Neglect...LPN was fired, RN was not

Nurses General Nursing

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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?

I agree 100%.... We can give our LPNs patients but we must chart behind them... What is the point.. If I'm gonna have to take care of my pts and hers then why not just give me all of them.. LPNs have licenses they should want to be responsible and do the job correctly, and not look for a coattail to hide under when things get rough...

you are a new nurse- let's not forget that. there are a lot of lpn's who know more than the average RN. now look at the nurse practice act and you will see exactly what an lpn is allowed to do. i can say some of them are lazy as are some rn's so don't go around saying people are looking for a coattail because they may just be practicing within their scope.

LPNs don't look for a coatail to hide under, and definitely not from one who just got pressed! Seemed to me the LPN took her lumps, and the RN ran for cover! But I am sure when this goes to civil court, and I am sure it will, I wonder whose coat the RN will hide behind! Probably the same RN was one of those running around talking about how it's her license this, and her license that! :chuckle! Won't make a bit of difference though.

And Cherish...you are totally right...admin had a hand in this too...and should, and probably will be held accountable:D!

I'm talking about the way things are at the hospital I work at.... I just don't understand why they can't have patients and be responsible for them. Why can't their charting be sufficient... Why must and RN chart behind them, which means the RN must go in an access that patient also... Most of the charge nurses on our floor refuse to assign pts to the LPNs and just have them pass medications... I just don't understand why one license seems to be more important that another...

And Symmy whatever.. Im not even gonna argue with you... That comment is barely worth recongnizing. :uhoh3:

you are a new nurse- let's not forget that. there are a lot of lpn's who know more than the average RN. now look at the nurse practice act and you will see exactly what an lpn is allowed to do. i can say some of them are lazy as are some rn's so don't go around saying people are looking for a coattail because they may just be practicing within their scope.

OMG, I love how people interpret things the way they want too.... In our state LPNS can chart, but an RN must chart on that patient every 24hrs... But at the hospital I work at, they make us chart behind them on every patient every shift.. WHY?? If the state says it must be done at least once a day??? And I am obviously not saying LPNs are lazy that is your reading into that.. Im just saying why can't the hospital recognize their license ALSO....

And let me ask a serious question... How can you refuse a patient load, especially when your head nurse calls at shift change and tells them we need another RN and all they say is "we sent you another Aide".... I currently work nights, and we have up to 15pts each a night... They will give us maybe 2 RNs for 30pts and maybe an LPN and 2 Aides.... That just seems like WAY too much, but what can you do... Can they fire you for refusing to take that many without more helP??

LPN's do Know how to chart and are responsible and just as loving of a care giver as anyone else(most of us anyway) :)

Doesn't the chart Q24 hrs by an RN have to do with Medicare rules?

Specializes in ICU,CCU,Med-Surg,Post Partum,Tele, ER.

I am a Med-surg nurse. I am sometimes responsible for 8 patients. We nurses at our hospital have been complaining about our patient load for the past 3 yrs. Because of the nursing shortage, we are putting our licenses on the line. I get tired of hearing "Do the best that you can". I feel that I am not giving good patient care. I am honestly looking into changing jobs because of the liability.

Specializes in Everything except surgery.
New RN? I'll run circles around u any day of the week.

You weren't responding to me ...were you?

You weren't responding to me ...were you?

nah, I think it was to me... but whatever :)

Did they not pass a new law pertaining to amt. of Nurse's to patients or was that only in a few states?

Specializes in Everything except surgery.
I'm talking about the way things are at the hospital I work at.... I just don't understand why they can't have patients and be responsible for them. Why can't their charting be sufficient... Why must and RN chart behind them, which means the RN must go in an access that patient also... Most of the charge nurses on our floor refuse to assign pts to the LPNs and just have them pass medications... I just don't understand why one license seems to be more important that another...

And Symmy whatever.. Im not even gonna argue with you... That comment is barely worth recongnizing. :uhoh3:

Ortho _RN, it comes with the territory...RN are the ones legally responsible...or should be. Your education is more indepth, and therefore...it stands to reason, that you would be the one who should be responsible for ensuring the quality of care, each pt. received from those under your supervision.

However, I have yet...(Thank God) to have ever had an RN regret she gave me an assignment, or would even think of not keeping an RN informed as to any problems or complications with any of my pts! However, if an RN wanted me to just pass meds, I would pass them. If an RN wanted gave me an assignment, I would treat, and care for each pt. as if I was the only one responsible for them. If I felt something was out of my scope of practice, I am the first one to say so!

I realize the huge responsibilities that an RN has, and respect their abilities, as long as they respect mine. But I also expect that RN to assist me, and have my back when the going gets tough, and not leave me alone, to make it thru the best way I can. As I have seen a few do!

Specializes in Everything except surgery.
OMG, I love how people interpret things the way they want too.... In our state LPNS can chart, but an RN must chart on that patient every 24hrs... But at the hospital I work at, they make us chart behind them on every patient every shift.. WHY?? If the state says it must be done at least once a day??? And I am obviously not saying LPNs are lazy that is your reading into that.. Im just saying why can't the hospital recognize their license ALSO....

And let me ask a serious question... How can you refuse a patient load, especially when your head nurse calls at shift change and tells them we need another RN and all they say is "we sent you another Aide".... I currently work nights, and we have up to 15pts each a night... They will give us maybe 2 RNs for 30pts and maybe an LPN and 2 Aides.... That just seems like WAY too much, but what can you do... Can they fire you for refusing to take that many without more helP??

Ortho_RN ...you and canp and should refuse such an assignment! I have worked Ortho MANY times, and I would never ever take that many pts!!!!

You're have a responsibility, and an obligation to advocate for adequate staffing, so you can provide quality patient care! It is the responsibility of the administration to ensure you have adequate staffing, or they are responsible for the outcomes! But you must object to such an assignment, or nothing will change. And yes...they can fire you...but you can also sue them for doing so. But you have to have doucmentation, and believe ...they won't want it to go to court!

I once reported to work, and discovered a new RN, and myself were going to be the only staff on nites, on a step down unit! The new RN was about to take report, and I stopped her, drug her to the NS office, and told them we refused to take report until the other nurse who was supposedly on her way...arrived, and that another nurse or a CNA was sent also! I didn't get fired....didn't even hint at it!

I walked onto a m/s unit on another occassion, and was told I would have 9 pts. plus pass meds for half the unit! I told the CN right in front of numerous other professionals in the NS, that I would not take the assignment, as I felt it was inappropriate, and put my license at risk. I asked her how to get back to the elevators! She stood there stunned! No one in the NS said a word!

The CN changed the assignment, and then asked me if it was acceptable! I continued to work thru an agency for the hospital for two years after this incident, and NEVER had to refuse another assignment!

Specializes in Everything except surgery.
Did they not pass a new law pertaining to amt. of Nurse's to patients or was that only in a few states?

Unfortunately ....it is only in one state that I know of, but others are considering it. But there are hospitals, that do abide by safe staffing ratios. There are a couple of hospitals I work, where an RN/LPN team are never given more than 6 pts. here in Washington. One of those I enjoy working at, and have been offered a job at many times. The RNs there are a joy to work with, and many times I feel quilty making the money I do there. Their professional is unmatched, and their teamwork is impressive! However...the other one I can't say the same about.

I totally agree with you. I haven't been an RN for very long(3 years and I am the "baby RN" on my shift, I work 12 hour shifts 8p-8a). If there is an all RN staff, then you know that they all held to the same accountability that you are. However, I have been the charge nurse on the midnight tour, and we each will have 11-13 patients. I came from a stepdown floor and only had 4 patients, 5 was our max. But many people feel that they can't refuse to take that many patients because they need a job. We all need to work, myself included. Any yes, I have heard over and over that the RN is ultimately responsible. I was a LPN for 5 years before I went back to school, and there are days when I wish that I was still a LPN.

Primary nursing is okay as long as you are not overwhelmed, but in reality, as you know, in nursing these days, it's not uncommon to have 7-9 patients to one nurse. It's getting unsafe out there. No wonder there is a nursing shortage.

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