Neglect...LPN was fired, RN was not - page 4

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   lastkiss32
    LPN's do Know how to chart and are responsible and just as loving of a care giver as anyone else(most of us anyway)

    Doesn't the chart Q24 hrs by an RN have to do with Medicare rules?
    Last edit by lastkiss32 on Apr 19, '04
  2. by   niecy_nurse
    I am a Med-surg nurse. I am sometimes responsible for 8 patients. We nurses at our hospital have been complaining about our patient load for the past 3 yrs. Because of the nursing shortage, we are putting our licenses on the line. I get tired of hearing "Do the best that you can". I feel that I am not giving good patient care. I am honestly looking into changing jobs because of the liability.
  3. by   Brownms46
    Quote from symmy
    New RN? I'll run circles around u any day of the week.
    You weren't responding to me ...were you?
  4. by   Ortho_RN
    Quote from Brownms46
    You weren't responding to me ...were you?
    nah, I think it was to me... but whatever
  5. by   lastkiss32
    Did they not pass a new law pertaining to amt. of Nurse's to patients or was that only in a few states?
  6. by   Brownms46
    Quote from Ortho_RN
    I'm talking about the way things are at the hospital I work at.... I just don't understand why they can't have patients and be responsible for them. Why can't their charting be sufficient... Why must and RN chart behind them, which means the RN must go in an access that patient also... Most of the charge nurses on our floor refuse to assign pts to the LPNs and just have them pass medications... I just don't understand why one license seems to be more important that another...

    And Symmy whatever.. Im not even gonna argue with you... That comment is barely worth recongnizing.
    Ortho _RN, it comes with the territory...RN are the ones legally responsible...or should be. Your education is more indepth, and therefore...it stands to reason, that you would be the one who should be responsible for ensuring the quality of care, each pt. received from those under your supervision.

    However, I have yet...(Thank God) to have ever had an RN regret she gave me an assignment, or would even think of not keeping an RN informed as to any problems or complications with any of my pts! However, if an RN wanted me to just pass meds, I would pass them. If an RN wanted gave me an assignment, I would treat, and care for each pt. as if I was the only one responsible for them. If I felt something was out of my scope of practice, I am the first one to say so!

    I realize the huge responsibilities that an RN has, and respect their abilities, as long as they respect mine. But I also expect that RN to assist me, and have my back when the going gets tough, and not leave me alone, to make it thru the best way I can. As I have seen a few do!
  7. by   Brownms46
    Quote from Ortho_RN
    OMG, I love how people interpret things the way they want too.... In our state LPNS can chart, but an RN must chart on that patient every 24hrs... But at the hospital I work at, they make us chart behind them on every patient every shift.. WHY?? If the state says it must be done at least once a day??? And I am obviously not saying LPNs are lazy that is your reading into that.. Im just saying why can't the hospital recognize their license ALSO....

    And let me ask a serious question... How can you refuse a patient load, especially when your head nurse calls at shift change and tells them we need another RN and all they say is "we sent you another Aide".... I currently work nights, and we have up to 15pts each a night... They will give us maybe 2 RNs for 30pts and maybe an LPN and 2 Aides.... That just seems like WAY too much, but what can you do... Can they fire you for refusing to take that many without more helP??
    Ortho_RN ...you and canp and should refuse such an assignment! I have worked Ortho MANY times, and I would never ever take that many pts!!!!

    You're have a responsibility, and an obligation to advocate for adequate staffing, so you can provide quality patient care! It is the responsibility of the administration to ensure you have adequate staffing, or they are responsible for the outcomes! But you must object to such an assignment, or nothing will change. And yes...they can fire you...but you can also sue them for doing so. But you have to have doucmentation, and believe ...they won't want it to go to court!

    I once reported to work, and discovered a new RN, and myself were going to be the only staff on nites, on a step down unit! The new RN was about to take report, and I stopped her, drug her to the NS office, and told them we refused to take report until the other nurse who was supposedly on her way...arrived, and that another nurse or a CNA was sent also! I didn't get fired....didn't even hint at it!

    I walked onto a m/s unit on another occassion, and was told I would have 9 pts. plus pass meds for half the unit! I told the CN right in front of numerous other professionals in the NS, that I would not take the assignment, as I felt it was inappropriate, and put my license at risk. I asked her how to get back to the elevators! She stood there stunned! No one in the NS said a word!

    The CN changed the assignment, and then asked me if it was acceptable! I continued to work thru an agency for the hospital for two years after this incident, and NEVER had to refuse another assignment!
  8. by   Brownms46
    Quote from lastkiss32
    Did they not pass a new law pertaining to amt. of Nurse's to patients or was that only in a few states?
    Unfortunately ....it is only in one state that I know of, but others are considering it. But there are hospitals, that do abide by safe staffing ratios. There are a couple of hospitals I work, where an RN/LPN team are never given more than 6 pts. here in Washington. One of those I enjoy working at, and have been offered a job at many times. The RNs there are a joy to work with, and many times I feel quilty making the money I do there. Their professional is unmatched, and their teamwork is impressive! However...the other one I can't say the same about.
  9. by   military girl
    I totally agree with you. I haven't been an RN for very long(3 years and I am the "baby RN" on my shift, I work 12 hour shifts 8p-8a). If there is an all RN staff, then you know that they all held to the same accountability that you are. However, I have been the charge nurse on the midnight tour, and we each will have 11-13 patients. I came from a stepdown floor and only had 4 patients, 5 was our max. But many people feel that they can't refuse to take that many patients because they need a job. We all need to work, myself included. Any yes, I have heard over and over that the RN is ultimately responsible. I was a LPN for 5 years before I went back to school, and there are days when I wish that I was still a LPN.
    Primary nursing is okay as long as you are not overwhelmed, but in reality, as you know, in nursing these days, it's not uncommon to have 7-9 patients to one nurse. It's getting unsafe out there. No wonder there is a nursing shortage.
  10. by   ninaldunn
    Wow, this is a scary story. We also team, everyone wants their assignments per region. (I'll take the first 3 rooms, you take the next 3 rooms). I always struggle, especially because maybe the LPN had these pts for 2 days, and wants to keep them, even though 1 is not so good. As an RN, I would want the most unstable patients, however, a GI Bleed bowel prepping would probably be one of the more stable patients, unless he had a hemoglobin of 7.2. If I do give a trusted LPN a patient who is borderline, I do try to get in to see them. Not necessarily to assess them, but at least to eyeball them. (most of our LPN's are very experienced & float) But, being I have heavy patients, I don't always get in there. I will ask during the shift, maybe at break/lunch time - How's our stroke girl? I work an Ortho floor, so if we have a CVA pt, I always ask if my teammate LPN or RN is comfortable doing neuro checks, and I ask them to get me to help with turns, or washing them up so I can get a peek at the patient.
  11. by   Brownms46
    Quote from ninaldunn
    Wow, this is a scary story. We also team, everyone wants their assignments per region. (I'll take the first 3 rooms, you take the next 3 rooms). I always struggle, especially because maybe the LPN had these pts for 2 days, and wants to keep them, even though 1 is not so good. As an RN, I would want the most unstable patients, however, a GI Bleed bowel prepping would probably be one of the more stable patients, unless he had a hemoglobin of 7.2. If I do give a trusted LPN a patient who is borderline, I do try to get in to see them. Not necessarily to assess them, but at least to eyeball them. (most of our LPN's are very experienced & float) But, being I have heavy patients, I don't always get in there. I will ask during the shift, maybe at break/lunch time - How's our stroke girl? I work an Ortho floor, so if we have a CVA pt, I always ask if my teammate LPN or RN is comfortable doing neuro checks, and I ask them to get me to help with turns, or washing them up so I can get a peek at the patient.
    Although I don't agree about the GI pt., especially since there is no real info given. It would depend on his underlying problems/DX, his speed of bleeding or how he tolerates it. As for his H&H...it would also depend on the pt. age/dx..etc.

    But I do wish to say...I like the way you supervise, and maybe if that RN has asked the LPN about her pt. during the night...she might have remember to go check on him.
  12. by   mattsmom81
    The nurse who did not check his/her patient for 5 hrs is likely the nurse that will be focused on if this goes to trial or a report to peer review/BON. If I am in charge and my LPN coworkers and I BOTH have full patient assignments I will likely NOT make rounds on her patients. My duty is to delegate, the LPN/PCT's duty is to keep me informed and look out for their assigned duties. My legal responsibility is limited UNLESS I put my hands on that patient personally, actually.My role is to delegate, assist, advise, WHEN NEEDED etc...doesn't mean I am wholly responsible. Let's not be so quick to make the RN responsible for 'everything'. If we do, why have a license for LPN's???
  13. by   justjenn
    I, as a SPN had an expierence last week that is still haunting me. We have started "team nursing" 4 pt.'s per 1. charge nurse, 1 med.nurse & 2 pt. care nurses. Ok - well, we were short 1 pt. care nurse, so I had 4 pt.'s to shower, feed, dress, do assessments, treatments & change beds in 3 1/2 hrs. in a nursing home that I had only been to 2 times last year. (this may seem like cake to some of you, but remember, I am a student & am not real fast). Well, to make a long story short, I ran my butt off & tried not to ask for help. In the "real" world, I may have to do this, so, I tried to handle it myself. Apparently, the stress showed on my face & the student med. nurse helped me out & gave one of my pt.'s a shower. The scary thing to me is that, I was so busy going from one to the other giving showers & handing out meals trays - I was unable to get back to all of them & check to see how they were doing. Someone could have choked on their breakfast while I was getting "hosed down" by a patient in the shower & who relieved themself after they were all clean.

    I felt that I was very neglectful, but besides for asking for more help, I do not see how in the blazes I could have done any better. If something did happen to one of those patients, I would have taken full blame.

    But, getting back to the LPN, RN thing. Honestly, how does one say "I cannot do this assignment." What does one do - you have a RN & LPN, thats it. So then what?

    Is not the hospital to blame because they do not staff their floors? Aren't they the ones who are really very neglectful? Why should they have put their nurses in that kind of situation?

    Anyway, my too cents.

    justjenn

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