Who is to blame

bbie17 · Sep 10, 2010

If all three nurses did not document anything, LPN 2 is probably held responsible. It was her patient and there was no documentation to prove she was busy at the time, so it seems like abandonment. She was supposed to round on her patients hourly so she can't really argue that she wasn't aware of the situation.

When someone falls at my hospital, everyone drops what they're doing and run into the room, ESPECIALLY the nurse who's assigned to that patient. If LPN 2 had been calling w/ pharmacy ALL shift...what makes her think the problem will be solved by staying on the phone??

CapeCodMermaid, RN · Sep 10, 2010

Where did you see that the LPN was supposed to be rounding every hour? That's not at all reasonable on a busy SNF floor.

Doinmybest · Sep 10, 2010

Chronic under staffing, that's who's really to blame.

Scarlette Wings · Sep 10, 2010

SCENE SET-UP: Unit 1 = 60 Residents, 2 LPNs, 1 RN, 4 CNAs. Split into two halls..
TIME: 10:30pm (30 minutes before shift change)
RN setting at desk,
LPN #1 charting restocking cart,
LPN #2 on phone with Pharmacy trying to get pain meds (that were supposed to be delivered 6 hours ago) for new admit. (Been playing phone tag with Dr. Pharm most of the evening) Family present and very upset.
CNAs doing last dry round
CNAs for LPN #2 come and say LPN #2, Resident X has fallen of the bed and hit her head. RN and LPN #1 go to evaluate Res. X, because LPN #2 is on the phone.
RN and LPN #1 agree Res. has to be sent out, due to hitting head. (LPN #2 still on phone) RN calls EMS and does paperwork to send to E.R. with asisstance from LPN #1. 10:45 EMS arrives, (LPN #2 still talking with pharmacy trying to get pain meds.) RN handles the transfer, gives EMS report etc. Res. leaves the building.
11pm CNAs, RN and LPN #1 go home. LPN #2 hangs up with pharmacy at 11:10, her whole crew had left, she leaves at 12:30 because she due to being behind because she had been trying all evening to get pain meds for new admit.
3am Res returns from ER diagnosis UTI !!!!! Res. didn't even have head looked at... No one called report to hospital, prior to transport!
8am family showed up and is not happy that a c/t scan wasn't done at hospital, ADON goes to look at nurses note just to see what happened, and nothing was documented anywhere. Who was at fault for this?
LPN #2? Although she was busy with another Resident, and basically had no knowledge of what happened, other then something happened, although it was her Resident that got sent out.
RN ? Her role on evening shift is to asisst LPNs when they get behind, and she left without reporting to LPN #2 what had happened and what needed to be done.
according to the ADON, to appease the family, someone has to be fired! Who would you fire? RN or LPN #2 or both?
I'll tell you the outcome after I get a few opinions...

Okay, I have an issue with LPN #2 who decided being on hold for a medication was a higher priority than her patient on the floor. I am sorry, I have a 5 minute maximum hold time and all my patients need me. Although it is important and a priority to relieve pain, if it was all "that" important I would not have hung up when my shift was over and past time for me to go home.

A nurse has to juggle many patient priorities and a Pt injury and need for transport out does take priority. Being on "hold" is not a solid reason for me if I were in that same senario.

It will be interesting to read the rest of these posts.

Scarlette Wings · Sep 10, 2010

rn. life's not fair.
no one being fired was not an option.
the family must be appeased. does anybody besides me wonder what kind of people demand someone lose their job to make them happy?

i used to wonder what kind of hateful, spiteful, two faced, miserable people with an arrogant, proud, self righteous attitude and a sense of entitlement would want someone fired when i first started nursing.....

.... but then i grew up and realized that there are more salomi's in the world dancing and acting the fool demanding "john the babtists head" than there are people who want to keep the peace. (is that enough adjectives to describe them???)

oh lord can you say been there and seen that done!

no one should be a scapegoat or be fired to appease a family member or patient, ever. nurse managers should back their staff like a momma bear with her cubs, most espically when they have not done anything wrong.

MAISY, RN-ER, BSN, RN · Sep 10, 2010

I used to have issues with floor nurses and their attitudes when I said I didn't have admitting orders for a patient.....after seeing how delayed physician calls and the crap that pharmacy gets away with in the hospital (family on floor) I can believe that the nursing home takes last priority for calls back. This is really a system problem....maybe they should hire disabled nurses that can no longer function on the floors for work like this that requires time away from the patients. Under no circumstances should a nurse have to choose which patient is more important, then be chastised that her choice was the wrong one because THIS TIME someone fell on her shift!

I don't think LPN 2 has any responsibility to this situation as the other two sent the patient out....furthermore, we can't know whether EMS related the incident, the hospital called and got a report, or whatever else was charted or not....the OP has to give us some more details....

M

noahsmama · Sep 10, 2010

I agree with those that say LPN # 2 is at fault for not dropping the phone (or passing the call off to LPN # 1 or RN, if possible) and going to see her patient who had fallen. LPN # 2 stayed on the phone for over 40 minutes while all of this was going on??? Bad priority setting.

But I also agree that no one should be fired -- unfortunately, I guess the world does not work that way.

NightNurseRN · Sep 10, 2010

so what was the outcome?????????

Anisettes, BSN, RN · Sep 11, 2010

Seriously, OP said she was going to post result "after getting a few opinions." Well that was posted Yesterday 6:31 PM (per post) and last post was Today @ 1:36 am and we're now at 31 opinions and counting.

What was the outcome?!

imintrouble, BSN, RN · Sep 11, 2010

In LPN # 2 defense, she stay on the phone because family was present and upset that meds not available. LPN # 2 tried to make the new admit family happy and did not get off the phone to check on her other pt. who was injured. Everyone was trying to pacify the angry new admit family. YIKES! Talk about a rock and a hard place.

Hospice Nurse LPN, BSN, RN · Sep 11, 2010

No one should get fired, but LPN #2 should be written up. She should have given the phone to LPN #1 and assessed her own pt. RN & LPN #1 should be written up as well. They should not have left LPN #2 and gone home. They should have stayed to help her finish tying up her loose ends.

BTW, how is the resident?

floatRN · Sep 11, 2010

When EMS arrived, wouldn't they have asked why they were called? Doesn't EMS also give a report when they arrive at the emergency room? If one of the nurses reported the fall to the paramedics that did the transfer and they didn't pass that on when arriving to the ER, aren't they partially at fault?