LPN Supervisor Would Not Let Me Call Doctor

[Googlenurse, ASN, BSN, RN]

At the LTC in Ohio I work at, we had a patient that was very lethargic. His vitals were stable but his bp was 88/50. This was around 0200. Patient was trach, vent, GJT, and had a PICC line. The supervisor (who is an LPN) stated to not bother the doctor and to just pass it on next shift. The patient did eventually get sent to an acute hospital two days later.

I am an RN  with 15+ experience and she is an LPN with 8 years experience. But she has been working at this facility for 7 years, and I just got here 1 month ago.

My question is this: If something happened to the patient, would  I be on the hook because I have the higher license, or would we both had taken the fall?

Also, I thought an LPN could not supervise an RN clinically?

Like, an LPN cannot tell an RN what to do clinically even if supervising?

[Davey Do]

"Damn the torpedoes, full steam ahead!"

When we are responsible for a patient or client's care & well-being, it is us who make the decisions on the course of that care.

It is difficult for me not to say "I woulda", or "I have done this" in similar circumstances. If I am responsible for another, then I make the decisions, and that is final. I will listen to feedback and suggestions, but the decision and ramifications of my actions are mine. I have stepped on toes in the name of What I Thought Was Best.

As far as the LPN supervising, I was an agency nurse assigned to fill in for the RN who was going to be off for surgery at a community mental health clinic. The RN I was filling in for had great respect for the LPN, who had years of experience at the clinic, and advised me to follow her suggestions.

I made it known that I would take the LPN's suggestions under consideration, but I was the one who would ultimately make the decision if such a situation arose. 

It all turned out okay, as there were no pissing contests, but had there been, it was either my way or I would have hit the highway.

I also have walked out on a MN LTC position and left the DON in charge of the residents when she ruled a CNA could make the decision not to care for a resident. "If you won't support me", I said, "then I won't work for you".

[NRSKarenRN, BSN, RN]

Clinically, you have the higher professional license over CLINICAL issues as LPN can not clinically supervise you under most states Practical and Registered Nurse license regulations. They can supervise RN only in administrative matters.   Clinical issue like you described, I would have called doctor. Yes, your license could have been on the line if adverse event occurred and patient injury/death resulted. 

Link to all states Board of Nursing to review current state regulations along with disciplinary actions found bottom each Allnurses page.

I'll take a doctors profanity over 2AM wakeup call over not notifying of change in condition any day rather than losing license for failure to notify.  Learned a hard lesson 40yrs ago as nightshift charge LPN when only telephone operator could call attending physician/physician unit director on night shift WITH RN Supervisors approval (the intern needs to learn how to manage the patient, no can't call.) Patient coded and died after MICU transfer-- directors phone number taped in medcart drawer behind narcotics tubex syringes next day for my future access.

[JKL33]

2 hours ago, Googlenurse said:

My question is this: If something happened to the patient,would  I be on the hook because I have the higher license,or would we both had taken the fall?

On the hook....taken the fall....who has the higher license....

All the wrong frame of mind.

You were not prohibited from calling and the rationale for not calling that you were given is lame (not bothering someone).

While we might choose to take advice from someone who, for one reason or another, has legitimate insight about a situation (be they LPN, RN, charge nurse, supervisor, whoever), they don't tell us what to do. Well not me, anyway. If I was actually concerned about my patient I would do what I thought was prudent.

That's pretty much all there is to it.

Are you really gonna feel better about doing the wrong thing for a patient as long as it is someone else who would "take the fall"?  No.

[Googlenurse, ASN, BSN, RN]

39 minutes ago, JKL33 said:

On the hook....taken the fall....who has t  he higher license....

All the wrong frame of mind.

You were not prohibited from calling and the rationale for not calling that you were given is lame (not bothering someone).

While we might choose to take advice from someone who, for one reason or another, has legitimate insight about a situation (be they LPN, RN, charge nurse, supervisor, whoever), they don't tell us what to do. Well not me, anyway. If I was actually concerned about my patient I would do what I thought was prudent.

That's pretty much all there is to it.

Are you really gonna feel better about doing the wrong thing for a patient as long as it is someone else who would "take the fall"?  No.

 

Let's face it,most people do listen to their supervisor,because well, they are the supervisor.

 

This is also the first time ever  in my nursing career having an Lpn supervisor.  So yes,this is new to me. 

[Googlenurse, ASN, BSN, RN]

I am the only RN in the building at night. There are 120 patients.

Does that mean I am responsible for all clinical decisions in the building even though I have my own assignment?

 

I guess what I am asking I would be  responsible for all clinical decisions in the building even though I am not the supervisor?

[NRSKarenRN, BSN, RN]

You are clinically responsible for patients assigned to your care who you've received report on and accepted the assignment.

If asked to help with a client elsewhere in the building who LPN is responsible for, may run into issue as the "professional RN nurse" in the building if you don't assist and adverse event occurs. Your NOT responsible for LPN's assignment and care they provide.  READ AND FOLLOW your RN regulations, guidelines and disciplinary actions (most alcohol/drug related in my state) to see what expectations of  "Professional RN Nurse" and actions your BON takes to keep you out of their crosshairs.

[JKL33]

1 hour ago, Googlenurse said:

Let's face it,most people do listen to their supervisor,because well, they are the supervisor.

Among the things you learn in nursing school is the idea of questioning things and making good nursing choices when something doesn't seem right.

It's an idea that is often taught through the use of an evil physician ? as the antagonist, but it very well could be "one of us" and VERY often, it IS. Either that or a business person.

[Googlenurse, ASN, BSN, RN]

So I’m only responsible for the clients in my care? I’ve read the Ohio Practice Act. 
I kind of figured I was only responsible for clients in my care. 
I did read some old threads from 2009  on Allnurses on this subject and some posters were saying the RN is responsible for the whole building even if those patients were not assigned to him or her. 

[CharleeFoxtrot, BSN, RN]

16 hours ago, Googlenurse said:

 

Let's face it,most people do listen to their supervisor,because well, they are the supervisor.

 

This is also the first time ever  in my nursing career having an Lpn supervisor.  So yes,this is new to me. 

I once worked in a SNF, and had LPNs as supervisors on occasion. I never said it out loud but, as an RN I decided should their judgement ever conflict with mine I would politely go with my own thoughts on the matter and chart the heck out of it.

I reasoned I would rather err on the side of good patient care than worry about discipline by a facility.

On the occasions when it did arise I calmly discussed my reasons with the LPN and they always agreed with me.

[JBMmom, MSN, NP]

8 hours ago, Googlenurse said:

RN is responsible for the whole building even if those patients were not assigned to him or her.

If you have not accepted a report of any sort on someone, and you have not been informed of a change in condition or specific occurrence with that resident/patient, there's no way you could be responsible for that person.

As for the original situation, if you think something warrants a call, make the call. When I'm charge in the ICU I've had some intensivists ask me not to let certain nurses call them overnight. I've had to tell them that while I encourage all of night shift to collaborate before we call someone at home, I will not keep a coworker from doing what they think is right for a patient. The questionable competence of some of the nurses is unfortunate, but I'm not responsible for that, either. 

[Susie2310]

20 hours ago, NRSKarenRN said:

 Clinical issue like you described, I would have called doctor. Yes, your license could have been on the line if adverse event occurred and patient injury/death resulted. 

 

As nurses we are the patient's Advocate.  In my state, nurses have autonomy in their right and obligation to report to the physician patient assessment findings/other info that indicates an adverse change in condition or that is otherwise concerning, and to use the chain of command when necessary to obtain necessary medical care for the patient, and no supervisor or administrator is permitted to interfere with this.

For myself, the risk of losing my license would be an important concern, but even more than that, I would be concerned about potentially being sued for negligence if an adverse event occurred and patient harm/injury resulted.