Skill level not high enough for acute care

Nurses General Nursing

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Specializes in LTC, Psych, M/S.

A RN on a M/S unit was recently 'asked to resign' .....I heard thru the grapevine that 'her skill level wasn't high enough' was the reason the manager gave. However I know it had to do with something else - however that is besides the point. This RN had been there over 1 year. I think it is a loaded statement IMHO but it got me thinking....and btw there are LPN's employed on this unit.

I guess it has to do with the whole education vs. experience issue.....what ensures a 'skill level high enough for acute care?'

Any thoughts?

Specializes in tele, oncology.

My unit has also asked RNs to resign before, when after multiple chances they were still deemed to be a danger to the pts due to their inadequate level of care. They were all given opportunity after opportunity to improve themselves, to no avail. Usually it was a P&P technicality that was cited by the end, in order to avoid potential legal issues.

So in short, a "high enough skill set" is one where you can provide adequate care, without endangering pts or consistently violating policies, within the working environment that you are in. Some areas give more leeway than others, and will actively do everything possible before termination, some have an attitude of "don't let the door hit ya on the way out."

BTW, not wanting to start trouble...you may not have realized how it might come off on a message board...but whether or not LPNs are on your unit or not is really a moot point. Some nurses are safe and have a good skill set, some are not, regardless of level of education.

Specializes in Case mgmt., rehab, (CRRN), LTC & psych.

Three sides to this story exist: (1) the manager's side, (2) the RN's side, and (3) the truth, which is somewhere in the middle.

Although I do not have all of the details, I am conjecturing that office politics had something to do with the demise of the RN's job unless, of course, she truly did lack the pace, sense of urgency, and skill level needed to stay afloat on a general med/surg unit (basic assessment skills, documentation, IV starts, medication administration, timely reporting of changes in condition, dressing changes, Foley insertions, ostomies, and so much more).

Specializes in Sub-Acute/Psychiatric/Detox.

I think the OP met by LPNS being employed on the unit means that there is a lot more nursing support on this unit. This whole skill set is dependent on what one what the unit needs. I couldn't start an IV to save my life.. because I was never trained I work in psych sure I could take a $700 IV course.

Sometimes its people not having common sense and putting patient safety first. Then again... each situation, unit, hospital and state is different.

I find it funny that working in sub-acute or Long Term Acute Care (aka the dumping grounds of hospital ICU Patients) if your an RN doesn't count as med-surg hospital experience to some white coat nurses. It all depends.. whats funny is that the people deciding how much experience you need may have not worked the floor since Clinton was in Office. Some competency is needed though. This is why I wish I could take a seasoned older nurse with me everywhere I go if I worked in a hospital.. They have answers the the books don't have.

Up here in the Northeast LPNs are gone out of most hospitals or "disarmed" meaning they can't do any nursing tasks like pass meds.

Specializes in LTC, Psych, M/S.
BTW, not wanting to start trouble...you may not have realized how it might come off on a message board...but whether or not LPNs are on your unit or not is really a moot point. Some nurses are safe and have a good skill set, some are not, regardless of level of education.

My point exactly!! In the real world of nursing, what is more important education or 'skills?' There is only so much you can learn in a classroom. I admit these LPN's are very good - apparantly they have had the opportunity for more 'hands on' training than the RN and had more 'acute care' experience.

Yet many hospitals are 'getting rid' of LPN's and not even hiring ADN's only BSN's. I have read posts about this just tonite. WTH???

Specializes in LTC, Psych, M/S.
I think the OP met by LPNS being employed on the unit means that there is a lot more nursing support on this unit. This whole skill set is dependent on what one what the unit needs. I couldn't start an IV to save my life.. because I was never trained I work in psych sure I could take a $700 IV course.

Actually, no there isn't. What is unfair is that they cant push IV narcs or do blood transfusions, that is about it. Thereby, one of the other RN's, who already has a full patient load, has to do these tasks if one of the LPN's patient has them ordered. So actually the LPN has a pretty sweet gig.

I was simply pointing out the irony that the nurse with the more education being deemed to have 'skill level not high enough.'

Specializes in LTC.
Three sides to this story exist: (1) the manager's side, (2) the RN's side, and (3) the truth, which is somewhere in the middle..

You forgot number 4 which is the side that develops from gossip and the rumor mill.

Specializes in LTC.
Actually, no there isn't. What is unfair is that they cant push IV narcs or do blood transfusions, that is about it. Thereby, one of the other RN's, who already has a full patient load, has to do these tasks if one of the LPN's patient has them ordered. So actually the LPN has a pretty sweet gig.

I was simply pointing out the irony that the nurse with the more education being deemed to have 'skill level not high enough.'

But I have a sneaky suspicion that these LPNs can run circles around the nurse who was fired for not having a good skill set.

I would take a seasoned LPN over a struggling RN any day.

Specializes in geriatrics, IV, Nurse management.
I was simply pointing out the irony that the nurse with the more education being deemed to have 'skill level not high enough.'

I fail to see the irony as 3rd year RNs were being trained and out skilled in the labs by 1st year and 2nd year RPNs (Edit: in my college). However, rather than being angry, or acting out, both the RPNs and the RNs worked together as a team in clinicals. That is how it works on the floors in the hospitals near me. Sure we can't push IV meds. But my partner RN will know I will help them out in another way to make up for them pushing or hanging meds that are not in my scope of practice.

To be out skilled in the situation the OP described, I'm thinking that the RN must have been talked to more than once. To have support and education and still not succeed, well perhaps another nursing role is that RN's calling. The best part of nursing is there is many many roles for us each to find a perfect fit.

Specializes in ED, ICU, MS/MT, PCU, CM, House Sup, Frontline mgr.
a rn on a m/s unit was recently 'asked to resign' .....i heard thru the grapevine that 'her skill level wasn't high enough' was the reason the manager gave. however i know it had to do with something else - however that is besides the point. this rn had been there over 1 year.

i have seen nurses fired or asked to resign for the same reason given above, where in most cases there were valid points made, after a much longer time than 1 year! it boggles my mind that it can take this long to decide that someone is not a good fit given a probationary period... however, sometimes some nurses have gotten past his/her probationary period because the manager(s) at the time were different people who wanted to give the new grad a chance. the same new grad after 1 or 2 years has not improved and has received multiple complaints from patients and staff (to include others not working as nurses or aids on the floor) that related to dangerous behaviors! the unit finally hired someone (a manager) who is scared more about liability than he/she is afraid of hurt feelings and starts the termination process.

i think that this is sad and a waste of valuable time when this occurs. for example, the terminated nurse could have worked for few years doing something more in-tune with his/her skill set or a unit more in-tuned to him/her if fired before probation was up rather than 1 or more years later. in any case, good luck to your friend. nursing is a big field and hopefully he/she will find something....

Specializes in Critical Care, Education.

Just have to jump in on this one....

There appears to be some misconception about "LPN vs RN". LPNs are not a replacement for RNs, these are 2 separate roles / scopes of practice. LPNs are focused on technical aspects of care - that are defined by each state - and must work under the supervision of an RN or physician. RNs can certainly perform the technical skills, but they are also responsible for overall management of patient care. RN responsibilities are not the same, so it the fact that there are LPNs working on the unit has no bearing on the termination of the RN.

Specializes in LTC, Psych, M/S.

Houtx - I agree that is how it supposed to be but not the case on this unit. The LPN's took on the same assignments as the RN's and if one of their patients needed a blood transfusion or IV narc push she would grab one of the RN's to do it. This is a rural hospital. And obviously the LPN was a' better nurse' than the RN - thereby going to show that education doesnt matter as much as skill level.

However, one of the highly experienced RN charge nurses recently quit and went to work at a ALF. She said one of the 'straws that broke the camels back' was that she was doing this LPN's narc pushes while the LPN was talking on the phone and it was obviously a social call.

This unit has crazy high turnover but they just hired several new grads so i wonder how many will be deemed to 'not have high enough skill level for acute care.'

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