[ERTraumaJunkie]

Okay, I need to vent. I'm an LPN working as the 2nd nurse in a small ER. I work the busy 11-11 shift. I am so frustrated with my RN! I don't know if its a lack of compassion or if she really doesn't know how she comes across. I usually spend the first 1/2 hour of my shift apologizing for the bad care the pt's have received and making excuses for why they haven't received meds, blankets, been changed, etc, and trying to explain away her pure rudeness. I probably get told on average of 3 times/day how hateful she was.

And its not just the comfort measures and manners that are lacking. I understand that she can be busy before I get there and maybe drinks and blankets don't get handed out. But some of this borders on negligence. If a Foley was ordered at 0838 for a CHF pt on Lasix and she has only had a total of 2 pts in the ER since 0700, why is the order waiting on me when I come in at 11? Maybe I'm looking for someone else's perspective on this? I don't want to be a total biotch, but it seems like everyday when I come in, I either have to fix something she's messed up or failed to do.

For example, pt SCREAMING with severe abd pain. Has been in a room in the ER for 1 hr when I walked in. Two other pts present. No one crashing. No one bleeding out. One of the two pts just waiting for floor to pick them up. Order has been written for pain meds, labs and CT. Orders not in PC; no IV; meds not given. I gave within 5 min of clocking in!! Can someone please tell me why they weren't given before I got there? I spent most of the next hour apologizing and making excuses to the pt and family and trying to smooth things over.

Then there is the other problem. I am an LPN. Granted, I am a good LPN. But I have been a nurse less than 5 years. My RN has been a nurse a lil longer than that. I understand and appreciate that she trusts me to do a lot of things independently. BUT...I am not in charge of the ER. She is. I do not get paid to run the ER. But from the moment I walk in, I am in charge. I am the one alerting the MD when pts go bad (i.e. new pt with 70/30 BP she did initial assessment on and then never checked on again. I wasn't aware of initial BP until I walked into room an hour later and found pt circling the drain), calling for transfers, calling report to floor, etc. I'm the one pointing out lab values the MD needs to be aware of, etc. And I feel totally responsible when something goes wrong. And the stress of this is overwhelming because I KNOW I am limited in my capabilities because of my education. To be honest, I am terrified of what happens when something comes through the door that I am not prepared to handle. I don't think it will have a happy ending.

Okay...give me your best RN opinions...from the examples given, am I just being one of those people that ******* because she thinks the person above her doesn't work hard enough? Or do I have legitimate complaints? I don't want to stir up trouble, but I don't know how much longer I can handle this. What should I do? HELP!

[NRSKarenRN]

Originally Posted by ERTraumaJunkie

Okay...give me your best RN opinions...

Can feel your pain:
Get thee into RN program so you can get paid for work your doing..... that's what propelled me into completing BSN program.

One thing to consider: How much did RN have to clean up from night shift?? # pts in ER prior hours before your arrival. Unless you have access to that info, unable have full picture what she's doing before you arrive.

Any chance you can have frank discusion with colleague about your concerns? If not, Sometimes just gotta stop being super LPN nurse and allow RN be in charge ---for better or worse.

Significant issues re delay in meds/treaments need to be communicated to ER Manager. Working as a TEAM instead RN vs LPN is what SHOULD be encouraged by mgmt and physicians.

Kudos for being so caring and PATIENT oriented.

[jlsRN]

Where I work we have something called a 'care and service report'. It's a way the clients (patients) can give positive or negative feedback to management about their care. It's a good way to handle complaints about other shifts or staff, without tattling. If the patient is complaining heartily, without being soothed, we just hand them one of these. I've never done it, but others have.

I figure that if there is a pattern of complaints or behavior, then there's probably validity to it.

[mom2michael]

I used to work the midshift with another RN that was EXACTLY like this person. Things were never done, orders were missed, patients were lined up ready for d/c when I walked in the door (ready for over an hour). Pain meds not given. Doctors about ready to kill her. It was great times. Usually I found her on the phone or outside talking to her husband when I came in. One time I walked in and found an ambulance wanting to drop off a patient and no RN in the ER until I walked in the door.

I just started dragging my supervisor in all the rooms when patients were complaining and carrying on about their care or lack there of. I started copying the charts whenever orders were missed and when the doctors started to complain, I handed them an internal complaint form......

She doesn't work there anymore.......

[jojotoo]

This doesn't sound like a problem where she's an RN and you're an LVN. The problem is that she's lazy and you're not.

I don't think you're going to be able to fix this without some help from the higher ups. Surely the MDs realize what's going on. Maybe they could speak to your manager.

One thing that you could do, is if your facility has business cards, when the patient is either admitted or discharged, give them one of the cards with BOTH of your names written on it. (Mary RN and Jane LVN). Just smile and say, "I just wanted you to know who your nurses were today." You don't have to do any other "prompting". I'll bet that about one third of the patients that you give cards to will call and either praise or complain about the care. Just make sure that the patient KNOWS that your are Jane LVN and not the other nurse.

[gr8rnpjt]

Just what is she doing when you are doing all the work? Is she trying to look busy or is she just sitting around doing nothing? You need to talk to her boss and give examples like the one's you gave above, only with dates and times, etc. File incident reports for meds and treatments not given when ordered.
I agree that you should go back and get your RN. You have better leadership skills than your colleague.

[BSNDec06]

Some of the things you described would be cause to write up an incident report at my facility. I am not saying that you should do so for the sake of tattling, but you need to cover yourself and make administration aware of these significant delays in patient care. Making your manager aware of the situation before it gets out of control is important. Administration might decide that you are equally culpable if you knew about the problem and said nothing. Good luck

[ERRNTraveler]

I agree- the only way to get anything done about this is to document it with incident reports. Also, encouraging patients to file complaints when they have one- for example, next time a pt. is complaining about her, give them your manager's card & encourage them to discuss their concerns with him/her. If enough people complain about this nurse, your manager will be forced to do something about it.

[ERTraumaJunkie]

Ok, I guess I'm just back to gripe some more. I took the advice all of you offered and did have a frank discussion with my NM after my original post. Turns out there had been complaints from other nurses that follow my RN as well as pt complaints. So she was given a small slap on the wrist and actually did improve for a couple of weeks. But then she quickly eased back into her old habits.

One day this weekend, I came in at 1100 as usual. There were 5 pts in ER. My RN had gotten a LPN and an aid from the floor to help her since floor census was low. We never have that much help. Usually its just the two of us, so you'd expect exceptional care with this type of staffing.

One of the pts had been dropped off by EMS before I got to work, but no one had been in with her when I got there. So I spent the 1st hour or so with her as she was covered in urine and feces and needed a good scrubbing in addition to all of the other things such as IV, telemetry, etc.

So when I finished up, I asked the other LPN what else we had going on. She proceeded to give me report starting with a pt she was very concerned with. Pt had a recent colon resection, c/o abd pain, pale, and some mental status change. "There's just something wrong with her" per the other LPN. She tells me she had told Nurse X that something is wrong with the pt several times and Nurse X just says "okay" and doesn't check on pt. Pt was in CT at the time I was being told this.

Pt returns to room and I'm in to check on her. Pt is very pale, cold, and diaphoretic. Lethargic with slurred speech. Abd very distended and tender to touch. Bright red drng from rectum. BP 58/36, pulse 104. This pt was brought to the ER at 0930 and this is what I find at approx 1230!!! BP was low on admission; granted, not this low, but low. In the 3 hours she was there, no line started, no additional VS taken. Nothing had been done for her except pain meds administered once.

I get pt into Trendelenburg and rush out to get IV tray. Nurse X asks me what I'm working on and I tell her pt is going bad, suspect massive GI bleed/perforation. She says "okay" and goes back to her pt with conjunctivitis!!!! Not once from the time I saw the pt at 1230 until I transferred her out, did the RN come into that room.

I did discuss this with the shift supervisor as soon as I had this pt safe and secure in an ambulance. And I showed her the chart so she would see for herself nothing had been done for this pt in 3 hours. She also talked to the other LPN who backed up my story about Nurse X not going into the pt's room. The supervisor promised to discuss it with my DM, but I really expect nothing to come of it.

I don't work with Nurse X again until late in this week. But I am really dreading working with her. I am to the point that I really expect her laziness/apathy to kill someone. I can give you more examples like the one above if you need them. I really don't want her to take my license down with her. What should I do? Can I refuse to work with her because I feel my license is jeporadized and because I don't want to see someone die just because she doesn't want to be bothered to check on them? What are my options here? Any advice is greatly appreciated. And if I'm being overly critical, I'd like to get that feedback too so I'll know if I just need to chill out.

[ERRNTraveler]

I don't think you're being overly critical. Unfortunately, all you can do is just keep writing her up, if she continues to do unsafe things like this, management is going to have to let her go, or a patient is going to end up hurt or dead. Protect yourself by charting religiously, and if management still refuses to do anything about her, then I think your only other option would be to quit- I don't think that you can refuse to work with her.