Who Must "Take the Fall?"

  1. 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?
    Last edit by Simplepleasures on Dec 30, '06
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  2. 68 Comments

  3. by   caliotter3
    I've had this sort of thing happen to me twice now. From my experience, the nothing at the bottom of the pile (i.e.-ME) is the person to suffer whatever the consequences are. And it does not necessarily have to have anything to do with legal or moral culpability for anything. This is just a hazard of this line of work and one of the reasons so many leave nursing. Yeah, like you said, RUN for the hills. But yes, you have to stop running sometime, and then what do you do for a job to support yourself and keep yourself off of the streets? Say anything to many strangers, and they look at you with a blank stare b/c they have no idea why a nurse is not in the land of milk of honey of available jobs. This aspect of nursing, and subjective and objective ways to deal with the eventualities, should be addressed in ALL nursing education, even nursing assistant.
  4. by   EmerNurse
    Face it - the fecal matter rolls down hill and nurses are at the bottom of that hill. Why else do WE get nailed for not catching a doctor's mistake (who got all those extra years of education and paycheck anyway)? Why can WE be short staffed and have to take a larger patient load and still manage to complete everything we usually can (aren't we still the same one person we were yesterday?).

    Illustration: Had a nice spreadsheet of "med errors" sent to us claiming we had far too many in 2 months. What were most of them? An order for a med that doesn't come in that strength - pharmacy had to clarify dose; med found BEHIND the accudose (erm.. I don't usually check back there m'kay?); med on recon sheet listed with dose that the drug doesn't come in (the box for patient RECALL was checked!!) and hoards of wrong dose written or whatever in the list. Only very few actually related to what I consider a med error - giving a patient a wrong med, wrong time, wrong patient, wrong dose, wrong route. Oh wait that's the 5 rights, isn't it?

    But all of these were called medication errors and were addressed to the NURSING staff. Not the docs, not the pharmacy (who created that list btw), not anyone else - the nurses.

    It's on us folks. I always say to nursing students, until you have that yoke of responsibility hanging around your neck EVERY moment of EVERY shift, you have no idea what nursing is really like. Bless them every one!
  5. by   meownsmile
    Thats exactly why i write up any meds missing in my cassettes on a med error sheet (directed at pharmacy). I write up a physician that is writing a illegal abbreviation or a wrong med on an unusual occurance. They MUST be held accountable too. If you dont utilize the avenues you are given then they can all claim ignorance of an incident and it will roll all the way to you. When they review they look at incident reports etc for patterns of problems, not just the specific incident. Im a little more lienient with my co-workers because i know how they are working and things can usually be recified by changing a med administration time or correcting the MAR. But it comes down to covering your behind and those of your coworkers if you have to because noone else will. Believe me noone else will and if we dont take care of ourselves and keep ourselves out of harms way we will keep getting the hit for everything.
    If you are working short, write it up, get it on the record that you asked for more help, you feel the staffing is unsafe and were denied any staff availablity. EVERYTIME. Bury them in paper. I know it seems as though it falls on deaf ears, but with the documentation in the book the powers that be cant say "well noone asked for help" or "well noone called and told ME they were short or they felt it was unsafe". On the record at least identifies to whoever may be reviewing the situation that YOU recognized and attempted to rectify the situation for the safety of your patients. At that point it may roll downhill and hit ya but some may bounce back up and off of you. CYA to the fullest extent. Use their own red tape to make them accountable.
  6. by   caliotter3
    The job that just showed me the door had lots of goodies going on, which I dutifully brought to the attention of mgmt. Everything was made my fault one way or another (I was just punished for bringing up the wrongdoing as far as I'm concerned; mgmt had/has no intention of rectifying anything). So I have my documentation. But to me it is of no use b/c I consider myself intelligent enough not to report anything to law enforcement or governmental agencies or any other interested third parties (you know, whistleblower consequences). But still, even though I am forced to keep my mouth shut so to speak, I have no job. Reams of documentation will do me no good when I look for new employment. I still wonder how it is that mgmt can accuse me of not putting the patient first. They must think I am mentally ill b/c I do not consider breaking the law to be in the best interests of patient care. Sort of like "One Flew Over the Cuckoo's Nest", or "Catch 22".
  7. by   linzz
    Meowsville is so right, my husband works in a supervisory type of job and they had a lawyer come in and talk to them and this lawyer told them to write down every little thing of concern to them in a journal that you keep at home or locked away in your locker. I had a preceptor try to tell my teacher that I had missed time that I had not, fortunately I had written this down and saved myself.
  8. by   Simplepleasures
    Quote from caliotter3
    The job that just showed me the door had lots of goodies going on, which I dutifully brought to the attention of mgmt. Everything was made my fault one way or another (I was just punished for bringing up the wrongdoing as far as I'm concerned; mgmt had/has no intention of rectifying anything). So I have my documentation. But to me it is of no use b/c I consider myself intelligent enough not to report anything to law enforcement or governmental agencies or any other interested third parties (you know, whistleblower consequences). But still, even though I am forced to keep my mouth shut so to speak, I have no job. Reams of documentation will do me no good when I look for new employment. I still wonder how it is that mgmt can accuse me of not putting the patient first. They must think I am mentally ill b/c I do not consider breaking the law to be in the best interests of patient care. Sort of like "One Flew Over the Cuckoo's Nest", or "Catch 22".
    I dont understand, if you have all the documentation and are not getting a job, sounds like you have been blackballed already, why wouldnt you report what you know? Get a lawyer , tell your story and start reporting to whatever agency oversees your facilty. Dont be a victim!!!PM me if you want.
  9. by   lindarn
    Quote from linzz
    Meowsville is so right, my husband works in a supervisory type of job and they had a lawyer come in and talk to them and this lawyer told them to write down every little thing of concern to them in a journal that you keep at home or locked away in your locker. I had a preceptor try to tell my teacher that I had missed time that I had not, fortunately I had written this down and saved myself.
    Nurses need to practice what I call, "Defensive Employment". The poster two posts up descrived it right- Bury them in documentation, and write on the bottom:
    CC: my records, board of health, JCAOH, et., and send copies to the above agencies.

    I would also keep copies of staffing sheets in my personal files. I also made copies of any incident reports that I wrote and also kept them in my files. If, and when I was ever called on the carpet for management-caused problems, and they were trying to pin the blame on me, I would have happily informed them of the documentation that I had, and that I would be happy to provide copies to the plaintiff attorneys so that they could sue the appropriate individuals, not me. I rest my case. JMHO, and $0.02.

    Lindarn, RN, BSN, CCRN
    Spokane, Washington
  10. by   Tweety
    LTC's are used to falls and patient incidents and being sued, etc. If they fried every nurse who had a patient crash, or break their hip in an LTC, wonder what would happen.

    Not that they would fry a nurse to save their butt.

    We recently had a death by restraints in our hospital. The family of course sued the hospital, administrators on duty, and the nurse. Lots of do do hit the fan and naturally the nurse had to give an accounting for what happened. Policies were changed. But a year later no one has "taken the fall", the hospital just added it to the long list of lawsuits that a sue happy nation throws at them. (I'm sympathetic, if it were my loved one I might have sued because there were staffing issues.)

    Cover your butt always, try to follow good procedure as much as possible given the situation, and hope for the best. What else can we do?
  11. by   subee
    Quote from ingelein
    I dont understand, if you have all the documentation and are not getting a job, sounds like you have been blackballed already, why wouldnt you report what you know? Get a lawyer , tell your story and start reporting to whatever agency oversees your facilty. Dont be a victim!!!PM me if you want.
    Agree that being a victim just eats your stomach lining away. Contact your SNA - if for nothing else for documentation. But they might also be able to help. Does your state have whistleblower legislation for nurses? Send cc. to your state agency which oversees nursing homes and to the attorney general. Your SNA will have a list of lawyers who specialize in representing nurses. Contact your legislator. Keep in touch with us.
  12. by   banditrn
    Meown - what do you write things like that up on? Forms for such as that seem different at every facility! And what about night shift?

    I have no problem with any nursing things I'm asked to do in LTC, but, good grief, the paperwork is stupid - and no one seems to know just how to do it all properly.

    At the last facility, I just wrote notes to the DON on regular paper when I saw something that needed her attention.

    At this LTC, the other nite when I came on, there was a med missing - no one had any idea what form or whatever they should write it on, and were running around like chickens! I made sure that we searched everywhere for it, and that the evening nurse checked ALL the books (I suspect that the count was off when she came on - just a feeling - but she didn't herself actually count the narcs - she had the book, while the nurse going OFF counted the pills - I instructed this new LPN on how to properly count narcs thereafter). But no one there knew what to do after that - and I'm the new guy - I told this nurse to write down exactly what happened, what we had done - to sign it, I would sign it as a witness and put it on the DON's door.

    Nope - at 10:45, the other girls convinced this girl to call the DON, who chewed on her face - and we ended up doing what I suggested in the first place.

    I think this is going to be my last nursing job. I'd really like to see improvements made for the nurses coming after me - but what I see is so few that are willing to stand up for themselves - they stand back and let the few others, like ingelain, try to make a difference - and give them NO support.
  13. by   Simplepleasures
    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.
  14. by   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.

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