my supervisor is becoming forgetful

  1. I am a LPN and work under an RN whose skills I question. She seems to be declining mental and emotionally. As time passes, her abilities are more erractic. I have contacted my superiors, but since I have been the only one to formaly state my opionions, nothing has been done.

    Here is some examples. The other day, I was caring for a man with bladder cancer. He had come to us post turp. He had a super pubic cath in place. On my shift, I noticed he was bleeding frank blood, and began to irrigate. The bleeding was a gross amount and upon vitals, I noticed he was begining to go into shock. I immediately called the RN supervisor and requested he go to the hospital, he was CPR and had no wish to die this night.

    My first mistake with her, was I that I, and LPN told her an RN, what needed to be done. This caused her to become resistive to my plan. I know she has this prejuice, and tried to be careful with my wording. But she didn't like the fact that I made the decision to send him. So she immediately nixed the plan.

    Then she noticed the cath sticking out of the abd, (supra pubic) and said there's your problem - look at the tubing he's pulled it out. It was perfectly placed. She confused the tubing length of the lenth of a cath placed through the penis. At this time there were two n/ars in the room with us and we were all trying to explain that this was a supr pubic cath and this is why the length of the cath on the outside was so long. But, she wouldn't hear of it and began to yank at the tubing, causing great pain to the pt. Finally another RN came in and just called 911.

    So no one is willing to report the many times this nurse is acting irrationally, so she continues to make bad decisions and wrong choices. Any suggestions?
    •  
  2. 10 Comments

  3. by   boggle
    What a scary situation. This sounds like one you will have to report to whomever is above this supervisor. It is fortunate that another Rn saw what was going on as well as the nursing assistants. Document what happened as factually and as objectively as you can and report this. Be strong. Let us know what happens please.
  4. by   nurseygrrl
    That's terrible. I am really sorry you're having to go through this with an incompetent and jealous nurse. I know exactly what it's like as I have been in similar situations. The only thing you can do is go to your superiors and maybe your state board of nursing. Whatever happens, I wish you the best of luck. Can you perhaps transfer to a different unit? If you have to stay working with her, just do your job to the best of your ability and try to keep your stress level down.
  5. by   Destinystar
    i am in california and the last time i looked if an lpn has accepted an assignment to take care of patients they can call the md to get an order to send the pt. to a hospital or call 911 whatever the nurse sees fit and is under no obligation to notify an rn first. lpn's in california dont need to ask an rn's permission to do anything unless they dont know what to do or if it is out of their scope. i will tell you a true story. an lpn in ca noticed that a pt. had a low blood sugar and called 911. then reported it to the rn. the lpn claimed the rn told her to cancel the 911 call. so the lpn cancelled the 911 call. full code patient died. a disgruntled don upon being terminated called the state and reported this 8 months later. an investigation was done. lpn & rn reported to bon. bon decision was to revoke lpn license b/c the lpn knew beyond a reasonable doubt that the pt. was in trouble and did the wrong thing by cancelling the 911 call. the bon stated if the rn did tell lpn to cancell 911 she should have told rn no!. its like if an md tells you to give your patient a bottle of aspirin you know it is wrong and you are to refuse such a bizarre request and it is perfectly fine to tell the md to come in and administer the bottle himself. i hate to say this but alot of rn's out there are figure heads and could not and probably would not be able to take care of a patient if their life depended on it.
  6. by   P_RN
    Excellent advice. DOCUMENT and have witnesses. Are LPNs allowed to call the doctor where you work? It's too bad this nurse is going downhill. Hopefully she will realize this and retire before she is made to.
  7. by   Hellllllo Nurse
    Quote from walkmygardenpath
    I am a LPN and work under an RN whose skills I question. She seems to be declining mental and emotionally. As time passes, her abilities are more erractic. I have contacted my superiors, but since I have been the only one to formaly state my opinions, nothing has been done.

    Here is some examples. The other day, I was caring for a man with bladder cancer. He had come to us post turp. He had a super pubic cath in place. On my shift, I noticed he was bleeding frank blood, and began to irrigate. The bleeding was a gross amount and upon vitals, I noticed he was begining to go into shock. I immediately called the RN supervisor and requested he go to the hospital, he was CPR and had no wish to die this night.

    My first mistake with her, was I that I, and LPN told her an RN, what needed to be done. This caused her to become resistive to my plan. I know she has this prejuice, and tried to be careful with my wording. But she didn't like the fact that I made the decision to send him. So she immediately nixed the plan.

    Then she noticed the cath sticking out of the abd, (supra pubic) and said there's your problem - look at the tubing he's pulled it out. It was perfectly placed. She confused the tubing length of the lenth of a cath placed through the penis. At this time there were two n/ars in the room with us and we were all trying to explain that this was a supr pubic cath and this is why the length of the cath on the outside was so long. But, she wouldn't hear of it and began to yank at the tubing, causing great pain to the pt. Finally another RN came in and just called 911.

    So no one is willing to report the many times this nurse is acting irrationally, so she continues to make bad decisions and wrong choices. Any suggestions?

    I worked with such an RN years ago when I was an LPN.

    She even refused to call the fire dept when our alarm system detected a fire. she just disabled it. finally, I called 911 and the fire dept did find smouldering wires in the crawl space.
    Another time, pt was admitted for pain control. He was on MS Contin q 12 hr, no order for breakthrough pain. Day shift did not give the MS Contin. The day nurse said "Pt can no longer take po meds, and I didn't want to give it rectally."
    I begged the nurse for 9 hrs of a 12 hr shift to get orders for breakthrough med. The RN refused.The pt had all the signs of severe pain, which i carefully documented.This pt retained his own pcp and we could not use standing orders for him. LPNs were not allowed to call docs for med orders per facility policy. I finally did it anyway, and got an order for sc MS04. The RN was furious and tried to get me fired. I was not fired but I was written up for insubordination. I told my NM that I had not considered politics or egos when I did what I did, only the pt. My name was mud at that place for a while because of that, but they finally got over it. I quit to go back to school. They even called me and tried to get me to come back after I became an RN.

    Keep a notebook of inappropriate things this nurse does. I did and was able to show documentation that another RN I worked w/ had a history of leaving the unit without RN coverage. She would leave the unit to drive her daughter to school. She would also sleep on the job. I have documentation of this, as well.


    Make sure you chart your findings, thoroughly, and that you chart that you reported them to the RN. Include her name, time and any comments. Chart objectively- what was observed said and done, only. Do not chart anything subjectively.

    The "old girl" network of RNs backing RNs over LPNs is alive and well. In my experience, NMs (who are always RNs), tend to back the RN over the LPN when any problems come up.

    Having been a CNA, and LPN and an RN, I have experienced all sides of this first hand.

    Sounds like you are doing well in your job. Good luck to you.
    Last edit by Hellllllo Nurse on Jul 10, '04
  8. by   jemb
    This is the sort of situation where a report to the BON is definitely in order!
  9. by   RN2CNM
    Quote from destinystar
    i hate to say this but alot of rn's out there are figure heads and could not and probably would not be able to take care of a patient if their life depended on it.
    wow......what a generalized statement to make about rn's.....i take it you are an lpv/lvn that knows the same if not more than an rn even though less education is involved with your career choice (thats if you are an lpn/lvn)and you should be making the same if not more than rn's(because of course you do everything an rn does).i work in the nicu and we only have 1 lpn/lvn and she or any other lpn/lvn can only work in the level ii nursery as lpn/lvns do not meet the job requirements to even step foot in the level iii nursery. so therefore i guess most of the premature infants probably are not being taken care of even if our lives depended on it as rn's (in direct quote of you, destinystar ) sorry a little straight forward, but as an rn......just took a little offense. please feel free to respond.
  10. by   Hellllllo Nurse
    Well, I'm an RN and I have worked under a few RNs who were just figureheads, and didn't have a clue- even about the basic stuff, such as turning a pt. There are some of these out there.
    Last edit by Hellllllo Nurse on Jul 11, '04
  11. by   RN2CNM
    agreeed helllllllo nurse...........there is one or two, but very few and I mean very few RN's that i know that need a little help. but for someone to just come out and sum up a majority of RN's capabilities to that of nothing.............. is just wrong:stone ....but again this is my opinion and everybody is entitled to one.
  12. by   Agnus
    There is no need for this to degrade into LPN vs. RN and personal attacks. The OP asked a very serious professional question with her post and deserves the same.

    Diverting the converstation to something else limits the sound advise that you could offer her.

    Document thoroughly. Keep a running documentation. Follow up with this nurse's supervisor. If you feel it necessary tell the person that you have been reporting to that you are going up the chain. (don't assend the chain of command without giving fair notice and a chance for that person to take action)

    If you do not get satisfaction turn over (copies of ) your documentation to the BON and to the agency that regulates the facility.

    You are not likely to have to report the agency as they will probably take action. You can't just fire someone based on hearsay. However, if you have accurate detailed objective documentation and expess yourself professionally with concern for both the nurse and the patient as you have here then they have a basis to begin addressing it with the nurse.

    There will likely be private counselling with the nurse followed by more agressive action if the behavior continues.

    You need to follow up with management. I believe you have a right to know what action they are taking though they may not tell you. Let them know if you see nothing happening and are not informed then you will have to assume they are ignoring it and will go the next step. You can do this nicely and professionally.
    Assume they will take care of it. But don't ignore it if they seem not to.

close