Neglect...LPN was fired, RN was not - page 6

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   fergus51
    I've never said I was responsible for LPNs jobs. I have always been told that as long as the procedure or assignment I delegate is within the LPNs scope then it's her responsibility. That's why LPNs are lisenced. I know a lot of RNs are afraid that it's their lisence, and they will get sued (and they could), but that doesn't mean hospital administration should go along with this. They should know what an LPN can and can not do and act accordingly. Otherwise, LPNs would be completely useless.
  2. by   jkaee
    Quote from Brownms46
    NO one said RNs were babysitter first of all! "I" did not state what "I" felt delegation was..."I" stated what the BON of nursing stated! Like someone else stated to an LPN...that is something you need to take up with your BON.

    Second...you can't be disciplined for pt. abadonment until you accept an assignment!

    Third....I just thought it was curious...after reading oooh soo many times, how the RN is responsible for the LPN...and how this or that RN stated that is was their license on the line...etc..etc...etc.. So in other words...none of that is really true..right?? The LPN is responsible, and educated enough to provide safe, and competent pt care. And that they have their own licenses, and are responsible for their own actions. Well what what do you know..!


    Before everyone gets all upset, I NEVER said that anyone said that RN's were "babysitters". This term has been used a lot in the places I work, because that's how the RN's are treated sometimes. I'm not against LPN's, I'm not against delegation, but what I am against is the RN's being responsible for every action that another professional nurse takes. Especially in the area that I work in, an RN can be responsible for literally hundreds of patients with several LPN's working under her/him. I can't do it all, and I rely on the professionalism of the nurses I work with.

    Regarding patient abandonment.....I have never done it, and never knew a nurse that has done that. It is not that easy to just reject an assignment. If staffing ratios are withing the regulated limits, what excuse do you have? I know, I have tried to go up against administration when I was a super and had to take a floor. It didn't work.....so I left. But I would screw a lot of people, not to mention the patients, if I walked into work and refused to take a wing and the house. That's not right.

    Third, I was just explaining MY perspective from MY experiences. I understand that everyone has different working conditions and in some places LPN's have different roles. Like I said, this is MY experience and this is how I feel in the situation that I work in. That's all. I'm not judging every LPN or RN or work situation. Just MY OPINION. Thats all,


    Take care....
    Jennifer
  3. by   Brownms46
    And Jennifer I respect your opinion...or I wouldn't even respond.
    And I am just going to add a little link here from the CNA....and their take on these issues. Good nitie!
    http://www.calnurse.org/102103/teamissues.html
  4. by   jkaee
    Quote from Brownms46
    And Jennifer I respect your opinion...or I wouldn't even respond.
    And I am just going to add a little link here from the CNA....and their take on these issues. Good nitie!
    http://www.calnurse.org/102103/teamissues.html


    Thank you Brownms46, I respect yours also, like I said, it just may have to do with the situation each nurse is in.

    I will have to check out that website.

    Goodnight to you!

    J
  5. by   moia
    I think we all know management will pile on as much crap as we are willing to carry. We grumble, we moan we complain to each other...if we are unionized we fill out unsafe patient load blah blah blah...nobody cares....nobody reads the reports after the first 10...and the first 10 were 10 years ago...
    Patients don't care, management doesn't care and truly nurses don't care...we still do the work


    Truly the only way patient to nurse ratios are ever going to change is when the patients freak out and make it financially unbearable the hospitals will choose to hire defensively.
    What I would love is enough support staff to get patients up to the bathroom and get them bathed, help them with their meals, and clean them up after accidents and get them a drink of water and all those little things that seem so simple but eat up huge blocks of time ...those tasks that create goodwill and happy families and happy patients. I want a RPN that is specialized in dressing changes and really is into that...goes to all the education/research days...gets trained on the really cool vac systems..knows about the stages of pressure sores and wound healing and all the treatments for them.
    I want to be an RN that gets to assess my patient...I want to see their lab work , read their chart, make a plan and try to see into their future a little bit...the job I was trained to do..I want to evaluate their meds...I want to decide if they are appropriate..are they doing what they need to do? Track BP's and HR and urine outputs to make sure my heart patients are getting the benefits of their new ACE inhibitor.....thats what I am supposed to be doing...surprising isn't it? You would never know because I am too busy trying to start an IV on a person with no veins who is obtunded and hasn't eaten and I havent had a chance to look at the MAR to figure out is it pain meds? sleeping aid? up all night and exhausted now? or is this patient going to arrest? ahhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhh hhh
    the other patient needs to go to the bathroom, the other guy is going to cath lab, the other is throwing up, the other needs pain meds.the other wants a television, the other wants to know why his son hasn't called yet ......it's ridiculous.

    About the blame game...first a little slap on the wrist to all...we have no idea what deal the RN and the LPN on that shift made...they could have very fairly traded off every two hours..which is common between friends...and it does mean if one doesn't do their job or by a nasty cruel trick of fate five minutes after a round that guy stumbled out of bed ,tripped bonked his head and the LPN on her round did a really crappy job and didn't go into every room. She may have just walked past the rooms listening for noise...who knows? we sure don't .
    We do know there were two people there and both of them had to provide an explanation for what happened...the LPN said or did something in that interview that noone could save her from and by the way the hospital NEVER EVER wants to fire someone after this kind of incident because by firing an employee they are agreeing that MALPRACTICE occurred. If you have enough sense to keep your mouth shut and give a recollection of facts that doesn't obviously make you sound guilty as hell the hospital will try to protect you.
    If you walk into the very first meeting and blow it and force them to fire you it nearly kills them because YOU are FORCING them to settle with the family.
    The hospital hired you and will be held responsible for some part of this disaster, ofcourse they hope by firing the LPN quickly they can mitigate some damages but truly the LPN must have made a statement or action that was impossible to defend. Her intial miss on rounds may not have been the problem, her behaviour after the discovery of the body may actually hold the real answers. We may never know.
    The RN may have been censured,( which by the way is NOT slap on the wrist because the licenscing board will be notified and she may be investigated at that level, so she may not be off the hook yet herself) because she made a poor decision when delegating a GI bleeder and when she designated rounds especially if she chose the every other 2 hours thing...meaning each nurse would only see their own patients once in 4 hours but ultimately the LPN accepted the delegated patients and accepted the rounds arrangement whatever it was.

    I think it was an awful thing and I am sure both of them feel just sick about it.
    There was no maliciousness in this...this was a night shift system that was doomed because it was a system failure...more and more all our systems are going to fail...we all have way too many patients and we are painted across them like fakebutter at the movies...we are doomed to have disasters like this.

    All we can do is educate every patient we have...any time they ask about why they have to wait..be polite and cheerful but give them the facts of life...stop beating the nursing shortage drum.....management loves this one ...just tell them that the management of the hospital feels very comfortable with this level of care and direct them to patient affairs with their concerns.
    Never ever apologize or blame it on the nursing shortage as if to say the poor management...they would hire tons and tons more staff to meet all your needs if only they could find them. We all know thats just not true.

    We know we need an educated support staff that truly wants to be there...not the 25% that are happy and the 75% that we have to fight with,bribe,beg and sometimes have to search for wasting so much time we could have done their job three times by the time we find them and cajole them into doing it.

    I wish every patient room came with a CNA just for that room and they were not allowed to leave that room unless they were off the floor on break and only one quarter could go on break at one time and they had to cover each other.

    The joy it would be...the acuity of our patients has become so high we desperately need the time to assess and check and recheck to keep our patients and ourselves self.
  6. by   LPN4Life
    I am an LPN, worked nites, responsible for 4 different wings, total pt load 90 or so. One CNA per hall, when my aides had to do the q 2 hr check, I also made my rounds, I called them breathing rounds....Once a CNA told me, Oh we don't have to check so and so, they do all of their care for themselves, then I asked the CNA what if so and so died at 11pm and you din't find them until they were gotten up for breakfast, he then started checking all his residents. Just an opinion, but Splitting up the work doesn't really sound too much like team work, RN and LPN should have done their rounds, if only to make sure everyone is breathing.........definately gonna be lawsuits out the ying yang on that one, and I bet its not over for the RN yet......
  7. by   FROGGYLEGS
    I think the problem with the RN lies in the fact that it is stated that this is a TEAM nursing floor. If the hospital has delegated it to be a team floor, I can not understand how you can justify splitting the team for any reason.

    If they can justify splitting up then, yeah, I think the LPN is solely responsible for the patient.

    I don't think that in this situation the RNs responsibility was solely to supervise the LPNs work. In my opinion both nurses should have been providing some form of care (even if its only checking the patients for signs of life :stone ) throughout the night. That is just my understanding of how team nursing works.

    I am not trying to defend this LPN...it is obvious that she did a poor job. Only because it is a team nursing floor do I think that the RN should have been in the room enough to know what was going on despite the fact that it wasn't reported to her. It sounds like she was assigned as a direct provider of care to the man. If her assignment were solely supervisory in nature, it would be a different story.
  8. by   Tweety
    Quote from Brownms46
    One question Tweety...how do we know it was a safe assignment??? If you as the RN didn't see an LPN go into a room all nite...what would you do?

    And just because someone is there, doesn't make them competent...nor does it mean they are able to handle the load assigned to them.

    I understand where you are coming from. However...I do feel that 12-14 pts...is too many pts...... if I were the RN , and was going to delegate. I would prefer to have the LPN do meds, and this would've alleviated the problem of this pt. not being seen for 3-4hrs....hopefully. JMO
    Depends on what is the established ratio for the unit. Again, I have only my own perspective and how LPNs are utilized here, which is basically as total care providers with an assignment of their own. Our ratio on nights is six. We don't do teams, but as the nurse practice act dictates, all patients are to recieve an RN level of care, so there is an RN assigned to each LPN. Usually it's the charge nurse. So that RN has his six patients and the LPN has his six patients, that's 12. 12-14 patients for two licensed profressionals is not unusual here for med-surg. I agree it's not necessarily the safest of ratios.

    It is the hospital's responsibliity to maintain competencies, so say an LPN floats to me that I've never met or worked with before. I'm not going to refuse the assignment because I don't know him. I'm going to have to trust he's passed all his competencies, and holds a valid LPN professional license. Where my job comes in, "is this a safe assignment", most of the time med-surg patients can be handled by an LPN, so usually it's not much of an issue.

    Do we know if the original OP's assignment was safe and the nurse was competent? Ultimately we don't really know. Often we don't really know until we get into the assignment what's going on. But if I delegate you to do the care for a group of patients, I'm delegate that you round on them q2h or however often their condition dictates. I'm not going to take care of my six patients, and the LPNs too. Until I know of a problem, then I feel I don't deserve the same kind of punishiment.

    It does get a little shakey when the LPN makes a fatal error or is incompetent. But if RNs were being dismissed or disciplined for every LPN error, or every fall on the floor, we'd be in trouble.

    I wholeheartedly agree the safety of the assignment should be investigated. Perhaps the RN should have taken the GI bleeder because of the potential for trouble. We can always second guess ourselves, I do it all the time when there's a bad outcome on my unit. Drives me mad.

    So I still maintain that the RN shouldn't have recieved equal "punishment" for the LPNs negligence. The key word being "equal".
  9. by   Tweety
    Quote from FROGGYLEGS
    I think the problem with the RN lies in the fact that it is stated that this is a TEAM nursing floor. If the hospital has delegated it to be a team floor, I can not understand how you can justify splitting the team for any reason.

    If they can justify splitting up then, yeah, I think the LPN is solely responsible for the patient.

    I don't think that in this situation the RNs responsibility was solely to supervise the LPNs work. In my opinion both nurses should have been providing some form of care (even if its only checking the patients for signs of life :stone ) throughout the night. That is just my understanding of how team nursing works.

    I am not trying to defend this LPN...it is obvious that she did a poor job. Only because it is a team nursing floor do I think that the RN should have been in the room enough to know what was going on despite the fact that it wasn't reported to her. It sounds like she was assigned as a direct provider of care to the man. If her assignment were solely supervisory in nature, it would be a different story.
    The main problem I see with team nursing not working well is that these patients in med-surg, need head-toe-assessments focused on their diagnosies. It gets a little tough and night when there's 12 patients in a team for one person to do all of that, and to chart those assessments. I think this is why the natural response is to utilize the LPN's assessment skills and split the assignment.

    But I see your point, if there's two or three people in a team, there's no excuse for patients not being checked on. The RN should have been more aware. I still maintain, though the RN should not have been fired along with the LPN., IF the assignment was appropriate.
  10. by   Sheri257
    Quote from 3rdShiftGuy
    It does get a little shakey when the LPN makes a fatal error or is incompetent. But if RNs were being dismissed or disciplined for every LPN error, or every fall on the floor, we'd be in trouble.

    So I still maintain that the RN shouldn't have recieved equal "punishment" for the LPNs negligence. The key word being "equal".
    I agree with you. But if the regulations state otherwise, it probably doesn't matter. What's going to happen if you're called before the BON or sued by the family?

    Are you going to argue that the law/regulations don't apply to you and that it's not your responsibility when the law says it is? Not a good idea.

    If Brownms46's links are any indication, it's going to fall on the RN no matter what. There goes your license, because the law says you're ultimately responsible for the LVN. And, the hospital may be even more liable (or, at least not look very good) for not firing the RN, if the law says she's ultimately responsible.

    BTW, thanks for this link as well Brownms46. Very informative.

    http://www.calnurse.org/102103/teamissues.html
    Last edit by Sheri257 on Apr 20, '04
  11. by   nurseunderwater
    Quote from Brownms46
    If she couldn't be everywhere, she shouldn't have accepted the assignment! What happened all of sudden to the "the RN is utimately responsible"??? Is that just for status, or does it mean anything when the crap really hits the fan??

    huray!!!

    this is just a shinig example of a double standard.......
  12. by   Tweety
    Quote from lizz
    I agree with you. But if the regulations state otherwise, it probably doesn't matter. What's going to happen if you're called before the BON or sued by the family?

    Are you going to argue that the law/regulations don't apply to you and that it's not your responsibility when the law says it is? Not a good idea.

    If Brownms46's link is any indication, it's going to fall on the RN no matter what.
    http://www.calnurse.org/102103/teamissues.html

    Yes, I know the RN is responsible for ALL outcomes regardless. As an RN, I know this very well. My agrument is about the nature of the punishment or discipline involved. Should they be equal. I argue no. With the condition that the assignment was appropriate to the skill levels. LPNs have licenses and a nurse practice act themselves. They are required to report to the RN.

    I realize I am responsible for the errors of the staff I'm in charge of. However, you kill a patient and we both go to the state board, I shouldn't necessarily be fired and loose my license along with the LPN.

    I don't have enough evidence, but from what I've seen in real world situations many RNs aren't loosing their jobs and licenses over the errors of LPNs........unless they've forced an unsafe assignment on the LPN, unless the LPN has reported a change in condition to the RN.

    In the original posters post, the LPN neglected her patient and acted independently what I can only presume was a routine and safe assignment. Had she said to the RN, "I'm so busy I can't check on my patients", or "that patient is having orthostatic hypotension when he gets up", or any other scenerio then the RN should have a greater "punishment" or be fired. But if that RN had no idea the LPN was not checking on her patients, then that's not 100% the RN's fault, in my opinion.
    Last edit by Tweety on Apr 20, '04
  13. by   jkaee
    Quote from lizz

    If Brownms46's link is any indication, it's going to fall on the RN no matter what. There goes your license, because the law says your responsible for the LVN.

    And, the hospital may be even more liable (or, at least, not look very good) for not firing the RN, if the law says she's ultimately responsible.

    BTW, thanks for this link as well Brownms46. Very informative.

    http://www.calnurse.org/102103/teamissues.html

    This site was very informative, and a real eye opener too. If that is the case in all states, then I can see why some hospitals in my area are no longer hiring LPN's (NOT bashing LPN's...just taking a legal viewpoint here). I don't do hospital work, but it makes me think about the legal ramifications that could occur in the situation I presented in my first post. Where I work now is much better staffing wise, so it's not really an issue for me anymore, but all LTC/subacute RN's should be more aware of this potential issue because we deal with such a large patient load. Who knew way back when we were in nursing school that we would have to be worrying about this kind of stuff?

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