Neglect...LPN was fired, RN was not - page 12
I wanted to get everyone's opinion on a heated debate at my workplace. I work in a large hospital's Med/Surg unit. Usually 8-9 patients are lumped together as a "team" with an RN, LPN and CNA on each... Read More
Apr 24, '04Occupation: RN Joined: Dec '00; Posts: 826; Likes: 16Quote from Brownms46I've worked nites on med-surg. Not counting post-op vital signs, frequent vs for blood transfusions, etc. -- vitals were q4hrs. Honestly. And I'm a "real" nurse.Have you actually worked nites on med-surg??? And since when is a pt. on a med-surg supposed to have VS taken Q 4hrs??? Are you a "real" nurse???
After rereading the posts, I agree that the RN should not have been fired. Hopefully, in her new position, the LPN will check more frequently on her patients.
Apr 24, '04Joined: Oct '02; Posts: 60,384; Likes: 16,559On med-surg here routine vitals can be q8h. Many docs order q4h vitals and we do them q4h. Also we as nurses use our descretion on upping the q8h to q4h or more often. A GIB perhaps should be q4h.
To me someone on the team should have been checking the patients within hospital protocol, here that would be q2h. If the LPN couldn't, she/he should notify the team leader of a problem. In the op's scenerio, it's not clear if the LPN notified the RN, as the RN thought the LPN was handling things. Now from a later post we know the night was hectic with things going on. As part of the RNs assessment she/he should have known this and delegated or assessed appropriately, unless of course the things going on were in the RNs assignment, then she/he might have thought the patients were being checked.
Ugh, my headache's back.
Of course the moral of the story is the RN is always responsible. I confess I don't check the LPNs I work with patients q2h or whatever, I delegate that and expect to be told if they can't meet the expectations of their assignment. I check the patients once usually mid-shift and that's it. Communication and teamwork are so important in our field.
But as was stated sometimes it's "Why are you checking up on me, I know what I'm doing." "Don't you trust me?" "What are you doing in my rooms?". The answer is "No I'm just doing my job as the charge nurse."
Apr 24, '04Occupation: Enterprise Application Systems Analyst Specialty: 27 year(s) of experience in Everything except surgery ; Joined: Mar '01; Posts: 5,601; Likes: 174Quote from tionaYou know I read that post differently, because there was no mention of a CNA in the mix, when the RN and LPN split "their" team. If there was....there was no mention of one in either of the posts by the OP.Yup, I'm "real." In CA vitals are taken Q4h on med/surg floors. Even at night. For a patient with a GI bleed or some other condition putting them at risk for shock, vitals are often ordered evey hour. If I read the original post correctly there was an RN, LVN and CNA on board. Isn't it a reasonable expectaion to at least look at the patient every hour? A patient on the floor long dead seems pretty inexusable to me. I stand by my original opinion. The LVN is responsible. I'm an LVN, BTW.
And I have never been anywhere....where VS "supposed" be taken Q4hrs...just because a pt. is on a med-surg floor. I also thought it was the pt's condition that determined the freq of VS, or an MD order. If the pt. is stable...VS are taken Q8. Unless the MD orders VS Q4, or the nurse feels the pt. condition/VS warrant them to be taken more often. Then when the pt. is stable....I have seen CN address the necessity of Q4h VS with the MD, and get a QS order.
However, I'm sure this GI bleed VS should have been taken Q4.
Apr 24, '04Occupation: RN-i (RETIRED) Specialty: ORTHOPAEDICS-CERTIFIED SINCE 89 ; From: US ; Joined: May '00; Posts: 14,479; Likes: 2,298Our VS were by policy q 4 for the first 48 hours of admission unless ordered more frequently. And since hardly anyone is in the hospital any more than 48h.....Q4 it is.
Apr 24, '04Occupation: Enterprise Application Systems Analyst Specialty: 27 year(s) of experience in Everything except surgery ; Joined: Mar '01; Posts: 5,601; Likes: 174Quote from 3rdShiftGuyGeeze...Tweety...I should have read your post before I responded, and save myself from stating the same thing...you had already posted.:chuckle!On med-surg here routine vitals can be q8h. Many docs order q4h vitals and we do them q4h. Also we as nurses use our descretion on upping the q8h to q4h or more often. A GIB perhaps should be q4h.
Apr 24, '04Occupation: New RN Grad... Just passed NCLEX.. Working on a Ortho floor Joined: Nov '01; Posts: 1,616; Likes: 37Our vitals are done based on the patients condition and what the doctor ordered...
Apr 24, '04Joined: Jan '02; Posts: 5,673; Likes: 159Ya know, long long time ago when I was young, it was policy for q1h visual checks of each medsurg patient. We on our 'team' shared this responsibility, took a small flashlight and quietly rounded hourly on our medsurg patients to make sure out patients were OK, didn't wake them if asleep, but observed they were in bed breathing normally, etc. Guess this is no longer done anymore but might be a good idea.....if I was in charge I would sure want this done. From a liability standpoint. Finding someone on the floor cold, dead many hours is every nurses' worst nightmare.
Apr 24, '04Occupation: Enterprise Application Systems Analyst Specialty: 27 year(s) of experience in Everything except surgery ; Joined: Mar '01; Posts: 5,601; Likes: 174Quote from mattsmom81I remember walking rounds with a flashlight. One person on one side of the unit, and another person on the other side. But then there wasn't the acurity, or the paperwork there is now either. However, during a shift...I see my pts. a whole lot more than Q1 hrs many times. As those of us who work nights...know that many pts. don't sleep at night. I also remember just about everyone had a sleeper ordered....at least where I worked.Ya know, long long time ago when I was young, it was policy for q1h visual checks of each medsurg patient. We on our 'team' shared this responsibility, took a small flashlight and quietly rounded hourly on our medsurg patients to make sure out patients were OK, didn't wake them if asleep, but observed they were in bed breathing normally, etc. Guess this is no longer done anymore but might be a good idea.....if I was in charge I would sure want this done. From a liability standpoint. Finding someone on the floor cold, dead many hours is every nurses' worst nightmare.
Quote from Ortho_RNThanks Ortho_RN, I thought it was just me.....Our vitals are done based on the patients condition and what the doctor ordered...
Apr 24, '04Occupation: Nurse Joined: May '02; Posts: 162; Likes: 8Quote from 3rdShiftGuyI have to agree with tweety here. A Med-Surg floor, 1 RN, 1 LPN, 1 CNA with 12 patients just doesn't seem to be that big a deal. I've certainly covered far more patients with the same staffing on Med Surg floors. I'd find that a problem in an ICU, to be certain, but not a Med Surg floor.Let me also clarify, I'm not in California with a mandated staff ratio, so perhaps this is why I'm not really bothered by the 12 patient assignment between two professionals, because it's so common here.
Moral: Don't move to Florida.
I find it odd that in "team nursing" they each took x number of patients and provided total care to those patients. That kind of negates the idea of team nursing. In true team nursing they would have worked on all of the patients as a team. I don't think that in a true team nursing environment, this incident would have as great a chance of happening as it did in a total care environment. Regardless, the LPN in question accepted assignment for a certain number patients to provide total patient care to those patients. That makes her responsible for those patients, end of discussion. She was sloppy, she failed to check on the patient for 3-4 hours and the patient died because of her failure to do her job. She is, or was, a licensed nurse and fully responsible for her own duties and deserved to be fired. The RN, who certainly has questionable supervisory skills, got reprimanded probably in her permanent record and perhaps even had the incident report to the BON. She deserved the reprimand she got but does not deserve to get fired over the screw up of another licensed nurse. One could easily put two RNs into this story, with one of them being the Charge Nurse. The punishments in that case should be the same as in the stated case. The supervisor does not receive the same punishment as the person who screwed up, PROVIDED that the assignements were made properly. It seems that, given what few facts we have, the assignments were probably correct. The GI bleed patient in question does not appear to be beyond the capabilites or scope of practice of a LPN to handle. Of course, we don't have the facts in this case, so conjecture is going to fill in the gaps.
Apr 24, '04Joined: Jul '00; Posts: 11,351; Likes: 385I don;t know if anyone has brought this up, but even if the RN is "ultimately responsible" for everything the LPN does, why do the consequences for both have to be the same?
Quote from fergus51Good point fergus51, and it was bought up. I think it was Tweety, and I agreed with him, that maybe the RN shouldn't have been fired...but a verbal/written waring was definitely not enough for such a failure to supervise, and the outcome. IMO And I agree with Sekar...that the way the team was split did negate the team approach. From the last information given by the OP...that the night was awful, and the LPN got hung up with other pts. It was indeed a team approach...maybe it would have been a good idea for the RN to make rounds on the other pts. while the LPN was tied up.I don;t know if anyone has brought this up, but even if the RN is "ultimately responsible" for everything the LPN does, why do the consequences for both have to be the same?
Even if you're not on a team, you can see other staf having a bad night...maybe the RN should have offered to check on the LPN's other pts. while the LPN was dealing with those pts. who were taking up much of her time.
Apr 24, '04Occupation: RN Specialty: 15 year(s) of experience ; Joined: Oct '02; Posts: 4,763; Likes: 843Quote from SmilingBluEyeswork an all RN floor where I am too. When and if an LPN is floated up, it almost becomes more work than its worth to have him/her. I have to still do all the assessments and sign off on his/her chart. SO not worth it to me. Give me an RN please. Til LPNs can be held similarly and individually accountable for their own patients, it's just not helpful to have them on the unit. NOT a knock against LPNs, as many of them can run circles around RN's in assessment and nursing skills. I just hate being held overall responsible for OTHERS' work as well as my OWN patients. It's just too much.
I agree. I was an LPN for seven years. So, I have nothing against LPNs. What bothers me is that as an RN, my responsibilites change when there are LPNs working with me. As an LPN, I had to be responsible for the CNAs, and myself. No biggie. As an RN, I hate being responsible for LPNs. I have worked w/ LPNs who have given PRN meds that they should not have, who have discharged unstable pts, and caused pt's B/P to bottom out by their inappropriate actions, etc. I have been called on the carpet for these actions and I RESENT IT. I am a nurse, not a baby-sitter.
Now- RNs where I work could easily make the same mistakes, and they may have- the difference is that I AM NOT RESPONSIBLE when another RN screws up.
That's why I love my new job in an all RN dept. I am responsible only for my own actions, and that's the way I like it.