HELP! LTC RN VS LPN!

[ricksy]

Fifth month in LTC as brand new nurse. Evening shift where either an LPN or RN has half a shift (and one floor to pass meds), and then the other nurse has whole shift (and one floor to pass meds). When the "half nurse" leaves, the other nurse takes both floors. So, there can be an LPN or an RN for a full shift, depending on how the schedule ends up. I had a new admit, (which no one told me about when I arrived on shift report, and found out when I was paged by someone to come to the nurses station -- to get a hand off report)! I was stunned that NO ONE running around the facility who runs the place had told me (it was 330pm and all still there), but took it in stride and got ready. Did the incoming assessment and got as much done as I could, knowing that third shift could put in orders and the rest of the paper work could be finished by first shift next day. That is what I have seen happen. I had all the meds to do for the shift and treatments, so went on my merry way. I was the RN on long shift, and the LPN on the half shift (12 years experience at this same facility) came to me and said that he got the orders out for the new patient and faxed the meds to our pharmacy. I said okay. The list was attached to the incoming paperwork and I let the house physican know about the new patient. He told me he would make rounds in the morning. When I left, the third shift nurse told me she would take care of imputing the orders (ALL-not just meds) and finish as much as she could as far as the admit packet. The nurse that FAXED the orders to the pharm was an LPN, I am an RN. Now, to shorted the story..three days later, another nurse was looking through those orders for something and found that they were not really orders...that they came from a "home med sheet". The DON has me to tell the same story to her as I just typed, wanting to know why the orders where wrong. I told her that I never saw the orders, as, as usual it is a GROUP effort to do the paperwork. She knows the LPN put in for pharm on the orders and she know that third shift typed them. She tells me I am ultimately responsible because I was the RN. True? So, If they put me with an LPN to work another floor at the same time, I am responsible for that floor too.? That makes me want to quit. HELP. Please clarify for me>>>>>>>>>>>>>>>>>>>>>>>>>..HELP

[systoly]

as usually, i don't see it as rn/lpn

the other staff member was a licensed nurse

the don needs to f/u with that nurse

i do have an issue with the fact that you

got a new pt. and you didn't even look at the orders

makes me wonder???

[CapeCodMermaid, RN]

Everyone is responsible for his/her own practice. I agree that you should have looked at the orders.

[withasmilelpn]

Actually - I can't believe the LPN didn't know those were not the orders - and there would be no way to for her know what he faxed either. He said he faxed them - a nurse with 12 years experience? That is within his scope and is his responsibility - it does not require an RN looking over his shoulder to make sure he did what he said he did. The fault lies with him. In long term care - LPNs do put in orders and other staff need to be able to rely on them to do so correctly - they have their own work to do. He needs to be the one disciplined - not you. I'd leave - not a fair or even safe situation to make you responsible for.

[serenidad2004]

Definately agree that you should have checked the orders.

[withasmilelpn]

I have to say to the others saying you should've checked the orders - I actually don't understand why it would be your job to go behind him and check what he faxed? Licensed nurses are responsible for their scope of practice. If he transcribed those orders - he's responsible. Now in my state - I can not transcribe or take orders that are out of my scope - which makes sense really - the person who takes the orders needs to have the ability to question the safety of those orders and recognize when they are not. For example: I have limited knowledge of IV push meds - I have no business transcribing or taking such an order from an MD.

The only way I see that this could be considered your fault is if your facility or state prohibits the LPN from transcribing or taking orders. Maybe you should read up on your facility's policy? That's something I always do - and has served me well in the past. (Sent back to the pharmacy Ativan that had been d/c'd not wanting my patient to be charged and a supervisor tried to write me up for it - was able to show her the policy for destruction of meds did not apply to schedule IV drugs - a bit off the point but trust me - know your facility policy - it helps.)

[TheCommuter, BSN, RN]

When I was an LPN in long term care, I was responsible for my own practice and working under my own licensure.

Anyhow, when I checked, wrote and transcribed orders for newly admitted residents as an LPN, I would have been accountable if something were wrong with them. The facilities where I've worked would have never attempted to turf off responsibility on the RN on duty if I had made an error.

[ktwlpn, LPN]

>>>>>>>>> So,color me confussed-did anyone run the orders by a doc before faxing them to the pharmacy? When we admit residents from home we get paperwork from their family physician (they have to have been seen within a certain number of days) and we also go by whatever the family reports.It's not un-common for the two sources to contradict one another-the physician almost always tells us to continue whatever the family was doing. If someone told you "I got the orders" Doesn't that mean they reviewed this with a physician? I am not getting this routine. How can you fax a list of meds to the pharmacy WITHOUT inputting orders? Omnicare would never send the meds without the orders. OH,my brain hurts.Bottom line-unless YOU are responsible for co-signing this mess you are NOT responsible. BUT go to your state's BON website and read up the scope of practice for LPN's and RN's and then check your policy at work. I work "under" an RN,that means there is always one in the building I report to.If I do something stupid without involving her, I'm the one going down...

[txredheadnurse, BSN, RN]

Regardless of the point of origin for the new admission (from home, another LTC or the hospital) it is the responsibility of the admitting physician to review the orders prior to agreeing to the admission. So if the home med list had a physician signature it was the orders. However if it the home med list was simply the discharge instructions then those weren't the admission orders. Hope that makes sense.

I agree with other posters that the LPN has the responsibility of ensuring the orders he faxed to the pharmacy were indeed the admission orders and the onus of explaining any errors from that falls on him. I also agree that it is a wise decision to make some time to review the orders for any new admit sometime during your shift. This is not to double check per se someone else's competency but rather to acquaint yourself with your new resident. It also serves as secondary check which is always a good idea. People overlook things, mis read things or get interrupted a jillion times and omit things when processing the giant stack of paperwork and tasks that go with the admission process.

The thing that really makes me worried is that is was 3 days later before someone else reviewed those admission med orders with a "critical eye". What happened during those 3 days; i.e. did the patient miss meds, treatments, incorrect diet, therapy etc. If that many people as the OP described in her posting had a hand in transcribing and processing and inputting orders not a one of them noticed anything off for 3 days?

[ricksy]

Thanks for your insights, everyone. I, too, wonder what happened in the three days I was off, after leaving a resident I had only cared for for 3 hours. As a new nurse, I appreciate your thoughts! Trying to understand the process.

[pebbles049]

I just need to say I am a new rn who was an lpn and some of the rns that i have worked with are careless in the way of orders to. lpns to . it happens. in my facility a second person is supposed to check the orders. How often does that happen? well ha ha. Good luck.

[txnurse01]

The lvn should be held accountable as h was he one that stated he took care of the orders. As an lvn I do not consider an RN I work with as my supervisor unless they hold the title. If the person came from home a home list would probably be all the had. I imagine a hospitilization and updates werent reflected. However a nurse manager should have caught it the next day as they should have been double checking the orders. Sad but some do hold RN up to a higher standard and it sounds like your supervisors do. Just do at least the Med part yourself from now on.