Who Must "Take the Fall?" - page 5

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   twotrees2
    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.
    only probelm is - the facility can fanagle numbers where and when they wish - i know this as fact as i have gone to bat on this issue and lost each time- at lesat in wisconsin they do not staff on acuity but numbers which in no way even comes close to what we REALLY need for staff- sad but true-
  2. by   twotrees2
    Quote from ingelein
    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.
    one of my past employers had at one time hung an article of a NH that was busted for neglect due to short staffing and other issues when they did an undercover operation ( had someone with fake id and history admitted and document everything - )

    i have emailed many big wig shows - opra , oreilly, the like - even the white house and my state board of nursing ( who by the way did investigate and sent me a nice note sayig their numbers were ok for staffing issues and so there was no problem,,,, lol - but seems noone is interested in that kind of story - none cares or they just think i am a disgruntled worker -
  3. by   twotrees2
    Quote from bshaw96
    See, THIS is a problem for me. You are talking down about them for "doing paperwork". And acted like it was a HUGE favor you fed the residents. First, paperwork has to be done. It's a big part of the job, in all areas of nursing, but esp. LTC. If not, I'm sure they'd get wrote up eventually. Second, you say you won't help feed the residents again b/c it made you late getting home? So basically, as long as you get home on time, you don't care if your residents get fed or not?
    in our facility the ONLY tme we see management come out to "help" is when either state ( gads, you shoudl see, even the office ladies are in feeding lol) and when corporate is in the big wheels ACT nicer - or when someone like me raises sucha big fuss over idiotic decisions they have no choice butto intervene and rethink thier stance cause the squeeky wheel needs to be abated and quieted to prvent further people from seeing the truth. unfortuantely they usually end up pushing the squeeky wheel over the edge to get rid of them which they are trying to do now and will but till im gone im still gonna be the thorn in thier idiotic sides vocalizing for my residents and staff.
  4. by   CapeCodMermaid
    So there's a big car accident on the highway and the EMTs have to pull people out of their cars. How do they know which one is the nurse?
    She has an empty stomach, a full bladder, and her ass has been chewed.

    Nurses have and will continue to take the blame for all the ills in LTC and since we have no power to change it........
  5. by   caliotter3
    CapeCodMermaid you said it right, hit the nail on the head. It's all the fault of the nurses, always has been, always will be. Bless you for telling it like it is, even if it only sounds like a joke.
  6. by   brendamyheart
    Quote from 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???
    MY problem also, however I will still continue to help out. The resident deserve that much!
  7. by   brendamyheart
    Quote from banditrn
    Yes, capecod, that is scary. And I understand what you're saying about the surveyors - I used to feel the same way about JCAHO at the hospital! Of all the potential for GOOD they could do - they would come in and get hung up on really stupid things that usually caused us to perform some MORE paperwork.
    I mean, is it really that awful that nurses kept their own coffee cups in the unit kitchen? It seems like they would get totally out of shape about things like that. I used to think they were a bunch of people trying to justify their jobs!!

    I'm getting a sick feeling when I go to work anymore, knowing that the biggest amount of my time will be taken up with paperwork instead of peoplework. And heaven forbid, if I don't have every I, dotted, and T, crossed!
    Amen on that !!
  8. by   brendamyheart
    Quote from ingelein
    Look CapeCod, I dont know you from Adam, all I know about you is what you post.When you make assertions that nurses who have problems in LTC are "slackers" and "lazy" you have made yourself a part of the problem. I dont know what goes on in the LTC you work in, but the concensus of most nurses that post on the LTC forum is that there are SERIOUS problems in LTC and the blame does partially lie with we nurses who continue to put up with deplorable work conditions.For management to deny their own complicity in the LTC situation is really just such a slap in the face of hard working nurses.
    OK. I am a unit manager. I could not in good conscious leave my nurses in a pickle. I help with admissions, help clarify orders and help were I am needed. However I do have a job also. I do PPS. If I do not get that done, we do not get paid. I am stressed out trying to help my nurses and also get my job done also. I am at the point now that this is not worth it. My DON comes down hard on me when my nurses do not do what they are responsible for. I have been on both sides of that fence and know what it takes to get the job done. Patient care comes first. I will continue to help. They cannot have it both ways. If I am late with my assessments, so be it!!
    Until nursing ratio's are mandated we are all in peril. Remember the Safe Harbor Act!!
  9. by   Franksters
    Tough question. It's really got me thinking. At my facility errors and sentinel events are treated as system errors. Initially. We work to look at the root cause and how to fix it. This is a long, painful process but when done correctly, it works well.

    I work in a non-profit acute care facility. Do corporations actually believe they can make a profit? Are they buying LTC facilities for tax loss?

    Running a health care facility regardless of type, is a multidisciplinary approach. Think about it, environmental services, maintenance, lab, radiology........all the way up to VPs,CEOs and The Board. I think the problem occurs when the nonclinical "higher-ups" do not place trust in their health care workers. I understand that finance is important. I must work to eat.

    I do hear horror stories abut the conditions of LTC facilities. Those of you who work it because you love it command my utmost admiration and respect. We (society) do terrible things to each other. We treat our elderly worse than our pets. That is pretty bad.
  10. by   Keysnurse2008
    Quote from ingelein
    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 "set up" to fail. not because mangement nessesarily wants them to fail, but because of corporate greed,mangement caving in to demands of administration, for whatever reasons, work conditions prevent the nurse from doing her job "by the book".im talking policy and procedure book here, the holy of holys.mangement if the truth were to be told know the nurse cannot humanly do her job by the book.

    so now the "worst" has happened,the family is suing, the nurse finds herself trying to explain what happened on that fatefull night when she was working short,was in the middle of the 2 hour med pass, all the call lights were ringing off the hook, mrs so and so had just fallen and broke her hip, mr so and so was tearing his room apart, two cnas were yelling at each other at the nurses station, and mr. so and so had just eloped, wander guard malfunction. the supervisor was also swamped because she had to take the other floor because of a call in.the meeting with the hr person,the don, the adon , the admininstrator and of course the nurse is over, the nurse is escorted to the door and wonders what just happened?

    who is to blame here? who will take the fall? who should take the fall? does management ever take the fall along with or even instead of the nurse? what would be an ethical resolution to this scenario? and by the way, this did not happen to me personally, but it could happen to you or maybe has.

    i might be the first to answer this by saying, run, run for the hills! but what if there is nowhere to run, what if this happens in all ltcs?
    [font="tahoma"]
    ingelin....i was discussing this with a friend of mine who does work ltc and she said what you are describing is verrrry plausible. she told me that on her wing she manages the care for 36 "skilled" patients,..."skilled" meaning these patients are dialysis patients or patients that have extensive wound care needs etc etc....and we all know what comorbidities go along with those type patients. patients on dialysis that have extremely high k+...or maybe they return from dialysis and have had too much fluid pulled off...they can crump on ya pretttty quickly. she has to do the assessments and give the meds...all the charting etc etc. i can not imagine that...it is difficult to see how that job can be done and assure that all the patients needs are safely being met ..ya know.and ...you are correct that instead of doing root cause analysis when things go awry and a patient potentially suffers as a result....the finger gets pointed at the nurse. however, ironically....when the nurse points out potentially unsafe staffing ratio's to the healthcare facility ...what happens? can anyone remember barry adams?- bc he is an example of what happens.

    also...what about california? i know they have staffing laws there to address safety...like icu patients max 2 pts to 1 nurse and general care i believe is a 4 to 1.....but what about ltc patients did they address those patients and mandate a safe staffing ratio for them?:deadhorse
    Last edit by Keysnurse2008 on Feb 18, '07 : Reason: removed another msp word...I need spell check!!!
  11. by   Simplepleasures
    Ive been off this LTC forum for a while, surprised to see more discussion on this posting. I am at the point now that I think that NOTHING will be done to improve this travesty for quite a while. Until we can vote people into the position to make change happen, we are screwed.This last 6 years has been wasted when it comes to healthcare reforms and actually has gotton even worse. Think HARD about who we vote into office, DEMAND EXCELLENCE from these candidates, hold their feet to the fire if they dont deliver on campaign promises. Contact Nursing Home Reform Advocacy Groups, they can point us into the right direction. As for now, all you nurses and in LTC, I salute you.
  12. by   lindarn
    Quote from twotrees2
    it is my understanding it is illegal to copy and keep any staffing lists - to do with the other personells privacy breeched - just what i have heard - correct me if im wrong cause ill start copying in a heartbeat of i am wrong
    If I am going to get nailed for situations that were out of my control and had no power to change and/or correct, I am going to take down ALL OF THE INDIVIDUALS WHO HAD THE POWER TO CHANGE IT AND MAKE IT SAFE. I don't give a hoot what is illegle and/or what isn't it. I will do/collect.make copies of what ever is in my power to accomplish this, and gather everything and anything that supports my allegations. I would rather indict them and deal with the ramifications of what I obtained and/or made copies of. Besides, don't you think that the public would rather be safe when these unsafe situations were made public, then deal with the possibly fatal results of short staffing, insafe situation, etc?

    Remember, THEY WILL COLLECT WHAT EVER THEY CAN TO DISCREDIT YOU, EVEN IF IT WAS ILLEGLE FOR THEM TO OBTAIN IT.

    They will only find out what you obtained, and how you obtained it, when the $#&** hits the fan, and it will look like retaliation on their part.

    I know what the others have said concerning calling/writing JCAHO, Department of Health, etc. and getting no results. I am personnally planning on writing to Lou Dobbs of CNN, and see if I can get a response, or even Jack Cafferty of CNN. They seem to have an interest in "digging up dirt", and this kind of stuff is right up their alley. I am in the process of writing a book, and have an rough outline done so far. I will keep you posted if I have any success with it.

    Lindarn, RN, BSN, CCRN
    Spokane, Washington
  13. by   Simplepleasures
    Lindarn, way to go girl, let me know if you need any help, my case against my employer is still in litigation, I have alot to spill my guts on. As far as the oversight agencies, this is laughable, there needs to be a huge investigation there also. Read "Patients, Pain and Politics" by Mary Richards Rollins RN BSN, former state surveyor of WI. This tells a sad tale of our oversight agencies.NO WONDER the LTC has not improved, the oversight agencies are not ENFORCING the laws that regulate LTC.You are so RIGHT when you say the LTC corporations wont hold back from doing ANYTHING legal or not to prove their case, and they spend thousands on lawyers to defend themselves.

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