Neglect...LPN was fired, RN was not

Nurses General Nursing

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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?

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???

Agree.....

Specializes in Everything except surgery.

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

Specializes in ICU.

Tweety is in essence correct. I know I am speaking from the Aussie legal framework but the principles are the same.

You and only you are ultimately repsonsible for your own actions. Delegation of responsibility is your own action. So the situation is this - if I assign you xyz patients and it is within your scope of practice - you are responsible - if it is outside your scope of practice and I KNOW that - I am responsible.

Our Enrolled Nurses here - esp here in QLD have, as part of thier licence that they are to ASSIST the registered nurse and that they are to work under direction of the RN. Legally they are more proscribed than LVN/LPN seem to be but the above holds true here as well.

Specializes in Gerontological Nursing, Acute Rehab.

Just my opinion....

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).

Also, working in LTC and subacute care, I have been in situations where I'm the only RN in the building, acting as supervisor, and working as a floor nurse on top of that. There is NO way that I can supervise every LPN and every resident. I count on my LPN's to give competent care and to let me know when there's a problem. If they don't tell me, I'm sure as h*** not going to be held responsible JUST because I'm the RN. LPN's are held to their own standards to act as competent responsible nurses. It is not the RN's job to "babysit" LPN's or any staff for that manner.

To give an example, I worked with an LPN that "forgot" to tell the RN super if there was a problem with a low blood sugar. In this instance, the pts BS was 40. She did not tell me this when she checked it. I found out about it as I was getting report from all the nurses towards the end of the shift. When I asked her why she didn't call me, she said she just gave him some juice and didn't think it was a big deal. I assessed the resident, who thankfully responded and had normal levels, and talked with the DON. She was subsequently disciplined, although that was not the first time this had been addressed with her.

Now, if the resident died from hypoglycemia, or wasn't rechecked, would that be on my head? I had my own wing to give meds to and work on, and 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. I can't supervise a 145 bed facility plus staff every single second of my shift. LPN's, CNA's, techs, etc all have the responsibility to report to an RN for problems. It's their job, and they should be held to it.

I think the appropriate action was taken in this situation. The patient died from NEGLECT on the part of the LPN. She had her own assignment, and she was responsible for providing competent care. She didn't, simply put. On the floor for 4 hours??!! Unacceptable conduct! The RN had nothing to do with that. Like I said.....we are NOT babysitters!

Sorry for the rant!

Specializes in Everything except surgery.

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..:D!

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.

Specializes in Gerontological Nursing, Acute Rehab.
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..:D!

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 :coollook:

Specializes in Everything except surgery.

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.:D Good nitie!

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

Specializes in Gerontological Nursing, Acute Rehab.
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.:D 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

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? ahhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhh

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.

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......

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.

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