Neglect...LPN was fired, RN was not - page 15

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   bigfishsmallpond
    [QUOTE=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:



    Great reply. Now, has anyone thought of this? Why was ANYONE fired? Hello, pts die in surgery, have MIs in the nite,suddenly choke....yes, it is unexpected, and it should have been caught earlier, but was she reponsible for the pt's death?????I don't think so.We had a similar event occur at my hospital A psych pt was found dead, cold and in rigor by the nurse going into draw blood. Supposedly, there are q 15 minute checks being done.Yes, it is shocking and sad, but no one was fired in this case! There was no malice, no neglect....should the LPN have been given the pt? Probably. The Lpn is best at the bedside, giving pt care. The RN was responsible to oversee her assignment, and that should have included doing an assessment, at least.
    No one was at fault. It was an unfortunate, unpredictable event. It could have happened at home, just the same. The nurse should have been counseled and assignments should be looked at more closely. But, fired? No.
  2. by   Hellllllo Nurse
    Maybe th Nurse Manager who made out the original assignment is responsible. The RN on duty that night was assigned pts, just as the LPN was, right?

    If so, then perhaps the NM is the one who did the delegating.
  3. by   mattsmom81
    Great reply. Now, has anyone thought of this? Why was ANYONE fired? Hello, pts die in surgery, have MIs in the nite,suddenly choke....yes, it is unexpected, and it should have been caught earlier, but was she reponsible for the pt's death?????I don't think so. No.[/QUOTE]


    So true...'shyt happens' and patients die...we can't always prevent it. But...if someone dies and it MAY have been prevented...whole different ballgame.

    The facility made the LPN the scapegoat is the simplest answer. I would have to know hospital policy to comment on whether it was truly a fireable offense....if policy states rounds must be made q hour the LPN broke policy.(fireable offense) The finding of a cold body dead many hours also implies negligence. The facility is trying to lessen their own liability by finding an appropriate scapegoat. This is business as usual in healthcare facilities where nurses make easy targets.
  4. by   ceceliajane2003
    [ :angryfire WHAT IN GODS NAME IS THIS? THE GOD**** INSTITUTION is at fault for setting up such ashoddy team plan. there are no players, no team mates. An LPN with the same responsibilities as an RN? Why be an RN? they took DIFFERENT EXAMS! It should be a team, RN the head, then LPN, CNA"S. F====== CRAZY. You all should strike,lest it happen to you.
    LISA the ROCK
  5. by   caroladybelle
    Quote from Kirstie
    Exactly...........RNs oversee LPNs........period!!!!!!!...that's how it is.....you have more schooling, ect......you are in charge when it is beneficial to you and not, when it is not?????????????????????
    Actually, I have more education so that I can take complete care of my patient. And have never wanted to "delegate" anything.

    Unfortunately corporate American has other, CHEAPER ideas.
  6. by   TinyNurse
    The RN responsible for 12-14 med surg patients with one LPN?????......... I would have hoped to have found a new job ASAP. I also learned in nursing school that the RN is the one ultimately responsible.
    Dead with rig set in........I can't believe that someone did not do at LEAST hourly charting
  7. by   Tweety
    Quote from TinyNurse
    The RN responsible for 12-14 med surg patients with one LPN?????......... I would have hoped to have found a new job ASAP. I also learned in nursing school that the RN is the one ultimately responsible.
    Dead with rig set in........I can't believe that someone did not do at LEAST hourly charting

    Sweetness, I will forgive you because you went from nursing school straight to the ER. But med-surg nurses do not do hourly charting. In fact if anything at all needs to be done q1h, then they are not med-surg, they should be in critical care or intermediate care.
  8. by   jkaee
    [QUOTE=Kirstie]That's why you go from LPN to RN........more responsibility, more money, ect...........so therefore you are more responsible if something goes wrong because you delegate........you can only delegate to someone you "know" will be able to do the job................if not, do not delegate to them even if they are the only one left..............NOT ME......NOT ME...........NOT ME.....wasn't that in a Family Circus cartoon in the Sunday paper.......apparently at your hospital there are a lot of "not me's" running around!!!!!!!!!!!!!!!!!!!!!!!!!!
    QUOTE=jkaee]Just my opinion....



    NO, Kirstie, that's NOT why I am an RN....I did not become an RN to delegate, or be responsible for other nurses actions....I became an RN to take care of people, and be responsible for my actions.

    Since you quoted my post, I assume that's what you were responding to, and let me clarify a few things.........the LPN's where I work aren't delegated by me to pass meds, do assessments and treatments, etc. THAT IS THEIR JOB. They are hired knowing full well what they will be taking on. If there is a problem, it is THEIR responsibility to report it to the RN. I'm an RN, and if there was a problem with one of my residents, I'd STILL report it to the RN supervisor, who after all is in charge, even though we have the same "responsbilities" and duties. The scenario that I presented was not meant to pass the blame on to someone else......but the fact still remains that if I am not told about a problem by an LPN, RN, CNA, housekeeping, the Pope, WHOEVER, then how can I be responsible for it???? I am talking about LTC and Sub acute/skilled nursing, which is completely different than the hospital setting. If, as a supervisor, I don't check on a critical resident, as well as the LPN not reporting to me any changes or declines, then we are both responsible. If, as a supervisor, I assess the resident, and they are stable, and I ask the LPN (or another RN) to report any changes to me, if she doesn't report to me and I go back and find the resident injured or dead, then that is HER responsibility, and the fault should be on her alone.

    And, as a side, how do you "know" for sure that you can safely delegate responsibilites to another nurse? What if you've never worked with them before, what if they are a float nurse, or an agency nurse.....or what if they were always a competent nurse before, but just had a really crappy day and made a mistake? You are putting way to much on RN's, my friend, and that is a very dangerous mistake....for the patients, nurses and administrations everywhere.
  9. by   Agnus
    When I worked Med Surg (12 hr nights) it was not unusual for me to have anywhere from 10-12 pts, with the ability to accept admits, so I don't think the pt. load is really an issue, as that's the standard ratio in most places I have heard about (whether or not that's acceptable standard of practice is debatable, but not an issue in this case).

    if the LPN didn't report it, how was I to know that there was a problem? That's 145 residents that I'm responsible for.....and it's ALL LEGAL staffing ratios, so I can't "refuse" anything, if I do, it could be considered patient abandonment, and I could be reported to the state. It most certainly wouldn't be on my liscence, because the LPN is responsible to call an RN for any changes in pt. status. If she doesn't, or she neglects a resident in any way, that's not on me.

    [/QUOTE][/QUOTE]
    I agree you can't know what is not reported to you and you can't personally check on each pt when you have so many.


    We are talking about an acute setting and team nursing with far fewer patients than 145.
    As for it being "legal assignment" there is only one state that has laws covering staffing ratios. So, in effect any assignment is legal in other states including yours.
    You have been talking to the wrong people about what you can and can not do. Facilities especially LTC love to intimidate nurses with the line that,"you have to accept the assignment because it is within leagal staffing ratios and we will report you for abandoment if you do not."

    One LTC pulled this on me when I left without accepting my assignment. Here is the outcome. The BON determined there was no abandonment because I had not yet accepted an assignment. It would be abandonment only if I accepted the assignment and then left.

    You can always and are legally obligated to, refuse an assignment you deem unsafe for any reason. Another nurse may feel just fine handling a certain patient mix. You may not due to the difference in your experience, education, physical, emoational or psycological limitations. You are responsible to know what your limitations are. Not all RNs are equal nor are any 2 people equal.

    Just because an RN (or LPN) is "supposed" to be able to do something does not mean you always can. It is up to you to know that. Maybe you are running on empty and you know you can't handle what you usually can then you are responsible to speak up. If you take the assignment and do not object you are responsible for the results.

    You do not have to accept add ons to an assignment that you already accepted without protest. Lets say you have a full patient load and later they want you to take an admission and you know this would jepordize your other patients. You can refuse to take the additional patient.

    Some times you end up with a bad assignment anyway. As you said s*** happens. But doing so without formal and written objection is fool hardy.

    Yes you can refuse "legal" assignments. Those "legal" ratios are only guidelines and cannot and do not pretend to cover ever situation.
  10. by   Dixiedi
    Quote from KacyLynnLPN
    I wanted to get everyone's opinion on a heated debate at my workplace. ....?
    I believe it was the LPNs resposibility to care for this man. She was assigned to him. His care was within the LPN scope of practice. The RN, unfortunately is resposible for the actions or inactions of the LPN/s she/he works with, but come on.

    The LPN was not given a pt that a reasonable and prudent LPN could not have cared for. The idea is not that LPNs only be given healthy patients to care for but to know how to car for seriously ill/injured people. To know when to call for help and to CHECK ON THOSE PEOPLE AT LEAST QH. Yes, accidents happen. A man fell and hit his head. If he had been found in a reasonable length of time, I would bet she would not have lost her job. She did not get fired because a patient fell and died. She got fired because hours went by and she was not doing her job!

    I've worked at hospitals that were so busy and so short staffed that our CNA walked around, stopped in every room and made sure everyone was breathing easily (as easily as possible, and as they were the hour before) no monitors or pumps were alarming and everyone was securely in bed. If something was not right, she either took care of it or called the appropriate nurse to the room. We as a group, two nurses and the CNA, made it a point to look in on the patients in the two adjoining rooms every time we came out of a room. A habit just this simple kept our eyes and ears on all of our patients every night.

    Little things make a big difference and "blaming" it on someone else, in this case the RN is just wrong. The LPN was assigned. That pt was ultimately her responsibility. Yelling, "it was the RNs responsiblity" is why so many RNs think LPNs to be useless. LPN school does indeed provide instruction and the boards also ask questions about GI bleeds. It's a very common med/surg problem. If she passed the boards, she can not say she didn't know how to take care of him. And even if she didn't know how to take care of him... he lay dead on the floor for 4 hours! No excuse.
  11. by   Brownms46
    Quote from Dixiedi
    I believe it was the LPNs resposibility to care for this man. She was assigned to him. His care was within the LPN scope of practice. The RN, unfortunately is resposible for the actions or inactions of the LPN/s she/he works with, but come on.

    The LPN was not given a pt that a reasonable and prudent LPN could not have cared for. The idea is not that LPNs only be given healthy patients to care for but to know how to car for seriously ill/injured people. To know when to call for help and to CHECK ON THOSE PEOPLE AT LEAST QH. Yes, accidents happen. A man fell and hit his head. If he had been found in a reasonable length of time, I would bet she would not have lost her job. She did not get fired because a patient fell and died. She got fired because hours went by and she was not doing her job!

    I've worked at hospitals that were so busy and so short staffed that our CNA walked around, stopped in every room and made sure everyone was breathing easily (as easily as possible, and as they were the hour before) no monitors or pumps were alarming and everyone was securely in bed. If something was not right, she either took care of it or called the appropriate nurse to the room. We as a group, two nurses and the CNA, made it a point to look in on the patients in the two adjoining rooms every time we came out of a room. A habit just this simple kept our eyes and ears on all of our patients every night.

    Little things make a big difference and "blaming" it on someone else, in this case the RN is just wrong. The LPN was assigned. That pt was ultimately her responsibility. Yelling, "it was the RNs responsiblity" is why so many RNs think LPNs to be useless. LPN school does indeed provide instruction and the boards also ask questions about GI bleeds. It's a very common med/surg problem. If she passed the boards, she can not say she didn't know how to take care of him. And even if she didn't know how to take care of him... he lay dead on the floor for 4 hours! No excuse.

    First of all how do you know the pt was "reasonable and prudent"??? Where you there?? And for your info LPNs are not always saying "it's the RN's responsibility! I have had to hear and read how "RN's are respnsible for the LPNs...etc..etc..etc..!! And there are definitely as many USELESS RNs as LPNS! GEEEEEEEEEZE!

    Had a GI bleed the other night...and guess what after the RN had to come in and give FFP...constant VS after his B/P started to drop...placed on tele...with freq ectopy...I again began to wonder just how stable the GI bleed this LPN had!

    And the fact that this RN thought nothing of going to at least put an eyeball on the pts. she as per the BON states that SHE is utimately and legally responsible for...not to mention..morally...I believe she was at least one of the useless! Geeeze people sure know a lot about a subject for which they weren't even there for.. :angryfire
  12. by   Dixiedi
    Quote from brownms46
    first of all how do you know the pt was "reasonable and prudent"??? i said any reasonable and prudent nurse, check the regs. if you find yourself in court, the first question will be "did she/he act as any resonable and prudent nurse would?

    where you there?? and for your info lpns are not always saying "it's the rn's responsibility! i graduated from lpn school 30 years ago and i have been listening to it from crappy lpns ever since. not all lpns. but in this world it is not the good word that travels, it is the bad.

    i have had to hear and read how "rn's are respnsible for the lpns...etc..etc..etc..!! and there are definitely as many useless rns as lpns! geeeeeeeeeze! i worked with a lot of those too. believe me, i am the first one out there batting for lpns and the useless manor in which our advocate groups lay down and allow rn schools tell the world and their students we are bed pan pushers. and then with the bon which allows that fallacy to continue.

    had a gi bleed the other night...and guess what after the rn had to come in and give ffp...constant vs after his b/p started to drop...placed on tele...with freq ectopy...i again began to wonder just how stable the gi bleed this lpn had! again, i never said i believe lpns should only have healthy patients. i worked post op trauma, tele, chemo for many years before i went into home care.

    and the fact that this rn thought nothing of going to at least put an eyeball on the pts. she as per the bon states that she is utimately and legally responsible for...not to mention..morally...i believe she was at least one of the useless! geeeze people sure know a lot about a subject for which they weren't even there for..true, she is ultimately responsible if it were her assignment and it apparently was since they were team nursing (as i remember the original post) however, on a busy unit such as that, the rn needs to know the lpn she is trusting with her license is going to keep her eyes and ears open and sound the alert when needed.
    :angryfire
    i still stand by it being the lpns responsibility first and foremost.

    i still maintain a reasonable and prudent nurse would not have ignored one of her patients for at least 4 hours. come on! she didn't even poke her head into the room!

    whew, i need a smoke break!
  13. by   Brownms46
    I ask again... How do you KNOW this pt. was reasonable and prudent??? Where you there????

    Again, I never said I believe LPNs should only have healthy patients. I worked post op trauma, tele, chemo for many years before I went into home care.

    Didn't say you did...I said HOW STABLE WAS THIS LPN's pt!!!! Has nothing to do with YOUR experience nor mine, which is considerable!


    And trusting Anyone has nothing to do with an RN's or anyone's responsibility for caring for the pts. assigned!!! If I see ANY nurse is busy...I'm going to ask her if she needs assistance..whether they are assigned to me or not!!! That RN should have morally felt an obiligation to ensure the assignment was being completed! I work with at a hospital where I work as agency now..and every night I work...and every RN except for one...has always eyeballed my pts. as well as her/his pts...and same with me..eyeballing her/his!

    And this is even though the staff have constantly commented on how good I am...but that doesn't make me perfect by another stretch of the imagination. I could just as easily miss something as the next person! But these RNs take their responsibility seriously...which I respect!

    The fact that these two split up their pts...means nothing as far as I am concerned! The LPN was assigned a pt. she didn't check on...WRONG on her part! The RN delegated the pt. to the LPN and then walked away from her responsibility to supervise the assignment she delegated! WRONG!
    Last edit by Brownms46 on May 11, '04

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