Neglect...LPN was fired, RN was not - page 10

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... Read More

  1. by   NursesRmofun
    Quote from Hellllllo Nurse
    Here is another case of a nurse being held responsible for the actions of another-

    I have an RN relative who works at an inpt lock-down psych unit.
    An LPN there was passing meds. One pt refused his meds, so the LPN mixed them in w/ the pt's food, which he then ate. Afterwards, the LPN told the pt what she's done. The pt got a lawyer and is suing for violation of his rights. The charge RN on duty that day (who did not even know what the LPN had done) is being held accountable by the hospital for the actions of the LPN.
    Totally unfair.
    Being an LPN does not excuse one from being competent and providing minimal care.


    BTW- I was an LPN for seven years and have been an RN for four.
    I cannot see how the RN could be held responsible by the hospital in that case. <shaking head>
  2. by   RMA
    I have worked in longterm care where the LPN works as a nurse, has her own team of patients and cares for them as I did my own team. Yes we all worked together and I treated them as co-workers not the typical RN-LPN roles. I found that many LPN's that worked there were nurses long before I was and could teach me. Now I work in a hospital and I find there is no team work. Everyone has to watch there own back. If The LPN and the Nurse split the team then the LPN is responsible.
  3. by   Sheri257
    Quote from Hellllllo Nurse
    The practice act says the RN is ultimately responsible.
    However, LPN in this case was primarily responsible. The LPN failed to provide minimal care. The LPN appears to be guilty of breach of duty.
    The RN was not assigned to the pt who died.

    If either nurse is sued, perhaps they can use the Aiken Study as evidence of the hospital being responsible for the pt's death, due to inadequate staffing.

    I have recently transferred to an all RN dept where I work. It is such a relief not to be responsible for the actions of others anymore!

    In my old dept (hemodialysis) I worked w/ an LPN who discharged a pt to go home w/ a B/P of 49/29. Somehow, this pt had managed to stagger to his truck and get in. I ran out to his truck, and stopped him just as he was trying to put the key in the ignition.
    I drug him back inside and stabilized him. He was stable enough to leave about an hour later. This LPN is very agressive and insubordinate. She is one of the reasons I left the hemo dept. She did not understand why I did what I did. She actually said "You need to assess the pt based on what is normal for him, not what is normal for you." (the pt's baseline B/P is low).
    I tried to explain to this mental giant that a B/P of 49/29 is not normal for anybody. But, she wouldn't hear it. Ignorance combined with arrogance is a dangerous combination in a nurse.

    She is currently flunking out of her RN prereqs. But, she is chomping at the bit to be charge nurse of the unit, which requires an RN.
    I'm sure she will get her RN eventually. I wonder how she's going to like being responsible for the actions of other nurses. I hope she doesn't have to work w/ another LPN like herself. Hmmmm.... or maybe I really hope she does. She could use a taste of her own medicine.

    Here is another case of a nurse being held responsible for the actions of another-

    I have an RN relative who works at an inpt lock-down psych unit.
    An LPN there was passing meds. One pt refused his meds, so the LPN mixed them in w/ the pt's food, which he then ate. Afterwards, the LPN told the pt what she's done. The pt got a lawyer and is suing for violation of his rights. The charge RN on duty that day (who did not even know what the LPN had done) is being held accountable by the hospital for the actions of the LPN.
    Totally unfair.

    Being an LPN does not excuse one from being competent and providing minimal care.

    BTW- I was an LPN for seven years and have been an RN for four.
    Thanks for yet another insightful post. Even though I'm just a student, I've been concerned about reports that hospitals are cutting back on LVNs to hire more RNs to meet California's new ratio law. Now that I'm reading stories like this, maybe that's not such a bad thing afterall.

    The phrase: "If you want to get the job done, do it yourself" comes to mind. Especially if it's ultimately your responsibility and license on the line.

    Last edit by Sheri257 on Apr 23, '04
  4. by   SmilingBluEyes
    work an all RN floor where I am too. When and if an LPN is floated up, it almost becomes more work than its worth to have him/her. I have to still do all the assessments and sign off on his/her chart. SO not worth it to me. Give me an RN please. Til LPNs can be held similarly and individually accountable for their own patients, it's just not helpful to have them on the unit. NOT a knock against LPNs, as many of them can run circles around RN's in assessment and nursing skills. I just hate being held overall responsible for OTHERS' work as well as my OWN patients. It's just too much.
    Last edit by SmilingBluEyes on Apr 23, '04
  5. by   Kalico
    This may or may not have a lot of relevance to this thread but I will say it anyway. I worked as a CNA on an ortho/neuro floor for six months before I wass fired. During my time there I was assigned up to 28 pts at a time. B/c I worked nights I did not have to give baths however I was the one doing the vitals on every patient including those getting blood transfers. In addition to that I was responsible for turning pts q2h, answering call lights, changing pts, etc. The reason I was eventually fired was because I went to m charge several times with concerns about pts not getting pain meds on time, not being able to turn a pt safely without help, etc. My charge reported to our manager that I was not wanting to do any work and that I would sit around all night and not do anything. My point here is that what happens on night shifts is generally bs. No one ever checked to see if this was the case with me even though the day that I was fired I had two depts, ER and Peds, call my manager and request me to be transfered to their units to work. In my opinion some, and I emphasize some RNs are not interested in giving good patient care, they are only interested in covering their own a$$. Most of the other RNs that I worked with were great and helped out by doing their own vitals, fingersticks, etc. My point here is that there needs to be more accountability for charge nurses on nights. I had absolutely no recourse and was unable to work on either peds or er b/c I was fired.
  6. by   Robinette
    It seems clear to me that the LPN is subject to the State LPN Practice Act, and therefore is the one and only responsible. State Nurse Practice Acts don't say that an RN has automatic supervisory and practice responsibility for an LPN. I mean, think about that. That would be a logistical and practical nightmare.
  7. by   Robinette
    "Here is another case of a nurse being held responsible for the actions of another-

    I have an RN relative who works at an inpt lock-down psych unit.
    An LPN there was passing meds. One pt refused his meds, so the LPN mixed them in w/ the pt's food, which he then ate. Afterwards, the LPN told the pt what she's done. The pt got a lawyer and is suing for violation of his rights. The charge RN on duty that day (who did not even know what the LPN had done) is being held accountable by the hospital for the actions of the LPN.
    Totally unfair."

    This just totally staggers me!
  8. by   Brownms46
    Quote from Hellllllo Nurse
    The practice act says the RN is ultimately responsible.
    However, LPN in this case was primarily responsible. The LPN failed to provide minimal care. The LPN appears to be guilty of breach of duty.
    The RN was not assigned to the pt who died.

    If either nurse is sued, perhaps they can use the Aiken Study as evidence of the hospital being responsible for the pt's death, due to inadequate staffing.


    I have recently transferred to an all RN dept where I work. It is such a relief not to be responsible for the actions of others anymore!

    In my old dept (hemodialysis) I worked w/ an LPN who discharged a pt to go home w/ a B/P of 49/29. Somehow, this pt had managed to stagger to his truck and get in. I ran out to his truck, and stopped him just as he was trying to put the key in the ignition.
    I drug him back inside and stabilized him. He was stable enough to leave about an hour later. This LPN is very agressive and insubordinate. She is one of the reasons I left the hemo dept. She did not understand why I did what I did. She actually said "You need to assess the pt based on what is normal for him, not what is normal for you." (the pt's baseline B/P is low).
    I tried to explain to this mental giant that a B/P of 49/29 is not normal for anybody. But, she wouldn't hear it. Ignorance combined with arrogance is a dangerous combination in a nurse.

    She is currently flunking out of her RN prereqs. But, she is chomping at the bit to be charge nurse of the unit, which requires an RN.
    I'm sure she will get her RN eventually. I wonder how she's going to like being responsible for the actions of other nurses. I hope she doesn't have to work w/ another LPN like herself. Hmmmm.... or maybe I really hope she does. She could use a taste of her own medicine.




    Here is another case of a nurse being held responsible for the actions of another-

    I have an RN relative who works at an inpt lock-down psych unit.
    An LPN there was passing meds. One pt refused his meds, so the LPN mixed them in w/ the pt's food, which he then ate. Afterwards, the LPN told the pt what she's done. The pt got a lawyer and is suing for violation of his rights. The charge RN on duty that day (who did not even know what the LPN had done) is being held accountable by the hospital for the actions of the LPN.
    Totally unfair.
    Being an LPN does not excuse one from being competent and providing minimal care.

    I don't believe you have read anywhere...that an LPN isn't responsible for their own competent, and the care he/she provides! LPNs didn't make the rules, nor are they the ones going around repeatedly stating:"the LPN works under my/our (RN) license...and "It's MY/OUR license on the line"! Which many LPNs have heard constantly over the years/months...on here, in the work place...and elsewhere!

    However, when the craps hits the fan...suddenly folks are saying...that the LPN has a license...bah bah...bah..yada yada.

    And for those who say they would rather..work without an LPN...Bravo...then go right ahead...and knock yourself out! I don't blame you at all...however, I get sooo tired of hearing this...and how the LPN can't do this, and the LPN can't do that! But let me or any other LPN working with some RN, who wants you to do this or that...and is PISSSSSSSED because you can't! And then have to show the RN the P&P...which she/he should've been aquainted with prior to this incident! If you don't want to do what comes with the terrority...move on and let someone who does!

    Also incompetent is definetly not the sole property of the LPN...or any other classification for that matter! I could fill up page after page of incidents I, and others have encountered with an RN, who did this or that...and wondered how they got a license to practice.

    But that isn't the purpose of this thread. To me ...the purpose is to state was or could the RN have been responsible in this incident. And per the NCSBN, and various other entities...including BON....state the RN is responsible for the outcome of the delegations they make. And it is their duty to continually supervise the assignments they give, and retain accountability for what they delegate! Unfair...or not...that is how it is!
    Last edit by Brownms46 on Apr 23, '04
  9. by   Brownms46
    [QUOTE]3) The registered nurse shall provide periodic and regular evaluation and monitoring of the individual performing the delegated tasks. (4) The registered nurse delegating the task may, at any time, suspend or withdraw the delegation of specific tasks to the patient's designated caregiver. (5) The registered nurse is accountable and responsible for the nursing care delivered to patients under the nurse's jurisdiction. Author: Alabama Board of Nursing.



    A professional nurse shall be responsible both for the nursing care directly provided by the nurse and the care provided by others who
    are under the professional nurse's supervision.
    AZ Nurse Practice Act

    7.7.1.2 "Delegation" - Entrusting the performance of selected nursing duties to individuals qualified, competent and legally able to perform such duties while retaining the accountability for such act.

    7.7.1.3 "Supervision" - The guidance by a registered nurse (RN) for the accomplishment of a function or activity. The guidance consists of the activities included in monitoring as well as establishing the initial direction, delegating, setting expectations, directing activities and courses of action, critical watching, overseeing, evaluating, and changing a course of action.

    7.7.1.4 "Accountability" - The state of being accountable, answerable, or legally liable for actions and decisions, including supervision.
    Delware NPA

    And the beat goes on.....
  10. by   susanmary
    Great thread with no easy answers to this question as each state board dictates what an RN/LPN's scope of practice is. Therefore, there is much room for interpretation; also, there may be facts regarding this case that have not been made public.
  11. by   Tweety
    I think more and more hospitals over the years have put RNs at risk for violations of the NPA. As they've added more responsibilities to the LPN, and the LPN has taken the over, such as taking their own assignments, pushing IV meds, starting IVs, giving blood etc, the RNs responsibility has become too great.

    Hospitals that split assignments, give LPN assignments, have too few RNs on the unit using LPNs in the role of primary patient care provider are providing potential liability for the RN.

    There are many times when there are two LPNs on my unit. They are doing their own thing, and I'm am "Entrusting the performance of selected nursing duties to individuals qualified, competent and legally able to perform such duties while retaining the accountability for such act." Sometimes when I think about it I get very bothered at the risk to my license that I'm having to work under.

    Again, fortunately here, although while an RN is responsible for the errors of the LPN, I don't see many RNs going down because of an LPN's mistake or incompetence. Doesn't mean that it doesn't happen. When push comes to shove the hospital is going to defend themselves, not me. Better renew that liability insurance.
    Last edit by Tweety on Apr 23, '04
  12. by   Agnus
    Quote from 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!).
    Actually (my friend a personal injury lawyer. Actually 3 of them who are personal friends) Would tell you they go after the hospital. They sometimes name others but it is the deepest pockets they go after. As far as finding out you have insurance. That usually end up being self revealing and comes out pretty early. Lawyers don't even have to run a search to discover it.

    For the most part though they are not interested in going after individuals they are after the deeper pockets. Even with your $3 million liability coverage your pockets are very shallow to personal injury cases.
  13. by   Tweety
    Quote from Brownms46
    Also incompetent is definetly not the sole property of the LPN...or any other classification for that matter! I could fill up page after page of incidents I, and others have encountered with an RN, who did this or that...and wondered how they got a license to practice.

    But that isn't the purpose of this thread. To me ...the purpose is to state was or could the RN have been responsible in this incident. And per the NCSBN, and various other entities...including BON....state the RN is responsible for the outcome of the delegations they make. And it is their duty to continually supervise the assignments they give, and retain accountability for what they delegate! Unfair...or not...that is how it is!
    To me the purpose of this thread was should the RN have been fired, not whether or not the RN was responsible. But I've already stated how I feel about that.

    Good post. In the years I've been around, I've seen many more incompetent RNs than LPNs. I mean that sincerely, some RNs scare me. What's bothersome is that I'm accountable for the LPNs incompetence, not the RNs.

    I willingly accept working with LPNs and all that goes along with it. But if you think I'm not going to I'm going to quietly accept my lot when the **** hits the fan, you're mistaken.

    Take the med error scenerio. You have a safe assignment, blah blah blah and draw up 50 units of insulin instead of 5 and kill a patient. When the Nursing Board comes to me and says I'm responsible for the outcome, don't think I'm not going to get angry and resentful and question the whole situation. Yes, I know that's the way it is, but I'm going to fight it tooth and nail when the **** hits the fan, yes I am.

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