Neglect...LPN was fired, RN was not - page 8

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   NannaNurse
    Oh Yeah...........I think the RN should have recieved a write up for this. He/She was to ensure the LPN was 'doing his/her job'..........sad enough to say since we are over-loaded as it is...........
    Just my opinion
  2. by   Tweety
    Quote from Brownms46
    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.




    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

    Again, I'm not saying the RN is an innocent bystander in this case, just that the "punishment" should take the RN and the LPN separately and should be appropriate to violations each incurred.

    I didn't mean to say I didn't want LPNs in my assignment. Daily I'm assigned one, if not more LPNs and I accept it.

    What bothers me about the RN being responsible for every outcome is when I've been off several days I know nothing about anyone in my assignment. The assignments are made by the charge nurse from the shift prior. And the way we use LPNs is as total care providers not teams, so literally my license is dangling on the line every day, since it may be way into our shifts that I realize that an assignment might not be appropriate, or what the LPN is and isn't doing.

    Once I was working with an LPN who decided to let a patient sleep through his 4AM vitals. The patient went into septic shock and it was only then that I was aware of the situation. Sigh..........sometimes makes me crazy.

    Anyway good discussion, even if we don't agree on the fine points.
  3. by   Tweety
    Quote from gij1
    1. Do not give high risk GI bleed patient to LPN. That is drilled over and over in nursing school, prioritizing patients.

    The patient was on med-surg, surely LPNs can take care of GI bleeds. I don't remember in nursing school reading what patients LPNs can and can not take care of on med-surg. Every patient has the potential crash. Every patient is a potential fall risk. Every patient is "high risk".

    But yes, it's drilled into us..........make appopriate assignments!

    If the patient was unstable, as wasn't indicated in the op, what was he/she doing on med-surg?

    Agree with the rest of your post!
    Last edit by Tweety on Apr 20, '04
  4. by   Tweety
    Quote from 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

    I hear ya Nanna, med-surg and rehab patients are sicker and sicker. When they get sick we're expected to privide a higher level of care while we wait many hours for a higher level of care, or to simply stablize them.

    Then there's the old assignments are made by number of patients rather than the acuity of those patients.
  5. by   meownsmile
    I have to wonder if this facility has a written falls program with guidlines for criteria, intervention, and monitoring. We do, it works very well, and the patients that meet the criteria(as this guy definately would have) are moved to a room closer to the nurses desk as soon as one is available, checked visually q1 hr, and are toileted, turned, repositioned q2. The guidelines are implemented day and night.
    Would be interesting to see what the charting looked like on this guy. That may have been the deciding factor in who got fired. If the Rn had done her required charting, and the LPN did little or no charting it kind of leaves the LPN out there for the liability.
    Last edit by meownsmile on Apr 20, '04
  6. by   NannaNurse
    The funny thing is..........we do aquity ratings every darn shift........for what?? We have a rating of 0-3+.........about 45% of our patients are 2-3+ and this means nothing.........we have 22 patients and they are ALWAYS divided up 3 ways........we are getting ready to move to another floor while our 'new rehab floor is being built'...and we are going down to 20 pts. We will be on a unit with med-surg who will have 10 pts........if their lights are going off, etc.........I see nothing but trouble with this one.....In our 'new' place, we will move up to 30 pts........man-o-man-o-man-o-man........are they hiring at Starbucks???
  7. by   meownsmile
    Nana,, im not that far from you and they do the "acuity" staff ratios every shift also. It means nothing here either, They still staff by numbers, and its usually 10 average per RN on days unless the census has dropped. I have said it before, they use their acuity tracking program each shift and it looks good when someone comes in and wants to see it, and thats about all its for. They sure dont bother using it when it comes to daily staffing.
  8. by   Brownms46
    Quote from 3rdShiftGuy
    Again, I'm not saying the RN is an innocent bystander in this case, just that the "punishment" should take the RN and the LPN separately and should be appropriate to violations each incurred.

    I didn't mean to say I didn't want LPNs in my assignment. Daily I'm assigned one, if not more LPNs and I accept it.

    What bothers me about the RN being responsible for every outcome is when I've been off several days I know nothing about anyone in my assignment. The assignments are made by the charge nurse from the shift prior. And the way we use LPNs is as total care providers not teams, so literally my license is dangling on the line every day, since it may be way into our shifts that I realize that an assignment might not be appropriate, or what the LPN is and isn't doing.

    Once I was working with an LPN who decided to let a patient sleep through his 4AM vitals. The patient went into septic shock and it was only then that I was aware of the situation. Sigh..........sometimes makes me crazy.

    Anyway good discussion, even if we don't agree on the fine points.

    You know...Tweety...I really do see, and understand your position here.

    I believe this RN wished she had supervised this LPN more closely, or maybe had peeked in on this pt. I sure she has gone over, and over in her head, what she could, or would've done differently....given the chance.

    For the LPN...I don't know what could've caused her to not look in on this pt. for 3-4 hrs! But I do believe...she would've done things differently also. For the rest of her life...she must live with the fact, that her carelessness...caused the death of another! Don't think I could function anymore...if this happened...ooooh please God forgive me for even writing such a thing! This is a mind blower for sure...no matter how many people are at fault! NO two ways about it!

    On some level .....I feel you are right...that maybe the RN shouldn't have been fired...but definitely given more than just a slap on the wrist. However, I do believe this RN has not heard the last of the situation.
  9. by   -jt
    <checked visually q1 hr, and are toileted, turned, repositioned q2.>

    The staff's debate shouldnt be about which one of the nurses should be fired. That focus is misdirected. The hospital and supervisor who allowed that kind of staffing, knowing it puts pts at risk, should be the ones the arrows are aimed at. Hold THEM accountable. Thats where the staff's anger over the situation should be directed - the fact that nurses (LPNs & RNs) are being put into impossible situations by supervisors, have no control over those decisions, but are being crucified for the adverse effects it causes.

    How are you going to check a pt & provide care q 1 hr on a med-surg unit if you have 12 pts? Q 1 hr care is INTENSIVE care & we can do it in ICU because we only have 2 pts. What did the nurse do wrong? What was she fired for? Was it because she didnt see the pt for 3 hrs? What is the norm on a med-surg unit anyway? How does anyone know the nurse was just "careless"? What else was going on the unit at the time and with her other 11 pts? 3 hrs between rounds doesnt seem unreasonable - especially if you have 12 pts to provide hands on care for, plus all the charting, meds, problems that may come up, ect. How can a nurse be expected to do all that for 12 pts AND check each one of them every hour? You could spend a whole hour in just one pts room, depending on the care the pt needs.

    If the policy was that the med-surg nurse MUST check each pt every hr, then the nurses should have put it in writing that it would be impossible to follow the policy with the kind of staffing they had to work with. They then could not be held responsible for not following the policy or used as scapegoats when an incident occurred because of it.

    IMO, neither of the nurses should have been fired when they were forced to work in an unsafe situation that was set up to fail & it subsequently did. And the staff should not be arguing over which one to fire. They should be outraged that anyone was fired at all and that they are being forced to work in unsafe situations and held accountable for it.

    To refuse an assignment is insubordination and we can be fired for that but we do have the right to protest an assignment & not carry all the liability for an unsafe assignment alone.

    The mistake the nurses made was not putting in writing that they recognized that this was an unsafe assignment & they were doing the best they could under the circumstances (ie: fill out a protest/assignment under objection form or even just a note to the supervisor). If the supervisor then allowed the staffing to remain as it was, the liability for whatever ill affects it caused would have clearly been on the supervisor & hospitals shoulders and that does stand up in court.
    Last edit by -jt on Apr 20, '04
  10. by   Nitengale326
    I personally think the actions were appropriate. The best thing for you is just to lay low and not get involved in the politics of this debate. Trust me, there will be another debate next week. I too have been an LPN and then onto my RN. Good luck
  11. by   SmilingBluEyes
    EXCELLENT POST -jt!!!!!!!!!!!!!
  12. by   nurseT
    God, that's awful. Severe neglect. 8-9 pts. Hmm. I have worked the skilled unit at LTC with 18 pts. Many different things going on. The skilled units now are like little hospitals. Pts get kicked out so soon now. I've had central lines, picc lines, mid lines,infusaports, peripheral lines, peg tubes, post surgicals with infected wounds, fresh amputees, pts being preped for tests, coordinating Dr. appts, new admits, discharges, admin all meds and txs all in one day, with one cna. I always new if someone fell. I thought 18 pts was too many. I can promise you i never walked the hall, I ran every where I went. Don't offer your opinion to your coworkers, just shake your head and start looking for a better job.
  13. by   meownsmile
    jt,, the OP wasnt talking q1hr checks,, that was my post about our falls program. And we do VISUALLY check patients on the program every hour whether it be as we are walking down the hall to another patients room or have a few minutes to go check. We have a system that alerts us to which patients are on the program and they are again,,, VISUALLY checked every hour, to make sure they arent getting out of bed unassisted, with q2 toileting,turning. In no way did i mean to imply that we went and did physical checks every hour,, that is intensive care and not available on a med/surg floor. Sorry for the confusion.
    Last edit by meownsmile on Apr 20, '04

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