. I personally think she would benefit more by being admitted into the hospital, but I do not think she has the mental capability right now to see that she is as sick as she is. I think she needs to have many different areas of medicine working with her from gastroenterology, endocrinology and mental health. I do get concerned because she has a strong history of depression and her brother actually committed suicide many years back. She needs to get out of her family lifestyle to get better because it is a dysfunctional situation, so she can concentrate on getting better.

 

[KuteNurse]

Hi KuteNurse, I'm a RN and I've seen this more times that I can count. We think we can save a person by hiding their 'disability' and because we don't want to get them in trouble. Well let me tell you...she's already in trouble! And so are her patients and co-workers who cover up for her. As nurses, we need to police ourselves. She needs an intervention plain and simple, she must be brought to the realization that it's dangerous to work under these conditions, besides it creates more work for you.
Discuss this with your supervisor. Relate details and not personal, emotional reasons.
Most employers have an employee assistance program. She needs to be directed to one. Usually it's the supervisor's job.
Also most employers have FMLA. She can take advantage of that as well.

As a nurse it's hard enough to take care of patients much less an impaired co-worker!
Yasmine

Yasmine you are correct in all you say. The main issue my coworkers and I struggle with is going over our supervisor's head to get her the help that she needs. My desk is right next to hers, so it has been a struggle seeing her spiraling downward for the past few months. I am hoping many of the doctor's may be aware of what is going on through word of mouth and observance. I do know for a fact one nurse practioner knows what is going on. Hopefully this will be enough intervention to get her set on the right path.

 

[Reen.Blom]

Ay KuteNurse sweetie, I pray you find the right thing to do, and that the lady gets help and feels better ASAP.... It is possible that work is all that keeps her going, with such situation at home.... maybe she is afraid to get the leave and be stuck at home and get more depressed.....

*hug*

 

[KuteNurse]

Ay KuteNurse sweetie, I pray you find the right thing to do, and that the lady gets help and feels better ASAP.... It is possible that work is all that keeps her going, with such situation at home.... maybe she is afraid to get the leave and be stuck at home and get more depressed.....

*hug*

I think work may help her in some ways to get away from her home life. I have not called work to find out what is going on. I kinda want to forget about it for a while.