Who Must "Take the Fall?" - page 2

I have wondered for many years about who is ultimatly responsible when a nurse who works in LTC has something tragic happen to her patient. Most nurses who have worked in LTC understand that they are... Read More

  1. by   meownsmile
    also banditrn,, maybe you should go to the DON and ask her if they are available so you can prevent the interruption she had the other night at 1045.
    I would think she would make sure they were where everyone could find them if that call upset her that much.
  2. by   CapeCodMermaid
    First let me put on my asbestos suit as I'm sure I'll get flamed......okay.
    1.As far as I know, there are no mandated staffing ratios in a SNF in Massachusetts so the numbers are pretty much up to what corporate decides.
    2.Most short staffing is caused by employees calling out so why do you all get mad at management when it is your friends and co-workers who have called out leaving you short. We work all week to make sure there is enough staff and then 2 people call out because they'd rather party than work. How is this management's fault?
    3.You make a med error or a treatment error or forget to do something and the patient suffers harm. The facility could get a G tag for which the DNS is considered responsible by most corporations even though she wasn't even in the building at the time the mistake happened, and yet you all seem to think you should not accept any of the blame.
    It's very easy to blame short staffing, too much paperwork.too many interruptions and the like for mistakes you've made. Most of the mistakes I've seen made were due to lack of following the procedures and disregarding the standard of care.
    I've made a few med errors over the course of my career and I cried over every one of them. Did I blame management? Nope...they were my fault and not only did I write myself up for them, I came up with my own plan of correction.
    All y'all seem to rant on and on about management. I'd like to rant on and on about nurses who don't want to take responsibility for anything they do. We all know good and rotten nurses...good managers and those who would sell their grandmother....let's try not to paint everyone with the same broad brush.
  3. by   SuesquatchRN
    Management can't do it if the rest of the staff isn't complicitous. Unfortunately, the management style is often unconciously approved of by those below because they know how to survive.

    I have no problem taking responsibility for things I have done wrong. However, when someone claims that my not messing with a patent airway caused a patient to die - well after my shift, when the nurse on with me is the DON's DIL and has 20 years experience and she gets meds and I get charge because she wants a 3 day a week schedule, the ED sends the patient back saying they see nothing - yeah, sometimes people take the fall. Oh, the diagnosis was aspiration pneumonia, which doesn't develop within hours, and I had been telling them for weeks to downgrade her texture and put her with the feeders. The nurse supervisor basically shrugged and said, "Oh, that hasn't been done? I'll look into it."

    I would have been happy to follow the procedure had someone ever told me what it was or trained me that the LTC world is different than the one for which I certified in BLS. No one ever said Heimlich or suction someone who can still talk and is breathing.

    Anyway. I'm gone, the relative is there. Quel surprise.

    New York is an "at will" state, meaning one can be fired simply because they think your hair looks funny. It never occurred to me to keep copies of everything I'd ever charted or submitted, nor that I would need them.

    I know better now.
  4. by   SuesquatchRN
    Oh, and ingelein - You know how much I respect your choice to fight. I hope you win, and wreak some change in you corner of the world.
  5. by   Simplepleasures
    Quote from Suesquatch
    Oh, and ingelein - You know how much I respect your choice to fight. I hope you win, and wreak some change in you corner of the world.
    Thankyou!! I cant do it alone though, I need the support of all the nurses out there especially in LTC who KNOW the truth , have been negatively affected by it and are willing to at least share their story here on Allnurses.com. BECAUSE you know what, you NEVER know who may be reading these forums, could be someone who really has the POWER and connections to take our stories and present them to the folks who have the wherewithall to make changes happen.
    Last edit by Simplepleasures on Dec 31, '06
  6. by   Simplepleasures
    Quote from CapeCodMermaid
    First let me put on my asbestos suit as I'm sure I'll get flamed......okay.
    1.As far as I know, there are no mandated staffing ratios in a SNF in Massachusetts so the numbers are pretty much up to what corporate decides.
    2.Most short staffing is caused by employees calling out so why do you all get mad at management when it is your friends and co-workers who have called out leaving you short. We work all week to make sure there is enough staff and then 2 people call out because they'd rather party than work. How is this management's fault?
    3.You make a med error or a treatment error or forget to do something and the patient suffers harm. The facility could get a G tag for which the DNS is considered responsible by most corporations even though she wasn't even in the building at the time the mistake happened, and yet you all seem to think you should not accept any of the blame.
    It's very easy to blame short staffing, too much paperwork.too many interruptions and the like for mistakes you've made. Most of the mistakes I've seen made were due to lack of following the procedures and disregarding the standard of care.
    I've made a few med errors over the course of my career and I cried over every one of them. Did I blame management? Nope...they were my fault and not only did I write myself up for them, I came up with my own plan of correction.
    All y'all seem to rant on and on about management. I'd like to rant on and on about nurses who don't want to take responsibility for anything they do. We all know good and rotten nurses...good managers and those who would sell their grandmother....let's try not to paint everyone with the same broad brush.
    So much hot air here, it blew the flame out.:flamesonb
  7. by   bshaw96
    Well, in reality, everyone is at fault, to blame. There is NO DOUBT management knows their staff is swamped, can't do everything by the book, but most don't care. And those that do can't get much done about it. But nursing, especially LTC, is a CYA job. Management will pass everything down until it can't go any further. That stop is the nurse. We are ultimately "legally responsible".

    That is why you must always look out for yourself. Cover your OWN @ss. You can't expect to take assignments that are unmanageable shift after shift without consequences. Yes, most times, the work will get done, the pills will get passed, the tx will get done, and so on. But one night, something bad can and may happen. The facility may get fined or tagged, but it's the nurse's license who will get taken. LTC is very dangerous. I love it, have done it for years, but am looking to get out for all the above and more. I've always thought it wouldn't happen to me, and by the grace of God so far hasn't, but I've got a lot of years left in nursing. Not a risk game I want to play!
  8. by   banditrn
    Quote from ingelein
    WOW, Banditrn ,THANKYOU so much for those words of support, you dont know how much they mean to me, Im practically crying.....well truthfully I am really crying.
    Good heavens, my dear, I'm sorry - I don't want you to cry! Of course you have my support, and that of a lot of others here!
  9. by   Simplepleasures
    Quote from bshaw96
    LTC is very dangerous. I love it, have done it for years, but am looking to get out for all the above and more. I've always thought it wouldn't happen to me, and by the grace of God so far hasn't, but I've got a lot of years left in nursing. Not a risk game I want to play!
    Well it didnt happen to me until I had been in LTC for26 years!!It is a game of risk and the toll it takes on a nurse physically and mentally is NOT WORTH IT.
  10. by   CapeCodMermaid
    Quote from ingelein
    So much hot air here, it blew the flame out.:flamesonb
    And yet, you talk of supporting each other as nurses. I guess, Ingelein, you only support those whose opinion matches yours.
  11. by   Simplepleasures
    Quote from CapeCodMermaid
    And yet, you talk of supporting each other as nurses. I guess, Ingelein, you only support those whose opinion matches yours.
    Cape Cod, I support all nurses who are not a PART of the problem, some of the words you have used to describe nurses who may be overwhelmed with the unrealistic work load in LTC is what makes me have a problem with you. I really did NOT want this to turn into a flame fest.
  12. by   CapeCodMermaid
    flame away,honey. I was on the dementia unit today feeding residents while the charge nurse and med nurse sat behind the desk doing paperwork....THEY get paid for every minute they are in the building but were out on time....I on the other hand had to stay late to get MY work done because I pitched in to help them out. It won't happen again...I you say I am the problem???
  13. by   TrudyRN
    Quote from meownsmile
    It should be written on the incident or unusual occurance report forms that your facility provide. Put them in an envelope and push it under the DON's door if that is who recieves them, but... make sure you keep copies of all documentation that you send to them. Dont make it accusatory, dont point fingers,, make it simple, matter of fact and to the point. No personal opinions.

    ie. Staffing for 100 patients at 1RN, 2LPN and 2CNA on (insert date). Facility policy number **** calls for XRN, XLPN and XCNA for Xnumber of residents,, director of nursing notified that staffing insufficient for resident census per facility policy. This nurse informed by (whoever you called) that no staff available for proper ratio on this date.

    This type of documentation may not keep you out of court entirely, but it will bring someone in with you and lessen your legal liability somewhat. It IS the facilities directors responsibility to make sure the policies are followed and residents are safe and secure in the environment they are paying for.
    They do take administrators down too. We just had a facility near us that had the DON canned and a stiff fine by the state for something that happened there, and noone even died. So when the chips are down if you have PROPER documentation and can prove (through copies of documentation) you took appropriate steps to recitify the problem even if it was to inform your superior and request more staff when you know there isnt any to be had, you have done everything you can legally do to prevent a problem.
    Nothing wrong with self-defense and taking others down with you when they deserve it but it's all just so sad, such a waste of time and money and effort. We could be doing good patient care and doing right in the sight of God and man. But, instead, we are doing this baloney.

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