Neglect...LPN was fired, RN was not

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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?
  2. 238 Comments so far...

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    We team also, and although we do not split assignments(as is done on other floors), the LPN is responsible for own actions under scope of practice, with RN responsible for 'overseeing' LPN. Ultimately the RN has to be sure the LPN is competently providing care during the shift for the whole pt assignment. This is why most RN's don't want to team. It does work well if you trust each others skills and know that communication is open. My favorite RN's to work with walk room to room while I do vitals and do a quick assessment on each of our pts. Of course, it is my role to report any status change to RN, as I am in pt room providing most bedside care(meds, vitals, site checks etc)
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    I tend to agree with you but question, who slipped up on the Q 1/2-1 hr HS rounds?
    Don't they routinely do those at your facility? Our Nurses or Aides check the pts at least Q hr thru the night.
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    the hospital i used to work at did team nursing and it worked for the day shift, but at night it was hard cause if you had a about 7 pts then if you both tied up with one the others would be left behind. so i guess that i can feel for all sides. it happens no excuses for it but......
    the nice part where i was was that we had a great staff and the other nurses would really help ya out!!!!!
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    12-14 patients between two nurses on a med sug floor are too many patients, even if they do not do total care. The hospital should be facing a law suit and they know it.

    The nurses might or might not be wrong in not having protested the assignment prior to accepting it under protest. Personally IMHO the nurses made a poor judgement in accepting such an assignment. (You do have the power to effect change)

    A GI bleeder is a very high risk patient. Putting such a patient into this kind of mix is just poor judgement.

    The nurses are responsible as they accepted the assignment witout protest.

    However, stuff rolls down hill. The hospital will Cover it's own backside at the expenses of the nurses'.

    They will always place blame on the lowest level of caregiver first. That enables them to legally distance themselves from responsibility. Firing the LPN was a pre-emptive move to protect thier own liability.

    They also cover themselves by slapping the RN's hands.

    The LPN should have protested the assignment. But more important the RN should have (being an RN) used better judgement in allowing either of them to take this assignment. As an RN I would not have assigned the the GI bleeder to the LPN (I was an LPN and now am an RN) not at least witout keeping some tabs on this patient myself.

    No the hospital is wrong. And the Nurses are wrong especially the RN for accepting assignments like this without protest. The RN carries > responsibility on this aspect because she (legally) has the education to recognze unsafe situations better than the LPN. (notice I said legally, this is not a putdown toward the judgement of the LPN. This is just how the BON and courts would see it, if they were to examine this aspect of the situation)

    The LPN holds some responsibility for accepting unsafe assignments but the RN is the role model here. The LPN is responsible for her patients and is responsible for notifying the RN if she is overwhelmed and can't get in to check her patients frequently enough.

    The hospital is wrong for it's staffing practice. However, it is the nurses that should be making judgement about that practice and effecting the needed changes. Administators do not care for patients, are not in a position to judge safe levels, are not usually even nurses. Administrations duty is to proved care at the lowest cost and greatest profit. They are resopsible for safty but the bottom line is $$$$ so if they can get away with cutting corners they will. The nurses need to become more pro active (ie get some back bone) in effecting safty. The nurses need to hold administrations toes to the flame.

    As I said it rolls down hill and hospital will ALWAYS disapline the lowest level care giver first to distance themselves from responsibility.

    See if they can show it was this low level person who "didn't have the education etc." of others higher up then those higher in the chain and the hospital itself are better protected. "It was that dumb girl we hired with out an RN education to help out that screwed up. We would never do that ourselves"

    You fire the maid or janitor if you can place blame there. Show that management is not responsible thier only mistake was in hiring a janator who did not know that if you mix bleach and amonia that it created a lethal enviorment.

    I know this sounds harsh but when it come to liability situations this is the way of the world. FAIR? ABSOLUTELY NOT. Real? Yes.

    I suggest you do not partisipate in the finger pointing blame game. This is a tactic that higher management uses to distract others from the responsibility they carry.

    In this case there were many level of people responsible. Everyone is trying to distract attention from themselves.

    Use this as a learning tool. Learn how to be a change agent.
    SilentfadesRPA likes this.
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    I hate to be a nag, but this is another example of why it's so important to carry your own liability insurance. Does anyone reading this believe that the hospital is going to lift a finger to defend either of the nurses? The LPN who was fired could now be sued for malpractice by the family, and she isn't even employed by the hospital anymore, SO .... No help there! The hospital was attempting to minimize its own liability by firing her. The RN who hasn't been fired could also be sued, and, if she's (he's?) expecting any support or defense from the hospital, I've got some swamp land in AZ that I'd like to sell her ...

    I notice that a lot of people who have debated against carrying your own insurance on this BB often seem to assume that people only sue out of some cagey, calculated determination of who has the money ... It's not that simple -- some families just sue because they loved their family member and perceive that the health professionals caring for them dropped the ball in a big way. It's not always about money; sometimes it's about justice ...
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    This is a tactic that higher management uses to distract others from the responsibility they carry.
    So true....

    ...the last hospital I worked at, I worked Med/Surg. We would typically have 11 patients, and keep admitting.

    We also did "team" nursing.

    This morale on the floor was very LOW even THEN ~ I shudder to think what it is now....they have gone to a "primary nursing" model, which means that there are NO CNAs on this very busy Med/Surg unit.

    I just talked to one RN who still works there...she told me they ROUTINELY had 6 to 7 patients, PRIMARY CARE, and SOMETIMES even as much as NINE PATIENTS APIECE........!!!

    NINE patients per ONE RN.

    She is still working there!

    I said, "How do you do it all?"

    She said, "You don't...you just do what you can."

    This was what the House Supervisor routinely dished out. I called one night because of my patient overload and he said, "Just do the best you can."
    Needless to say, I am no longer working there.

    They LOVE new grads there...LOL....they don't know any better than to take those kindof assignments, although the lady I spoke to wasn't a new grad.
    This is what makes me mad and this is why this stuff goes on:

    JUST SAY NO.

    Nurses like this will take ANYTHING and never utter a peep of protest!

    I don't understand it.
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    Quote from elkpark
    I hate to be a nag, but this is another example of why it's so important to carry your own liability insurance. Does anyone reading this believe that the hospital is going to lift a finger to defend either of the nurses? The LPN who was fired could now be sued for malpractice by the family, and she isn't even employed by the hospital anymore, SO .... No help there! The hospital was attempting to minimize its own liability by firing her. The RN who hasn't been fired could also be sued, and, if she's (he's?) expecting any support or defense from the hospital, I've got some swamp land in AZ that I'd like to sell her ...

    I notice that a lot of people who have debated against carrying your own insurance on this BB often seem to assume that people only sue out of some cagey, calculated determination of who has the money ... It's not that simple -- some families just sue because they loved their family member and perceive that the health professionals caring for them dropped the ball in a big way. It's not always about money; sometimes it's about justice ...
    A better form of Liability Insurance would be for the nurse to take responsibilty to refuse unsafe assignments or to accept only under formal written protest. Insurance in this case would help defray the cost of defending herself in court and before the BON. Keep in mind though she is responsibe. and the BON and court could still rule against her. Insurance does not protect you from irresponsible behavior and there was irresponsiblity or at least poor judgement on the part of the nurse.

    Personally I would rather practice in a way that lessen my likely hood of finding myself in a legal situation than buying insurance, thinking I will be protected. Insurance will not keep you from loosing your license, will not protect your reputation, will not keep you out of court or explaining yourself to the BON it will only defray the cost of these things.

    You will still have to defend your actions.

    Practice safely and the likelyhood that you will ever have to use your insurance decreases astronomically.
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    I agree with everything that everyone said.

    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.
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    A better form of Liability Insurance would be for the nurse to take responsibilty to refuse unsafe assignments or to accept only under formal written protest. Insurance in this case would help defray the cost of defending herself in court and before the BON. Keep in mind though she is responsibe. and the BON and court could still rule against her. Insurance does not protect you from irresponsible behavior and there was irresponsiblity or at least poor judgement on the part of the nurse.

    Personally I would rather practice in a way that lessen my likely hood of finding myself in a legal situation than buying insurance, thinking I will be protected. Insurance will not keep you from loosing your license, will not protect your reputation, will not keep you out of court or explaining yourself to the BON it will only defray the cost of these things.

    You will still have to defend your actions.

    Practice safely and the likelyhood that you will ever have to use your insurance decreases astronomically.
    Well, duh ... I wasn't suggesting that the point of insurance is that it enables you to do any ol' dumb thing you feel like, and I certainly wasn't defending the actions of either of the nurses (don't know enough about the situation to have an opinion on that).

    I have practiced safely and responsibly for some 20 years now, but have carried liability insurance all that time, too. I drive very safely and carefully, too, but I carry liability insurance anyway. Things happen ...

    I hope that your plan works for you and you never find yourself in the position of having to defend your actions in court or before the BON -- but if you ever do, you will find that "only defray(ing) the cost of these things" will make a BIG difference ...


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