Neglect...LPN was fired, RN was not - page 16

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   ceceliajane2003
    [QUOTE=jkaee]
    Quote from 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.
    I REPEAT: A PISS POOR SET UP FROM THE "ESTABLISHMENT"that whether your an RN-or LPN, makes no difference to them.And it should. What about the law that says if a doctor writes an order, its wrong (dose, route,whatever) the nurse administers it, and she's to blame.Or the pharmacist that sent me 90mg blister tabs in a card labeled 30 mg.I just happen to know the patient and meds well, and thought the size was awfully big, so I checked first. Would have been my fault, according to law. disgusting. such a lawsuit happy society, that cant accept human beings are just that.And we all make mistakes. HOWEVER,its ******* dangerous and asking for trouble when the staff to patient ratio is way off. And who decides whats way off? WE SHOULD. for we know how much a nurse can take.anyone want to be a nurse.Well, I guess I still do, very much.Just been through burn out a couple times.We need some political nurses in here, a voice, a lead. I wonder if we can come up with something, use it for the upcoming election.ah--going to bed........
    :imbar
  2. by   CayRN
    I workrd night shift on a med surg ward for many years. I can honestly say that for that ward in that hospital having worked all of the shifts, night shift was the busiest by far, considering nurse patient ratio. But I was never 3-4 hours late making a round. Both nurses were responsible for the ward no matter how you split the load. They both should have been fired. I also agree that any licensed nurse be it RN or LVN/LPN should be held accountable for thier own practice, I was an LPN for 10 years.
    We are all fallible and there but for the grace of God......
  3. by   CayRN
    Quote from Dixiedi
    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!
    LOLOL....me too.....
  4. by   marymary
    Quote from KacyLynnLPN
    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?
    Hey
    I agree with you, a similar incident happen at one of the facilities that I worked for, same ending LPN fired while the RN skated. The RN evidently just resigned because of the way the staff was ostrasizing her. Unfortunately life is not always fair. Both nurses should have been suspended, and counseled regarding the episode. But because there is a shortage of RN's things are not always done that way.
  5. by   mscsrjhm
    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


    Just read this reply. If sued, the facility and staff could be named. Facilities carry insurance (mandatory). Having worked with medmal/neglect attorneys, the nurses/staff will be sued IF they have insurance.
    We have all worked stretched to our limits, falling hours behind, playing "catch up" all night. Under the assumption that the nurses, both LPN and RN, we hard-working, honest people, then my thoughts go out to both of them for what they must be feeling. If this is the case, then I sincerely hope that neither of the nurses had insurance, as it would only continue the nightmare.
    Attorneys "sue" on behalf of the families, however, unless the families have BIG money to pay the attorney's hourly fee, attorneys work on a contigency basis, obtaining monies only after a settlement or judgement. So, if these nurses had insurance, their nightmare will be greater and more prolonged then if they didn't.
    Again, assuming they are decent, good people, my heart goes out to them.
  6. by   mattsmom81
    Someone in that facility made the judgment the LPN was to be fired but the RN was not. We can't possibly know all the details. We don't know everything about how that facility was set up, their policies and procedures, their job descriptions.Personally I think it is quite telling that so many LPN's here AND in that facility are up in arms that the RN was not fired too.

    Well I guess some LPN's might feel better seeing a RN take the fall with that LPN. I always feel bad when ANY nurse takes a fall for bad outcomes when she is trying to do her best in a bad situation. Most workplaces today are understaffed but its easier to blame a nurse than look at the system problems and correct them...this is a reality in a nurses' life today. We make easy scapegoats.

    These LPNs can always get satisfaction by reporting an RN to the BNE if that makes them feel better. Let the state investigate. We always have that option, they are obliged to followup all complaints, and will make sure the facility is looking at this incident.

    I would only hope the facility, possibly peer review is reviewing this and that an incident report was filed so that the situation is fully reviewed. We can hope that policies and procedures are initiated and enforced to help ensure another patient never lays 4 hrs dead before someone finds them. If this isn't happening: nurses at this facility pick up the phone. There are state agencies that will be interested.
  7. by   Brownms46
    Quote from mattsmom81
    Someone in that facility made the judgment the LPN was to be fired but the RN was not. We can't possibly know all the details. We don't know everything about how that facility was set up, their policies and procedures, their job descriptions.Personally I think it is quite telling that so many LPN's here AND in that facility are up in arms that the RN was not fired too.

    Well I guess some LPN's might feel better seeing a RN take the fall with that LPN. I always feel bad when ANY nurse takes a fall for bad outcomes when she is trying to do her best in a bad situation. Most workplaces today are understaffed but its easier to blame a nurse than look at the system problems and correct them...this is a reality in a nurses' life today. We make easy scapegoats.

    These LPNs can always get satisfaction by reporting an RN to the BNE if that makes them feel better. Let the state investigate. We always have that option, they are obliged to followup all complaints, and will make sure the facility is looking at this incident.

    I would only hope the facility, possibly peer review is reviewing this and that an incident report was filed so that the situation is fully reviewed. We can hope that policies and procedures are initiated and enforced to help ensure another patient never lays 4 hrs dead before someone finds them. If this isn't happening: nurses at this facility pick up the phone. There are state agencies that will be interested.

    I don't feel this has anything to do with wanting an RN, or anyone to take "a fall". It's about what some (including some RN's also) who felt that the LPN shouldn't have been the only one punished. I also don't think that the LPNs should take it into their own hands to report this RN to the BON. I don't believe that was the point at all. The point in MO...was that the RN has accountability for the delegation she makes, and to me, this was just casually tossed aside by their employers. But then again...*&^% always did run down hill.

    NOT saying this LPN shouldn't have been held accountable. YES it was HER responsibility ALSO to ensure this pt. was taken care of, and not left totally off her radar! But when you hear soooo many say..."YOU are working under MY license", and "I and responsible for what you do or don't do." Then when the stuff hits the fan...."Hey you have a license, and you accepted the assignment, so you are the only one responsible". Makes ya wonder... :stone

    Thankfully... I work with RNs, who believe that just because an RN "splits" a team, doesn't mean she/he doesn't STILL have the 'ULTIMATE" responsibility for those pts. she delegated! When they ask me...even though they KNOW I am a "STRONG" LPN...(their words not mine), they STILL ensure everything has been completed, and check in with me to see how everyone is doing. Makes sense to me...but then I am probably the only one...who sees it that way.
  8. by   SRbear
    LPN's work on their own license, for the hspital. RN's work on their own license, for the hospital. RN's are not "the boss" over the LPN'S. So glad I have not had to do any team nursing for the last 16 years. It all comes down to accountablility of one's own actions. Speaking of accountability, I think NA's should be held more accountable than they are now, the problem might just be at my hospital though.
  9. by   leslie :-D
    Quote from SRbear
    Speaking of accountability, I think NA's should be held more accountable than they are now, the problem might just be at my hospital though.
    i so agree with you. it drives me crazy when i find an opening or a large ecchymotic area (shape of a handprint???) that is starting to yellow and no one reported it to nsg???????? all the na's say from all 3 shifts, "i didn't see it"... they're not all like that but some of them should be held accountable. in their job descriptions it clearly states that when doing care, to report any variations in status to the nurse. and i do not see why there shouldn't be some form of accountability among nursing assistants, especially the certified ones.
  10. by   SRbear
    How to you put a quote like that in your post...I cannot quite figure it out. I have heard responses from NA's like....Oh, I forgot to tell you the temp was 103, or when asked what was pt's accucheck, I went to lunch. I am trying to get the NA's to give a full report to the RN at end of shift....some info might get to nurse late, but better than not at all.
  11. by   Dixiedi
    Quote from SRbear
    How to you put a quote like that in your post...I cannot quite figure it out. I have heard responses from NA's like....Oh, I forgot to tell you the temp was 103, or when asked what was pt's accucheck, I went to lunch. I am trying to get the NA's to give a full report to the RN at end of shift....some info might get to nurse late, but better than not at all.
    Don't take the qoute so literally. We all know when we say "everybody does it" we are not actually referring to EVERYbody. We are referring to those in that situation. Come on, you know that. You are just nitpicking and/or looking for an argument.
  12. by   SRbear
    I can see how you must have taken my post....but I was really really asking for help...how does one put quotes like that in your own post.....I have not been able to do it yet......I went to reply and clicked on quotes, but could not figure it out from there !!!!!!!! If you re-read my post, you will see that earle and I agree. I will be careful from now on how I word things!!!!!!!
    And I do not nit-pick.......but I have been know to argue now and then !!!! Take care
  13. by   Dixiedi
    Quote from SRbear
    I can see how you must have taken my post....but I was really really asking for help...how does one put quotes like that in your own post.....I have not been able to do it yet......I went to reply and clicked on quotes, but could not figure it out from there !!!!!!!! If you re-read my post, you will see that earle and I agree. I will be careful from now on how I word things!!!!!!!
    And I do not nit-pick.......but I have been know to argue now and then !!!! Take care
    Oh I am soooo sorry! I didn't see it that way! And I just responded to another post by saying that people will pick out 1 word or totally not understand the post and tear ya to shreads over it! AND I DID IT!

    I don't know why you don't get the post you are responding to as a quote. I click the reply button at the bottom of the individual post and it's there in the text area where I will type my post (just like above.) Sometimes it can be a pain becasue I will read a list of posts then decide to reply to a specific post and have to go looking for it so the quote will be there. Sometimes it just doesn't work when the reply I am replying to isn't a quote at the beginning and things REALLY get taken out of context!
    This is a riot! I am guilty of what I complain about! LOL

    I honestly thought you were praising your NAs for reporting to you. That didn't quite make sense but with the "how do you say that" at the beginning I figured your grammar just missed the mark a bit.

    I'm not going to forget this one for a while. :imbar
    Last edit by Dixiedi on May 30, '04

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