I am an RN. I manage a unit and LPNs do the floor work. They are subordinate to me, in licensure and hierarchy. I do NOT play that up.
This morning, a "floating" nurse had the 6 a.m. medication pass and missed meds for 4 patients. Most were not critical, one was a huge dose of insulin for a diabetic whose blood sugar has been out of control.
The LPN notices the meds were missed. They are now 1 1/2 hours out of range for compliance with being given at the right time. The night nurse was still in the building so I verified with her that she had NOT given the meds. I told the current nurse to give them. She said nothing.
At 1130 she tells me that the patient who gets the insulin has a blood sugar of 463. I asked, "Even after the 36 units of Lantus?" She says, "I didn't give any Lantus. It was out of the time range." "Did you give everyone else their meds?" "No, I can't. They're late." Now, "nursing judgment" is the prerogative of every nurse, but the supervising RN supersedes the LPN. I've been an LPN and know how frustrating that is, but LPNs work under the direct supervision of RNs. And I am responsible for what happens when I am the supervising RN.
At this point I have to call the doctor AND write up the night nurse for med errors. What should have been simple is now a big hairy time-consuming deal. Of course, he tells me to give all the meds as none are that time-sensitive and need to be given.
I note all the charts and tell her to give the meds.
And I write her up.
All hell breaks loose. Even the aides are yelling about how unfair it is that A made an error and B is getting written up. I leave the unit for 20 minutes to compose myself. Meanwhile, I have a resident running two separate IV antibiotics and have administrative tasks to perform and am now behind because I spent an hour writing up errors, calling doctors, and writing up people. None of which whould have been necessary had she not just been defiant.
2 pm comes and I notice that she hasn't given the meds. I start passing them. She actually says, "Are you giving those 5 am meds?" "Yes." "You need to write orders for them all." "Um, no, the system will mark them at the time they were given." "Yeah, but no one will know they were late unless you write a note." "You think I didn't write progress notes two hours ago when I gave you the instructions to give them?"
WTH?! HOLDING 36 UNITS OF INSULIN? THAT'S NURSING JUDGMENT BY HER? And holding glyburide on someone else, who gets only that all day for her BS?
Is about good nurses and others.......if you are a good one prove it, take the good decisions or admit when others had a much better ideas than you or you did a bad one, and NOT pass the accountability...
I seek to understand. Exactly what was it that the other nurse did that the OP tried to take away from her?
Did she( the nurse) take the initiative herself of calling the physician, or just decide to waive it off as being late already. What we need to be asking are the basics- how long has this person been a nurse?That matters too.
Let's try not to get too carried away with emotion. How did the night nurse herself pass on the situation in report?
And again, why were the aides screaming?Had they gone loco? Being charge is NEVER a popularity contest.They will either like you or hate you but one thing- be fair to all. The "likers" and the "haters".Plus they will end up respecting you, true reluctantly at first, but it's still there.
I think you handled it just fine Suesquatch. I can just "see" that nurse after you told her to give the meds.....the passive agressive behavior, with her probably thinking, "Im not giving a med thats out of range no matter what she says." She has an attitude problem, and is obviously threatened by your seniority.
As far as the aides go....the hollering and questioning your judgement is unacceptable. They dont know the whole situation, and they dont need to.
I would watch your back...she seems like is trying to get you in trouble. Dot your i's and cross your t's. Follow P&P to the letter when things like this come up.
As far as the comment about LVN's and lack of critical thinking......lack of critical thinking encompasses ALL titles in the medical field. Its useless to make rude generalizations. I know plenty of LVN's who are MUCH more qualified and experienced than I am.
This is the difference between an RN with critical thinking skills, and an LPN who just "does' or doesn't," without any thought as to what the ramifications are. I cringe when I hear about hospitals who continue to allow LPNs work in the ICU, or ER. JMHO and my NY $0.02.
LIndarn, RN, BSN, CCRN
This LPN as mentioned by the OP lacks critical thinking skills, I'll give you that. Granted there are bad LPNs, just as there are bad RNs. Again, I will grant you that. LPN or RN, we're in this field together and should learn to work alongside each other. However, You shouldn't base your opinion of all LPNs based on one post or experience. By the way, I've worked with many Bachelors and Master's degree prepared RNs who will disagree with you. I think this comment is close minded, as well as ill-informed. Allow me to educate you! Many LPNs have been in the field for more than 10 years and are very good at their jobs. In fact, the hospital that I work in ( yes, I work in a hospital, and am doing just fine thank you) I work with an LPN who has worked in Med/Surg for 45 years and whom I would trust to care for myself, should I ever require hospitalization on a Med/Surg floor. Let me ask you this, would you ever take a list of patients greater than, 10 people? Make sure they get their medications on time, and treatments on time, as well as dressing changes? there are LPNs in LTC centers across the nation that do this on a daily basis. They are the lowest paid, least respected members of the nursing field, mind you. Using their CRITICAL THINKING SKILLS they do the work of 4 nurses in order to get medications passed, sick residents taken care of, dressing and other treatments done, and still have time for charting. Many of them go without lunch breaks, barely get enough time to use the bathroom, and are pressured to the max making sure that all aspects of patient care is done during their 8 hour shift.
Now, I will ask you this,
Do you think it would take critical thinking skills to care for 30-50 people in one shift, manage any emergencies (staff or resident) make sure all breathing treatments, medications, dressing changes, as well as other treatments are done as well as charting? calling physicians? What about nursing judgement or time management?
Sue, getting back to your original post, this LPN deserved correction. You did the best you could under the circumstances. I would have done the same thing had I been in your position. Perhaps, if she would have spoken with you at the time, you both could have worked together to get those medications out after calling the doctor and making sure you BOTH followed facility protocols.
Specializes in Dialysis, Nephrology & Cosmetic Surgery.
I hope things work out ok for you Sue. I'm out of management now and I don't think people realise how difficult it is, I never realised adults could be so childish until I was a ward manager.
Specializes in Dialysis, Nephrology & Cosmetic Surgery.
Did the night nurse bear the brunt? She seems more the source of the problem. Had she done her job there wouldn't have been a problem...
Your right there wouldn't have been a problem, but as there was a potential problem the LPN only served to compound it. From my understanding the AM insulin had been missed by the night nurse but was promptly picked up by the day staff and so should have been given without further delay. As the night RN was still completing the med round it was hardly a delay, it seems like the LPN is just orificey and probably delights in seeing others get in trouble.
Specializes in Gerontology, Med surg, Home Health.
You had every right to write her up. As the RN you're ultimately responsible for everything that she does. Let me know how this one turns out.
I keep seeing statements like this in here. LPNs have licenses. They have their own licensing board and requirements. While the RN is most often in charge, people are responsible for their own practice. The RN oversees the LPN but the LPN is still responsible for her actions (or in this case, lack of action).
Specializes in Med Surg, Nursing Administration for SNF.
I keep seeing statements like this in here. LPNs have licenses. They have their own licensing board and requirements. While the RN is most often in charge, people are responsible for their own practice. The RN oversees the LPN but the LPN is still responsible for her actions (or in this case, lack of action).
Not sure that the issue has to do with credentials (I know many LPNs who could leave me in the dust with critical thinking skills) as much as those of us who supervise anyone are responsible for thier actions as we supervise them or delegate to them. My friend who works in the ER (RN) just went before the board and was fined almost $3000 because of something that another nurse (RN) did who was helping him. He was up to his eyeballs with too much to do, she offered to help and took one of his pts and then neglected to perform an essential task which fell back on HIM. Cant say where his supervisor was - just know that he would not have allowed the other nurse to help if he thought she was a dimwit.
I agree with those who have said that this second subordinate nurse was insubordinate, defiant, and more concerned about her ego and showing Sue that she doesnt have to do what Sue tells her to do. Hmmm . . . sounds more like my kids when they were toddlers than the behavior of a competant, caring nurse who is licensed to perform pt care. Write up? That was being easy on her. But appropriate for the first nurse who needed counseling and education and possibly the start of a paper trail. Suspension? Absolutely, for the second "nurse" who refused to perform her job duties as requested. Good luck Sue and keep us posted.
I was critical thinking when I started on many years ago as a cna. We didn't call it that. It was doing our job to notify the nurse of changes in patients. What ever the change we notified and documented in our books.
When I was an LPN I knew the RN was ultimately responsible, but I knew what my scope of practice was.
I would have wrote the med error for the night nurse. Recommending more training on the new system and might recommend if some stays over, they stay on the same floor. The day shift nurse would have been shot more then once. The cna's would have been called in and told that it is not their business who gets disciplined. Ask if they would like it put on the street when they are disciplined. Discipline is private one on one. Reward is loudly announced with everyone knowing how well you did.
I would love to come to work for you. Sounds as if you handle business and are fair to everyone. Keep up the good work
Katie5
1,459 Posts
Everything that should have been said has already been said. But what was it with the aides yelling and screaming like you said.Had they gone loco?