Need advice, being called in to the DON on Tues a.m.

TexasPediRN · Mar 5, 2006

:angryfire Help :angryfire I am being called in for a meeting with the DON on Tues a.m. for refusing to do an RN function. The boss tried to delegate to me to go out and "assess" a resident to return to our ALF. I said I called the state BON (I really did) and that is not in my (LPN) scope of practice. The BON stated the RN must assess the patient/resident to determine their needs and if the needs can be met at the place they are returning to. Well, the boss claims I would not be "assessing" just "gathering data" trying to hook me into doing it. The boss (RN) claims he/she is allowed to delegate that duty to an LPN. I still refuse to do it. I am short staffed at my facility and am the only nurse for 60 residents. I do not have the time to be driving around "gathering data" on residents in the hospital. He/she is trying to dump training of unlicensed caregivers on me also and LPNs in my state are not allowed to "teach". The RN is to check them off on their skills before they even work on the floor and this is not being done. There is other stuff going on there that I could elaborate on but will keep this short. I am not backing down and compromising my integrity to do his/her job. I have been covering this person's buttocks for months at my facility. thanx for letting me b----.:smackingf

All I know is this- an RN cant delegate an assessment to a LVN. Its a big no-no in my book! :nono:

I wish you luck with your meeting with the DON- but if possible I'd get out of my place. Thats just unsafe!! Not that I dont trust the LVN's I work with- but its my license on the line too if I were to even ever consider delegating that task to them..

Long Term Care Columnist / Guide · Mar 5, 2006

I don't know what the ALF regulations are where you live, but here in Oregon the RN does all medical assessments. The LPN, the resident care coordinator, even the administrator can gather data on a prospective resident, which is often loosely termed an 'assessment'. Is this what your RN is asking you to do, or is s/he actually delegating this to you? (That IS a big no-no:nono: )

I'm also a bit confused as to your being 'the only nurse' for 60 residents.......what is the RN doing, then? I'm asking because I'm the RN health services coordinator for a 42-apartment ALF, and I can't imagine leaving everything up to the LPN (which I don't have BTW---my RCC was the lead cook a couple of months ago, very few of my caregivers are certified, and I AM the only licensed professional in the building). I also can't imagine doing it all myself, so unless something is completely out of your scope of practice, I would be relying on your help, and that might include data gathering.

Maybe if you could elaborate a little further, I could assist you.........?

DutchgirlRN, ASN, RN · Mar 5, 2006

What about looking up your states reg's on the net or calling and having them faxed to you. When the DON gives you her line..."show her the proof in black & white." I agree, I'd be booking out of there pronto! Good Luck, let us know.

**canoehead, BSN, RN** · Mar 5, 2006

It's a word game, you can do data gathering, but you can't do an assessment. So you were qualified to go out and look at the resident and gather data and bring it back for the RN to make a decision on it.

I think the best way to attack this is from a patient abandonment stance. If you are responsible to 60 people you can't just leave no matter whose idea it is. They cannot remove that responsibility without providing another staff member to take over your duties.

Mandylpn · Mar 5, 2006

I don't know what the ALF regulations are where you live, but here in Oregon the RN does all medical assessments. The LPN, the resident care coordinator, even the administrator can gather data on a prospective resident, which is often loosely termed an 'assessment'. Is this what your RN is asking you to do, or is s/he actually delegating this to you? (That IS a big no-no:nono: )
I'm also a bit confused as to your being 'the only nurse' for 60 residents.......what is the RN doing, then? I'm asking because I'm the RN health services coordinator for a 42-apartment ALF, and I can't imagine leaving everything up to the LPN (which I don't have BTW---my RCC was the lead cook a couple of months ago, very few of my caregivers are certified, and I AM the only licensed professional in the building). I also can't imagine doing it all myself, so unless something is completely out of your scope of practice, I would be relying on your help, and that might include data gathering.
Maybe if you could elaborate a little further, I could assist you.........?

Yes, I am the ONLY nurse in the building for these residents, many of whom should not be in ALF but the RN is never there to assess them to be transfered out. I like the comment about "abandonment" that makes a lot of sense and i am going to bring that up in the meeting. There is NO ONE to take over my duties. The RN is going between two facilities, is never at ours, and has not been on a consistent basis since they started several months ago. The other facility has called us looking for the RN and saying they have not seen them for days and we have to tell them the RN is not with us today. Please do not think I am bashing RN's because I am also in school to get my RN. I have total respect for their advanced knowledge and have learned a lot from some I have worked with. There are far too many problems there to go into without giving out too much info. Let's just say I have some info that the BON would love to get their hands on. I have too many sick people and no one to cover for me. I feel very used but I love the residents and want to stay. I am hoping they get a different RN, maybe they will when all of this hits the fan.

Long Term Care Columnist / Guide · Mar 5, 2006

Yes, I am the ONLY nurse in the building for these residents, many of whom should not be in ALF but the RN is never there to assess them to be transfered out. I like the comment about "abandonment" that makes a lot of sense and i am going to bring that up in the meeting. There is NO ONE to take over my duties. The RN is going between two facilities, is never at ours, and has not been on a consistent basis since they started several months ago. The other facility has called us looking for the RN and saying they have not seen them for days and we have to tell them the RN is not with us today. Please do not think I am bashing RN's because I am also in school to get my RN. I have total respect for their advanced knowledge and have learned a lot from some I have worked with. There are far too many problems there to go into without giving out too much info. Let's just say I have some info that the BON would love to get their hands on. I have too many sick people and no one to cover for me. I feel very used but I love the residents and want to stay. I am hoping they get a different RN, maybe they will when all of this hits the fan.

Sounds just like the assisted-living management company I worked for a few years ago. I was the RN for THREE buildings and a total of 160 residents, and was never in a given facility more than 10-20 hours a week because nurses 'cost too much'. There were about 10 residents in each building who were definitely candidates for the nursing home---they had stage IV decubs, severe behavior problems, brittle diabetes, two-person transfers etc.---and not one of the administrators of those buildings had the nerve to ask them to move out, because their families were adamant about their staying in ALF.

We couldn't take care of them, but they were your basic cash cows, so they stayed..........well, I figured MY license was being put at risk and the company couldn't have cared less, so I got out and swore I'd never go back to assisted living.

Fast-forward five years........... :lol2: Now that I'm in a situation that's do-able, I have room to deal with a few residents who need heavier care, which is good because acuity levels are rising in every single area of healthcare. It sounds to me as though your facility is trying to cut nursing costs at the same time that they're increasing the level of services.........in which case I don't blame you a bit for wanting out. It also sounds like your RN may be a bit overwhelmed as well, and s/he may have more problems at the other building---at least s/he has YOU at the one facility, and there may not even be an LPN at the other. I've been in similar straits,(I'm playing devil's advocate here), so I can see why s/he may be relying so heavily on you.

At any rate, I wish you the best.........nursing is never just plain and simple, is it?:uhoh21:

HannasMom · Mar 6, 2006

I'm also an LPN/Care Coordinator in an Oregon ALF. I work in our Alzheimer's Unit. I do resident assessments, actually they call it an Intial Assessment at my facilty. I do these Intial Assessments when a resident is either returning from the hospital or skilled facility or a family would like their family member to be admitted to our facilty.

I don't do medical assessments, that is the RN's duty. Plus I don't do delgations. As I continue to work in ALF, I have learned there is a very fine line between what a LPN can and cannot do. It all depends upon the RN, Administrator, Activities Director, etc, and how they feel that day. I have also had to unclog a toilet on a Saturday, because the Maintenance man didn't feel like coming into work to assist us, so the flooded carpet had to be cleaned up by little ole' me, using the wet vac. Fun! :uhoh3:

sbk · Mar 6, 2006

I have been in this situation before. I did get called in front of the nurse examiners for insubordination...When they heard my story, and it was proven, I won, and am not the one to get in trouble. fight for yourself. Not your job. Because it is noo fun to go to court. and that is where you are headed, and the R.N. will NOT be on yur side. :nono:

jasonswancvt · Mar 6, 2006

good luck in your meeting with the don. Sounds like someone just wanted to be lazy and make someone else work.

Mandylpn · Mar 18, 2006

I have been in this situation before. I did get called in front of the nurse examiners for insubordination...When they heard my story, and it was proven, I won, and am not the one to get in trouble. fight for yourself. Not your job. Because it is noo fun to go to court. and that is where you are headed, and the R.N. will NOT be on yur side.

Well i have ended up having to give notice, as i do not want to jepordize my license. I was counseled for even calling the BON, I stated this was my right to find out what I am allowed and not allowed to do in my state. It all ends for the best, I could not take the stress anymore, and no one to back me up was the worst part. And I feel very used. :angryfire thanx for all your replies.

flwannaB · Mar 18, 2006

I am sorry to hear you had to put in your notice. But as you said, it's all for the best. You will find a job that appreciates you and gives you the support you deserve. Good luck. :)

Well i have ended up having to give notice, as i do not want to jepordize my license. I was counseled for even calling the BON, I stated this was my right to find out what I am allowed and not allowed to do in my state. It all ends for the best, I could not take the stress anymore, and no one to back me up was the worst part. And I feel very used. :angryfire thanx for all your replies.