Neglect...LPN was fired, RN was not

[KacyLynnRN]

I wanted to get everyone's opinion on a heated debate at my workplace. I work in a large hospital's Med/Surg unit. Usually 8-9 patients are lumped together as a "team" with an RN, LPN and CNA on each time. At night, it can be 12-14 patients, often with only an RN and LPN. Usually you 'split' the team with the LPN taking some patients, the RN taking some patients, and each person doing total care for their patients. One night about a month ago, an RN and LPN had 'split' their team. One of the LPN's patients was found dead on the floor at about 5am, they called a code but he had been dead awhile and rigor mortis had already set in. The patients was in his 60's and a GI bleeder, he was being prepped for a colonoscopy the following morning. I heard through the grapevine the hospital had done an autopsy and the patient had fell on the floor, hit his head, and died as a result. He had been dead about 3-4 hours before he was found. As a result of this, the LPN who was responsible for this patient was fired. The RN on the team recieved a verbal warning, but otherwise she was not disciplined. A lot of people at our work complained to our manager, and she said the LPN has a license too, and therefore she is legally responsible for her patients just like the RN is. I am an LPN but am also a full-time RN student and will graduate in 11 months with my RN. The LPN's at work have been bad-mouthing the RN and our manager, saying that the RN is over the LPN, and she should have been fired too. I personally agree with our manager...I feel that while I am not an RN, I am an Licensed nurse and with that comes personal responsibility for my nursing actions. A lot of my LPN peers disagree, so I have kept my opinion to myself for fear of my coworker's backlash. It is really a HOT topic at work now. What do you all think?? Am I right in my opinion?

[MandyInMS]

While the RN was of course in charge, the LPN was responsible for her assigned pts..if the LPN had reported a problem and the RN didn't assist, that would have been different..I'm no legal wizzzz by any means, but how can the RN be held responsible when she had her own full load of pts and didn't know there was a problem, and thought the LPN was checking/assessing her own pts??? I dunnooooo on this one ~confused~

[Brownms46]

She shouldn't have been just "thinking" she should've been checking! And she should have never accepted such an assignment in the first place! Where were her critical thinking skills??? I must add I also fault the LPN for accepting the assignment, and for neglecting to check on her pt. Yes she should've been fired, but so should the RN, as both used POOR judgement!

[Town & Country]

"It would be nice to be able to "just say no", but not everyone has that luxury.

It, in most cases, wouldn't change the assignment and might get someone fired. Some people can not afford to lose their job, for whatever reason, they have a family to support, whatever.

Just refuse is so easy to say, but not always so easy to do, and I would imagine that the majority of people that keep saying "just refuse" have never actually done it."

I guess if you think of refusing unsafe assignments as a "luxury".

I cannot afford to lose a job, but I have, rather than take an unsafe assignment. I have kids to support, myself.

And.....yes, I have done it. Several times, and will continue to do it, if necessary.

Until nurses stop this "victim" mentality (i.e., "I can't afford to refuse", "I can't afford to lose my job",), the unsafe staffing will continue.

I didn't want to lose my job, either, but at least when I lay down at night, I don't have anyone's injury/ or worse, their DEATH on my conscience.....just my honest opinion.

[Town & Country]

P.S.

With the nursing shortage now, there's no reason anyone should be a slave to their job.

You can ALWAYS find another job.

[fergus51]

I can't see blaming the RN for this. If LPNs want to be recognized as professional nurses, that means they have to take responsibility for their own patients. If the LPN didn't check this patient in 5 hours, that should be her lisence on the line. The supervisor can't be everywhere.

[Brownms46]

If she couldn't be everywhere, she shouldn't have accepted the assignment! What happened all of sudden to the "the RN is utimately responsible"??? Is that just for status, or does it mean anything when the crap really hits the fan??

[Cherish]

LOL! Good one, BrownMS. Both individuals were responsible and so was Management (12-14 patients????). They may have fired the LPN but if the family was to find out about the WHOLE situation. I doubt the LPN would be the only one sued (honestly, with no job right now the family would go for the corporate giant!).

[fergus51]

If she couldn't be everywhere, she shouldn't have accepted the assignment! What happened all of sudden to the "the RN is utimately responsible"??? Is that just for status, or does it mean anything when the crap really hits the fan??

I do think the RN is responsible for her patients. But if this floor allows them to split teams of patients like this, then the RN can't possibly be responsible for doing everything for all of them. If she is, then what is the point of even having LPNs? If a facility allows delegation by RNs to LPNs that means they are competent and able to do the job without an RN standing behind them. The question to me is who was responsible for checking that patient? If it was the LPN's patient, then I assume it was her. An LPN doesn't need an RN to hold her hand while she checks to see if someone is still breathing.

If an RN can't delegate to an LPN within their scope of practice, what's the point of having LPNs? Is the RN responsible for everything the LPN does? If that's the case, then it seems like the LPN is working on the RN's lisence and as far as I knew LPNs have their own lisences.

I have to say, this is one reason I prefer primary nursing.

[carcha]

Is it just me or is the main point of this sad tale being overlooked. A lot of people appear to focus on either the size of the caseload or the GI bleeder aspect or the LPN, RN aspect. What worries me is that from what I can gather a patient lay on the floor for several HOURS before being found, long enough for RIGOR MORTIS to set in!. That is incredible just incredible. I qualified in an age when I would be in charge of a nightingale ward of 29 patients with a health care aide to assist, over a 12 hour period. While I would never want to go back to that again, I would never have had a patient lying on the floor for 10 minutes and not known, I cant believe it. Did no one just check the patients every so often?, surely one of them could have done a walk around every so often, it would have taken a few minutes. Yes she should have been fired, what was she doing?. I feel this whole incident was a combination of poor organization, poor prioritisationd, poor nursing skills and lack of foresight, they concentrated on the immediate job at hand instead of considering the unit as a whole. I feel the hospital was correct in its actions.

[NursesRmofun, ASN, RN]

Judging soley by your account of what happened, I would say they were about equally responsible. The RN should have checked the patients, and, obviously, the LPN should have. The LPN may have been slightly more in the wrong...but both were wrong. You have to eyeball your patients to see that they are okay/safe.

.

[Brownms46]

B. CMR 3.02 Responsibilities and Functions-Registered Nurse which states, "A registered nurse (.e.g., Directors of Nursing), within the parameters of his/her generic and continuing education and experience, may delegate nursing activities to other registered nurses and/or health care personnel, provided, that the delegating registered nurse shall bear full and ultimate responsibility for the outcomes of that delegation"... "and make informed judgements therefrom as to the specific problems and elements of nursing care mandated by a particular situation." Responsibilities and Functions also state a registered nurse will "collaborate, communicate and cooperate as appropriate with other health care providers to ensure quality and continuity of care" and will "serve as patient advocate.'

First the assignment shouldn't have been accepted, especially if RN could not adequately ensure the appropriate care was given:

The Five Rights of Delegation

One that is delegable for a specific patient.

Right Circumstances

Appropriate patient setting, available resources, and other relevant factors considered.

Right Person

Right person is delegating the right task to the right person to be performed on the right person.

Right Direction/Communication

Clear, concise description of the task, including its objective, limits and expectations.

Right Supervision

Appropriate monitoring, evaluation, intervention, as needed, and feedback

I agree that this LPN shouldn't have needed the RN to stand over her, while she checked the pt. But it is obvious she didn't perform her delegated assignment properly. Why this pt. was not observed for 3-4 hrs, I have no clue.

I know that many times, when teams are "split", the LPN many times will get the greater amount of the pts. and the RN has to be available, and has the greater responsibility to the whole team. But if this RN had not agreed to care for so many pts., maybe she would have had the time to go in, and make rounds on the whole TEAM! Which she should've have felt ethically bound to do!

Then I have to wonder ...why was this GI bleed was not one of the pts. the RN kept, instead of giving him to the LPN. Surely he was one who would need to be observed more, d/t his dx! This pt. was at risk for fall, and injury, d/t possbily a low crit, and because if he was being preped for a colonoscopy, he was probably getting up to the BR freq! Since the RN probably had the least amount of pts...THIS is a pt., I would not have delegated to the LPN.

Also there is the possibility that this pt. was receiving or possibly might need to receive blood. So again, not a pt. to delegate the LPN.

Although I don't know all the circumstances of this incident, I do feel this was a bad decision on the part of the RN, who was the one who made the decision to accept this assignment. The RN had the responsbility to adequately assess the pts., and decided the assignment was appropriate, and the LPN could safely be delegated to. Obviously ...she was wrong, and should be held accountable for her error in judgement.

[LisaRNinarkansas]

I believe this was solely the responsibility of the LPN in this situation. She had her pt's and the RN had hers.

I worked step down in a hospital right out of nursing school. The RN charge nurse for the shift sometimes had to take pts herself, at times, when census was lower, she didnt take them and could help the other nurses...however, when u have ur own set of pts, u dont have time to go around to make sure the others are doing what they r sposed to do.....our RN in this situation, who would take the pts...she still had to make her charge rounds once per shift and get her sig on every chart. After that, she only had to help the other nurses and take up slack.

If this RN had not had her own pts, i think she should have had to face more discipline, but that wasnt the case.

Also, as some one pointed out.....how could that pt lie there on the floor for that long? Rounds are sposed to be made a minimum of q2h.

just my opinion..