Neglect...LPN was fired, RN was not - page 7

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   Tweety
    Quote from nurseunderwater
    huray!!!

    this is just a shinig example of a double standard.......
    It's also a double standard when the **** it's the fan the LPN claims "it's the RN's fault I'm only an LPN". But the rest of the time it's "leave me alone, I know what I'm doing".
  2. by   nurseunderwater
    Quote from 3rdShiftGuy
    It's also a double standard when the **** it's the fan the LPN claims "it's the RN's fault I'm only an LPN". But the rest of the time it's "leave me alone, I know what I'm doing".
    For some Tweety this may be true, not for all.....

    And we all know where that discussion leads... :uhoh21:

    another example of the need for a "clearer" more standardized scope of practice for "us" LPN's.....
  3. by   Tweety
    Quote from nurseunderwater
    For some Tweety this may be true, not for all.....

    And we all know where that discussion leads... :uhoh21:

    another example of the need for a "clearer" more standardized scope of practice for "us" LPN's.....

    Yes, let's not go down that road. Just wanted to note the double standard runs both ways, for some, but not all. I mean that matter of factly and not maliciously. Agree with your last statement as well.
  4. by   Sheri257
    Quote from 3rdShiftGuy
    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.
    I do understand your argument. But I wouldn't count on it. I've been involved in four lawsuits both in state and federal court. If you even try to tell a judge you're not responsible, and law says you are, good luck. Game over, IMHO. I wouldn't want to even try to make that case. You're essentially counting on discretion that even the most sympathetic authorities probably can't provide, even if they wanted to, under the law.

    I realize these kinds of cases don't happen every day and that it's rare. But all it takes is one bad case to ruin a career. The family is going to want to blame someone and, it sounds like they have a great case in this particular instance.

    All I can say is that I'm glad to have learned this information and will definitely keep it in mind for the future.

    Last edit by Sheri257 on Apr 20, '04
  5. by   BBFRN
    http://www.kentucky-nurses.org/Assig...onForm2003.htm

    Here's a link to a copy of an Assignment Under Protest form for anyone who's interested. This may come in handy for those who don't work in unionized facilities that don't supply the form.
  6. by   amoymak
    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.
    it's not that one license seems more important than another, lpn's are not allowed to assess so an RN must either chart the assessment or initial the one performed by then LPN. an lpn cannot perform IVP meds so if she has a pt who requires that- an RN must do it. i can go on and on about the limitations but at the end of the day, it's not the
    lpn's fault- she's practicing within her scope. maybe hospitals shouldn't hire LPN's . Keep in mind that most LPN's working in hospitals are probably quite capable of performing some of these skills that are "out of their scope".
  7. by   Tweety
    Quote from lizz
    I do understand your argument. But I wouldn't count on it. I've been involved in four lawsuits both in state and federal court. If you even try to tell a judge you're not responsible, and law says you are, good luck. Game over, IMHO. I wouldn't want to even try to make that case. You're essentially counting on discretion that even the most sympathetic authorities probably can't provide, even if they wanted to, under the law.

    I realize these kinds of cases don't happen every day and that it's rare. But all it takes is one bad case to ruin a career. The family is going to want to blame someone and, it sounds like they have a great case in this particular instance.

    All I can say is that I'm glad to have learned this information and will definitely keep it in mind for the future.

    No I don't count on it, which is why I try to stay within the guidelines of the Nurse Practice Act. It's one area that I vehemently oppose, but like it or not, that's the way it is. I'm responsible for ALL outcomes, when it should be a case by case basis. I'd hate to think that if an LPN doesn't follow the 5 rights of medication administration and has a bad outcome, I'm going to loose my license while I'm happily trusting that nurse. Scarey.
  8. by   MandyInMS
    ~sighs~
    This thread is giving me a headache..lol
    I just don't understand how another nurse requardless of title can be held accountable for EVERY action of another.And, if a nurse isn't capable of working in any given area under his/her own liscense why are they even allowed to work in that area.
    I'm an LPN...If I give pt X the incorrect med..that's MY error.
    I'm an RN...If I give pt X (LPN's pt) the wrong med..that's MY error.
    All this does make ya think..huh?
  9. by   gij1
    1. Do not give high risk GI bleed patient to LPN. That is drilled over and over in nursing school, prioritizing patients.

    2. The man was not checked for 3 to 4 hrs!! GI bleed! Come on, that is just pure neglect. Just because it is night shift you must be aware of what is happening with your patients.

    3. Do not agree to work in unsafe environment. Patient/nurse ratio not safe, quit, go somewhere else. Just say No!!!!!!!!!!!!!!!!!!!!
  10. by   Brownms46
    Quote from 3rdShiftGuy
    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".
    Tweety I agree with much of what you have posted. However...the BON in each state has deliberately placed the burden on the RN. And unfortunately....the rules they make up...are made up to meet the whims of TBTB!

    And I don't blame you for not wanting to take care of another licensed person's assignment, but that is how BON has set up the rules. Fair NO! But that is the way it is.

    As you say...you don't know how competent a person is, until you get into the assignment. Well...then this means, you must continue to assess. Assessment doesn't end when you make the assessment, assessment is an ongoing process.


    Accountability

    The last and surely not least step of delegation probably causes nurses the most concern. After the delegator has assessed patient needs, assessed qualifications of the personnel, made the assignment and granted authority, the delegator's role has just begun. The delegator must supervise the personnel to validate that the care was performed as was delegated and according to the established policies and procedures within the agency. The process of supervision is necessary in order for the delegator to maintain accountability for the nursing care.
    Take a little gander at this link, as I found it very interesting. I feel it really drives the point I'm trying to make about, delegation, and accountability.

    http://caring4you.net/delegation.html
    Last edit by Brownms46 on Apr 20, '04
  11. by   Brownms46
    Quote from lizz
    BTW, thanks for this link as well Brownms46. Very informative.

    http://www.calnurse.org/102103/teamissues.html
    You are very welcome lizz!
  12. by   Tweety
    Quote from MandyInMS
    ~sighs~
    This thread is giving me a headache..lol
    I just don't understand how another nurse requardless of title can be held accountable for EVERY action of another.And, if a nurse isn't capable of working in any given area under his/her own liscense why are they even allowed to work in that area.
    I'm an LPN...If I give pt X the incorrect med..that's MY error.
    I'm an RN...If I give pt X (LPN's pt) the wrong med..that's MY error.
    All this does make ya think..huh?

    Gives me a headache too. But the nurse practice act is very clear. The RN is responsible for ALL OUTCOMES.
  13. by   NannaNurse
    This nurse made a very grave mistake, not doing rounds and tending to the needs of her/his patients. The fact that it's a LPN doesn't bother me, she is a nurse too..........same argument, different thread.........

    This is a growing trend in all medical facilities across our great nation.......over loading ALL nurses and expecting us to handle the constant stress and we are expected to wear that 'secret S' under our scrubs!! Well, personally I'm sick of it. Fewer people are going into the nursing profession and we wonder why?? :chuckle The pay sucks, the hours stink, the paperwork causes brain damage and what do we get??? More patients than we can adequately care/provide for, BS from the higher ups and always told to '....deal with it' or '....just do the best you can'........Is anybody else fed up with this crap?? I work Acute Rehab.....I walked into work yesterday and was met with...."have a nice day, one of your patients just died".....we get patients who are SICK and NOT ready for Rehab.....we are doing blood Tx, 1:1 nursing supervision, elopement checks every 15 min .......AROUND THE CLOCK, skin care tx that take >1hr, suctoning q 15-20 min, vent pts pt that require 4-6 assist......I wish the nurses of this country would pick a day and EVERY SINGLE NURSE WHO CARRIES HIS/HER LIC. PROUDLY WOULD CALL OFF D/T SICKNESS.......sick and tired of not being heard.
    ........sorry for the 'soapbox' here, but I'm just mad :angryfire

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