By Ryan Gray, MD

Unfortunately, bad nurses can make a significant negative impact on patient care—sometimes even more profoundly. So, how do you spot a bad nurse before it’s too late?

Here are some telltale signs that a nurse is bad news:

1.Job hopping. Although a lengthy job history can provide a nurse with a range of experiences in a variety of care settings, a job-hopping nurse can spell trouble. If a nurse has had many jobs and only stays for a short time (say, around a year or so), be sure to carefully question the nurse about his or her job track record during the interview.

A history of problems with co-workers, management or patients will usually be detectable, but only if you are paying close attention. When asked to explain the circumstances surrounding the departures from previous jobs, bad nurses will often appear angry, badmouth their previous employers or blame others.

2. A bad attitude. If you encounter a nurse who become easily frustrated, is curt with patients or complains constantly, run in the other direction. Now, everyone has a bad day once in a while, but a continuously disgruntled nurse is in no position to care for sick patients and family members who are sad, scared and overwhelmed. A nurse with a bad attitude will seldom smile, can be sarcastic and is always quick to make a negative remark.

3. Gossiping. Nurses should be loyal to their patients—period. Although some patients can be especially challenging to deal with, that is no cause for a nurse to badmouth them behind their back. If a nurse is gossiping, mocking, judging or otherwise saying negative things about a patient or their family, beware.

At best, this kind of talk is unprofessional and could damage the nurse’s relationship with the patient. At worst, undue negative chatter could result in a serious privacy violation or distract the nurse from performing his or her duties. And, although it seems less insidious than gossiping about patients, gossiping about co-workers is another warning sign.

In his book, Dave Ramsey likens gossip to poisoning your team. I agree 100% and try to stop gossip in it’s tracks. Gossip, according to Ramsey, outside of the traditional sense, is any complaining to somebody who can’t fix the problem you are complaining about.

4. Ignoring protocols. This is a no-brainer and can have potentially serious consequences for patients and co-workers. If a nurse ignores contact protocols in isolation rooms, he or she could be responsible for spreading highly contagious illnesses to other patients and co-workers. Improper charting could result in patients receiving the wrong medications/dosages or doctors getting inadequate or incorrect information. Even a failure to use hand sanitizer or wash hands between patients demonstrates a disregard for patient safety and a lack of understanding about how to behave in a health care setting.

5. Always overwhelmed. Everyone gets busy from time to time, but when a nurse seems to be constantly overwhelmed and frantic, it can signal more serious problems. Feeling constantly busy can lead to forgetfulness or cause acrimony among co-workers who are always picking up the slack and being asked for help.

Nurses who are overwhelmed all the time may have gaps in their training or an inability to multitask. Plus, nurses who are anything but cool under pressure are more likely to experience stress-related ailments, take more sick days and experience burnout. And, you can forget about getting any kind of competent help from Nurse Freakout in the event of an emergency.

6.Shirking job duties. Avoiding patient care duties or always wanting to be the charge nurse could be a sign that a nurse just isn’t cut out for the job. Disappearing when the IV bags run dry, always being too “busy” to lend a hand and trying to get out of doing new admissions are all red flags. Lazy nurses also tend to delegate more unpleasant duties—particularly those involving, you know … patient cleanliness—to CNAs.

7. Incompetence. If you receive reports from patients, families or co-workers that a nurse is unable to start an IV, administer complicated medications or follow simple procedures, take the complaints seriously. Be alert for indications of incompetence when talking to references at previous jobs. When it comes to past-employer references, anything other than a glowing testament to a nurse’s caregiving skills should be suspect.

The ability to spot a bad nurse is something that all doctors (or human resource staff members) should learn to do. By paying close attention to the warning signs and taking quick, appropriate action, you can keep your patients safe and save yourself and your co-workers a whole lot of aggravation.

We unfortunately work in an environment where being understaffed can be detrimental to everyone, but taking your time hiring the right nurse is paramount to patient safety and the team’s happiness and effectiveness.