LTC and Hospice

[Nurseonthenet]

I have been working at this LTC facility for 6 months, so far it has been a lot of challenges but I am very receptive to learning and survive with no write-up or warning. I comply with all rules and policies. I come to work on time, no call-off, I even work double, triple shift when they are short in staff, provide assistance to anyone in need, no complaint from staff. I got a call last week and learned that I am suspended until further notice. Here's what happened.

My shift that day was 3-11, busy shift as usual as an RN supervisor, supervising 3 stations, with the total of 180 patients, with 2 admissions, 2 transfer-outs, dealing with one patient's behavior who returned after being transfered, bed/room changing, IV meds, incidents, charting, telephone orders, carrying out the orders, phone calls, handling call-offs... I've been there for 6 months, so I am somewhat familiar with all except for admissions and transfers (not to mention anything unexpected). One admission avaragely takes me about 4 hours to finish with everything. Like I said I had 2 that shift, but one was going to be done by a hospice nurse who was coming in later of the night after the patient arrived, since the patient is on hospice. The patient came at 7pm, meds delivered by hospice pharmacy at 8pm, the hospice nurse came at 8:30pm.

When the hospice nurse settled down in station 2, I left station 1 (where I usually stay most) to come and introduce myself as well as to assist her with the facility's admission process (it's her first time with the paperwork in this facility). I took my other unfinished admission to station 2 and continue to do it by herside. She said she needed a CNA to help with skin assessment, supplies for wound care, physician order sheets. I quickly provided her with the CNA, with our treatment cart parked outside the patient's room, with all paperwork she needed, and continued to sit by her side. She was then on the phone with someone taking about administering pain meds to the patient "right after she got to the station", and that the patient is NPO, didn't need IV hydration, and that she was close to finish the admission (the patient has end stage cancer with multiple skin sores). I finally finished with my admission. I told her: "I need to take the chart back to station 1, I will be back."

When i'm back, she then said that she needed a set of vital sign, so the charge nurse, who is a brand new LVN 1st day on the floor, went in the patient's room to take a set, but unable to since the patient is edematous. He asked for my help, then I went in and take it. When I came out, the hospice nurse was not there at the desk. I was thinking she stepped out for a minute. I went back to station 1 to finish everything else that needed to be done since it was almost 9:30pm. About 45 mins later I came back to find she was not at the desk again. I didn't even put a question in my mind that I needed to go find her. I went back to station 1 until shift change at 11 when the next RN supervisor came in. I told her there is a hospice admission and we needed to check out the admission progress. Together we came to station 2 and confirmed that the hospice nurse was really gone, leaving the chart and all orders open on the table, narcotic IV meds left unattended at the nursing station, no medication administration record or report of any kind.

We started to count the narcotics, and called hospice at 11:30pm until 1:30am, 4 times but no nurse call back. The other RN supervisor gave the IV pain meds as directed on the label (no narcotic count sheets), and then continued with the admission, which was not much we could start off with because there is no hospital discharge med list available. I clocked out at 1 am but stayed at station 2 until 3am to finish things I did not get to finish during shift (and if you are still interested, continue reading to find out what I did not get to finish at the end).

So I got suspended for 2 reasons: (1) delaying of care resulted in neglegence (fail to report to DON at time I realized the hospice nurse left, my documentation about the event that basically set trouble for the facillity for saying that the nurse left things incomplete (for saying incomplete, what did I do to corrrect it?)) (2) fail to mentor the new LVN as a supervisor.

I know there are things could have done differently in a better manner, but if anyone has worked in a 200+ bed LTC, they would understand what I am talking about regarding addmisions, charting, transfers... It was one of the busiest shifts to me and I did not stop working the entire time until 3am. Time goes by so fast when you are on the floor. The actual time we confirm the hospice nurse really left was pass 11pm. We picked up the work right away, there was no delay. So how could it be a delay of care? If anything, I would say I fail to report the info to my DON and fail to realize the nurse had been long gone. I was told on the phone that hospice was washing off their hands and did not accept the responsibility. I learned soon after that the 11-7 RN supervisor that night got to talk to the hospice nurse who left during admission. She was first aggressive but later said that she had an emergency at that time, she could not find me anywhere, so she left.

For reason #2 - fail to mentor new LVN: I knew he was new but no one told me it was his first day on the floor. The hospice admission and 2 transfer-outs that shift were all his, but he didn't get to do any of these since med pass took him the entire shift to finish. I specifically told him x2, with a witness, that if he has any question, come and ask me anytime, and that I will come back after to help him finish all the transfer documentation and paperwork, which I did after 11pm. I wonder how could that become a lack of support?

I would like anyone's opinion on this situation. I am not familiar with hospice and this kind of situation. The only thing I know is that hospice is very territorial and that's why I brought myself to sit next to the nurse for any assistance. As of right now, the facility wants me to come tomorrow morning, not sure what is going to happen yet. What should I have in mind when I come in tomorrow?