Neglect...LPN was fired, RN was not

Nurses General Nursing

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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 time. At night, it can be 12-14 patients, often with only an RN and LPN. Usually you 'split' the team with the LPN taking some patients, the RN taking some patients, and each person doing total care for their patients. One night about a month ago, an RN and LPN had 'split' their team. One of the LPN's patients was found dead on the floor at about 5am, they called a code but he had been dead awhile and rigor mortis had already set in. The patients was in his 60's and a GI bleeder, he was being prepped for a colonoscopy the following morning. I heard through the grapevine the hospital had done an autopsy and the patient had fell on the floor, hit his head, and died as a result. He had been dead about 3-4 hours before he was found. As a result of this, the LPN who was responsible for this patient was fired. The RN on the team recieved a verbal warning, but otherwise she was not disciplined. A lot of people at our work complained to our manager, and she said the LPN has a license too, and therefore she is legally responsible for her patients just like the RN is. I am an LPN but am also a full-time RN student and will graduate in 11 months with my RN. The LPN's at work have been bad-mouthing the RN and our manager, saying that the RN is over the LPN, and she should have been fired too. I personally agree with our manager...I feel that while I am not an RN, I am an Licensed nurse and with that comes personal responsibility for my nursing actions. A lot of my LPN peers disagree, so I have kept my opinion to myself for fear of my coworker's backlash. It is really a HOT topic at work now. What do you all think?? Am I right in my opinion?

Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac.

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.

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."

Specializes in Everything except surgery.
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.

You 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.

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.

Specializes in Everything except surgery.
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.

You 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.

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.

Specializes in ORTHOPAEDICS-CERTIFIED SINCE 89.

Our 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.

Specializes in ORTHOPAEDICS-CERTIFIED SINCE 89.

Our 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.

Specializes in Everything except surgery.
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.

Geeze...Tweety...I should have read your post before I responded, and save myself from stating the same thing...you had already posted.:chuckle!

Specializes in Everything except surgery.
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.

Geeze...Tweety...I should have read your post before I responded, and save myself from stating the same thing...you had already posted.:chuckle!

Our vitals are done based on the patients condition and what the doctor ordered...

Our vitals are done based on the patients condition and what the doctor ordered...

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.

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.

Specializes in Everything except surgery.
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.

I 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.

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