Neglect...LPN was fired, RN was not - page 17

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   mariedoreen
    Quote from Brownms46
    I have done so, and will do so again, if I'm conforted with the same issue! The RN should've been fired also!
    so out of curiosity, what happens in such a situation when you say no? what's the response? do they bring in another RN? or relieve you for the night in favor of someone who will do what they want?
  2. by   kat911
    Quote from mariedoreen
    so out of curiosity, what happens in such a situation when you say no? what's the response? do they bring in another RN? or relieve you for the night in favor of someone who will do what they want?
    It depends on what staffing you have available. I supervise a 350 bed hospital, there are nights that I have to rob one unit in order to staff another. I may make one unit one nurse short in order to staff a unit that is 2 or 3 nurses short. I don't like to do it but that is my job. If a nurse refuses an assignment she is sometimes sent home, most of them lately (tonight) have walked off the unit without contacting the supervisor. :angryfire They have just screwed their fellow nurses on another unit. We don't pull people just to be mean but some nurses seem to think we do it just to spite them. I try very hard to be equitible and make sure everyone gets the help they need but the truth of the matter is if no one will come in to work and 14 nurses have called in "sick" on Saturday or Sunday night then we "do the best we can". :stone
  3. by   Dixiedi
    Quote from Brownms46
    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.
    When something is delegated, the person delegating someone to it evaluates the appointees abilities. That done, her responsibilty is done. In an acute care setting, the RN may have other responsibilites depending on the hospital, but the actual care of that pt has been delegated to the LPN. The LPN proved her ability many nights over and over again. That pt was her responsibility.
    If the LPN were new or had never worked that area before it would have been the RNs fault, she would have been overwhelming her, a bad chioce when she delegated the responsibility.
    No matter how you look at it, it was the LPNs responsibility. An LPN does not work under an RNs license, she has her own license. If there were too many pts for her, it was her responsibility to say so.
    However, as neglectful as I find the LPN to have not even "sneaked a peak" one can not forget the institutions neglect by not having enough staff.
  4. by   leslie :-D
    Quote from Brownms46

    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.
    i'm an RN and i agree with you. if i am the team leader, i ultimately feel it is my responsibility to oversee others, usually by my communicating/touching base/being kept updated. i don't care if it was a team of RN's; hypothetically if i was assigned team leader, there are certain responsibilities that i would feel were mine. but as we do not know the intricate details of this case, there are always circumstances that will sway one's perspective.
  5. by   Dixiedi
    Quote from earle58
    i'm an RN and i agree with you. if i am the team leader, i ultimately feel it is my responsibility to oversee others, usually by my communicating/touching base/being kept updated. i don't care if it was a team of RN's; hypothetically if i was assigned team leader, there are certain responsibilities that i would feel were mine. but as we do not know the intricate details of this case, there are always circumstances that will sway one's perspective.
    As a team leader it's your responsibility to be the resource, the "helper" if needed, and many other things. It's not your responsibility to follow your team members around to make sure they are doing their job.
  6. by   leslie :-D
    Quote from Dixiedi
    As a team leader it's your responsibility to be the resource, the "helper" if needed, and many other things. It's not your responsibility to follow your team members around to make sure they are doing their job.
    no, i would not follow them around but as i stated, i would communicate with them throughout the shift. that's my personal style and not a generalized endorsement.
  7. by   Dixiedi
    Quote from earle58
    no, i would not follow them around but as i stated, i would communicate with them throughout the shift. that's my personal style and not a generalized endorsement.
    Keeping in touch with another nurse who's response is "I'm making it" or "Not completely drowned yet" or some other indication that she/he is aware of the status of all his/her pts is what you are talking about. Understood. However, if he/she does not know anything to tell you because he/she has not done his/her job how oculd you possibly know and feel anyresponsibility?
  8. by   leslie :-D
    Quote from Dixiedi
    Keeping in touch with another nurse who's response is "I'm making it" or "Not completely drowned yet" or some other indication that she/he is aware of the status of all his/her pts is what you are talking about. Understood. However, if he/she does not know anything to tell you because he/she has not done his/her job how oculd you possibly know and feel anyresponsibility?
    dixie,

    let me give you a gen'l rundown on how i start my shift. even when another nurse has her/his own pts., if i'm doing charge i make it my responsibility to know what's going on with all of them. then i give my 2 cents on what my expectations are: for example, if there's a patient that presents with clear indications of potential problems, i would make sure i communicated my concerns to the staff involved. call me neurotic or whatEVER but if i'm doing charge, i am (or feel) ultimately responsible.
  9. by   Dixiedi
    Quote from earle58
    dixie,

    let me give you a gen'l rundown on how i start my shift. even when another nurse has her/his own pts., if i'm doing charge i make it my responsibility to know what's going on with all of them. then i give my 2 cents on what my expectations are: for example, if there's a patient that presents with clear indications of potential problems, i would make sure i communicated my concerns to the staff involved. call me neurotic or whatEVER but if i'm doing charge, i am (or feel) ultimately responsible.
    That's pretty much what I said. And that does not put your eyeballs on that pt. My point was that the responsibility was delegated to her, that took the responsibility away from the teamleader/charge nurse for watching after him. It was her responsibility and her responsiblity alone.
    If an LPN on your team made a medication error would you consider that your responsibility too? What if another RN on your team did the same?
  10. by   mscsrjhm
    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 ...
    Yes, the hospital insurance company will "lift a finger" to minimize/defend its money against civil action. They will make the nurse look like Nightingale. Families might WANT to sue, but that isn't how the system works. It IS about money when it comes to actually filing a civil action. If the family had to pay "out of pocket", it could end up costing them thousands, with no absolute that they would receive any of that back. Only very rich persons could afford that kind of money.
    Remember, it isn't the families fronting the money, it is the lawyers. So, they will not spend unless they know they will get their $$ worth.
    Remember, it isn't the FACILITY fronting the money for defending an action, it is the insurance company. They want their staff to look like the greatest nursing staff ever.
    Major misconceptions in the nursing liability insurance issue- propaganda from the insurance companies.

    Mschrisco
  11. by   Destinystar
    The reason why the LPN got fired is because she took report on the pts. and it was in her scope to do rounds and check on her pts. at the beginning of the shift. The RN did not take report on the LPN's pts. & was not responsible for providing any care for them unless it was out of the LPN's scope like giving an IV. I do not think that the RN should have even been written up. It is customary practice that RN's and LPN's often divide tasks, or pt loads and each take their own report. In court it could be proven beyond a reasonable doubt that the LPN got report and was responsible and accoutable for those pts. The RN could prove that she had no knowledge or report on the pt. It could also be proved that it was a custom or practice for licensed nurses to take report only on the pts. they were responsible for.
    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?
  12. by   CHATSDALE
    the lpn was wrong for not checking on pt in timely manner...may not have saved pt but certainly would have made a better case than the one presented that the pt had laid there for a lengthly time
    as for insurance it is worth the cost....just as having car insurance doesn't let you drive recklessly but when you need it and don't have it that will be a terrible feeling THAN GOD I HAVE NOT BEEN IN THAT POSITION but i know people who have mortgaged their homes to pay for lawyers.
  13. by   mscsrjhm
    Quote from CHATSDALE
    the lpn was wrong for not checking on pt in timely manner...may not have saved pt but certainly would have made a better case than the one presented that the pt had laid there for a lengthly time
    as for insurance it is worth the cost....just as having car insurance doesn't let you drive recklessly but when you need it and don't have it that will be a terrible feeling THAN GOD I HAVE NOT BEEN IN THAT POSITION but i know people who have mortgaged their homes to pay for lawyers.
    What were these people defending themselves against?
    Mschrisco

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