Scolded WHY?

  1. RN admitted patient to home health the day after discharge from the hospital, LVN assigned to follow up 4 days later and discovers that patient has a wound (skin tear) the dressing has a moderate amount of drainage, but their is no order for dressing change and their is nothing noted from the admit about a wound that the RN likely missed this with the initial skin assessment 4 days ago,patients states happened at hospital, well the LVN calls the doctor he states oh yes I remember that happened the evening before discharge go ahead write the order for tx and fax I'll sign it. LVN cleanses wound changes the dressing goes back to the office faxes the order and reports her findings to supervisor and preceptor and gets the A$$ chewing of her life.
    She is told what she did was out of her scope of practice she could lose her license what was she suppose to do?
    agency basically told her she should of ignored it. were they upset that now this is documented that this obviously was missed, what would you of done.
    •  
  2. Visit BeautifulDoeLVN profile page

    About BeautifulDoeLVN

    Joined: Oct '10; Posts: 50; Likes: 38
    from US
    Specialty: Acute Rehab, Med/surg Pediactrics

    22 Comments

  3. by   xtxrn
    Quote from BeautifulDoeLVN
    RN admitted patient to home health the day after discharge from the hospital, LVN assigned to follow up 4 days later and discovers that patient has a wound (skin tear) the dressing has a moderate amount of drainage, but their is no order for dressing change and their is nothing noted from the admit about a wound that the RN likely missed this with the initial skin assessment 4 days ago,patients states happened at hospital, well the LVN calls the doctor he states oh yes I remember that happened the evening before discharge go ahead write the order for tx and fax I'll sign it. LVN cleanses wound changes the dressing goes back to the office faxes the order and reports her findings to supervisor and preceptor and gets the A$$ chewing of her life.
    She is told what she did was out of her scope of practice she could lose her license what was she suppose to do?
    agency basically told her she should of ignored it. were they upset that now this is documented that this obviously was missed, what would you of done.
    So the LVN is supposed to blow this off ? A good friend of mine is an LVN, and worked home health for a while- and she had no issues calling docs and getting what the patient needed- without having to worry about it not "looking good" back at the office It got taken care of- isn't that more important? How can she lose her license? LVNs I've worked with have been absolutely capable of taking phone orders/fax orders (who does most of that in LTC????). This sounds nuts. JMO
  4. by   TheCommuter
    Maybe I am not understanding the situation fully. What was out of the LVN's scope of practice? Unless there's more to the story that what was presented, it appears as if the LVN obtained a telephone order for a dressing change on a skin tear that was not previously noted during the admission.

    Are LVNs not allowed to obtain telephone orders in the state where this occurred? When I was an LVN, I obtained plenty of telephone and verbal orders.
  5. by   BeautifulDoeLVN
    Quote from xtxrn
    So the LVN is supposed to blow this off ? A good friend of mine is an LVN, and worked home health for a while- and she had no issues calling docs and getting what the patient needed- without having to worry about it not "looking good" back at the office It got taken care of- isn't that more important? How can she lose her license? LVNs I've worked with have been absolutely capable of taking phone orders/fax orders (who does most of that in LTC????). This sounds nuts. JMO
    I no longer work for the agency but remain friends with the said LVN, she's biding her time so she can transfer to another facility told her I'd go back to former employers while their still calling her to come back RUN from this place.
  6. by   BeautifulDoeLVN
    Quote from TheCommuter
    Maybe I am not understanding the situation fully. What was out of the LVN's scope of practice? Unless there's more to the story that what was presented, it appears as if the LVN obtained a telephone order for a dressing change on a skin tear that was not previously noted during the admission.

    Are LVNs not allowed to obtain telephone orders in the state where this occurred? When I was an LVN, I obtained plenty of telephone and verbal orders.
    Yes LVN's they are allowed to take verbal and telephone orders in California, This is how this place operates by threatening and using scare tactics on LVN's, if we challenge the RN's or have a difference of opinion.
  7. by   caliotter3
    The exact opposite, you are prone to get in trouble over doing nothing when action is called for. You did what any responsible nurse should have done. Sounds like the people at your agency are flaky. Watch yourself with them.
  8. by   BeautifulDoeLVN
    Quote from caliotter3
    The exact opposite, you are prone to get in trouble over doing nothing when action is called for. You did what any responsible nurse should have done. Sounds like the people at your agency are flaky. Watch yourself with them.
    That's what I told her do you really want to stay for 4 more months until you can transfer? she did nothing wrong this place has no clue of a LVN's scope of practice she was damned if she did, damned if she didn't do anything.
  9. by   xtxrn
    Quote from BeautifulDoeLVN
    Yes LVN's they are allowed to take verbal and telephone orders in California, This is how this place operates by threatening and using scare tactics on LVN's, if we challenge the RN's or have a difference of opinion.
    That is so sad, but I've seen the RN-Queen syndrome a LOT. I hated the hierarchy in that it made those with bizarre ego problems absolute tyrants to work with. The other staff avoided them, and the Tyrant would get mad at anyone the other staff would talk to. No insight at all. When RNs, LVN/LPNs, and CNA/PCTs work at the same facility, there has to be good working relationships. They can hate each others' guts- but the professional behavior can't be compromised. It's about the patients- not someone's big head.
  10. by   KalipsoRed
    So I guess you work for a bunch of RNs who have little to no understanding of the scope of practice of an LVN. I'd find that frustating...hell I find it frustrating as an RN who has little to no clue what LVNs can do. All they kind of push on you in school is that RNs are responsible for everyone's actions under their delegation and they enclude LVNs in that statement. So when you have little idea of what LVNs and CNAs can be responsible for legally, and big ugly bosses threating you with your license, things can get pretty aggrivating.

    Kudos for making the right decision and taking care of the patient. The RNs that you were working should have been greatful for your detail and if they were scared by your scope of practice, they should have looked up what your abilites are before they hired you.
  11. by   Whispera
    You did nothing wrong.

    I would think what you did would be standard operating procedure. You can't just act as if nothing was going on, and to wait to have the RN call for the order leaves the patient with a potentially dangerous wound waiting to get infected.

    Also, a dressing needed to be changed. Nurses can't just DO that in home health and call the doc to tell him and get official order then? Wouldn't a family member do the same in this situation?

    I'm not a home health nurse, but have been a home hospice nurse. Maybe I don't know all the ins and outs, but....
  12. by   Spidey's mom
    I think she should calmly take the scope of practice of LVN's into her boss and not put up with this tush chewing.

    Professionals do not behave this way.

    Do not put up with it.
  13. by   slackula
    Ok, I have to chime in here. I am an RN with home care experience. She did not call the supervisor. That is what she did that was wrong. There is always someone in the office or on call to report to.LVN's can take orders over the phone, but this was an unusual situation. The RN missed it on the skin assessment.The LVN was out of her scope of practice on this. That is why only RNs can open new cases in NY at least. It's about assessment. There is nothing worse than hearing an LVN when something goes wrong say"But I'm not an RN!"
  14. by   Isabelle49
    I don't think the LVN had to call her supervisor while with the patient. What is the supervisor going to do? The LVN acted appropriately, called MD, reported to supervisor on same day in office. The person who screwed up was the RN, she needed the chewing out for not doing a complete skin assessment. There are too many RN's and LPN's in the home health arena that are in in just for the $$. The faster they work, the more people they can see and the more money they can make. Been in home health for 9 years, see it all the time and report it. Had a recent complaint from a patient that LPN didn't even sit down when she came to see her - nurse was in and out so fast patient didn't even know if her vitals were taken - says LPN does pt/inr, has patient sign nurse note and leaves in less than 10 minutes. Like I said earlier, the RN either needs to be chewed out and needs an inservice on correct assessment of skin. The LVN needs an apology.

close