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
I can certainly understand why OP wasn't able to look over everything on the new admit.....long term care can get crazy, and it sounds like a mad house there. but admissions are one of the areas that an RN is expected to assess or at least directly oversee.
I think that sometimes supervisors use this responsibility thing as a catch all to fit their need when they are feeling some type of way. Several years ago, I was working on an ltc with an lpn, we split the hall. one of her patients was a diabetic and had an expremely elevated cbg. he was sent to the e.r. per md order, and when i retured 2 days later, the don informed me that I should have taken over the care of this patient once it was obvious he was "going bad". why? b/c he was a diabetic.
In my facility the 11-7 nurses are responsible for doing 24 hr chart checks on each chart. That's not to say the day and evening nurses are supposed to purposely leave orders for them to take care of, but of course that happens. But ideally it's a second check system to make sure nothing goes overlooked.
Bringonthenight
310 Posts
The LVN should have meeting with the DON as well but as the RN I think you should have read through the orders.