LPN Supervisor Would Not Let Me Call Doctor

[Googlenurse]

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?

[Susie2310]

15 hours ago, offlabel said:

No one is questioning the role of advocate for the nurse. But we can't cloak ourselves in such a noble title if we all we do is reflexively respond to wooden parameters completely removed from the context of the actual patient situation. You don't need nurses for that. A freshly trained EMT could be given a quick reference card with hard and fast numbers to call the doctor for. We need to move away from the "my license is on the line" mentality, firstly because it is incompatible with advocating for the patient in that it puts the nurse's interests above everything else and secondly because it can be (and has been) used as an excuse to hide behind passing the buck to someone else and ceding our autonomy and scope to someone else. Given the scenario, there was no reason to make a 0200 phone call to the physician at that time, and that would be a completely defensible nursing call. 

I disagree, given the scenario, that there was no reason to make a 0200 call to the physician.  This is what the OP said:

"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."

This is my interpretation of the situation:  "Very lethargic" and a low blood pressure could mean severe sepsis, pneumonia, or ARDS.  We aren't given any more information about the patient to allow us to conclude that this isn't an emergency, and we don't know the patient's usual baseline blood pressure/vital signs.  Additionally, the patient has a PICC line and other invasive tubes that all predispose to infection and is on a ventilator, which also predisposes to infection.  The OP, who is an RN, described the scenario as though this is a new change of condition for the patient.  The OP was there; we weren't.

I understand from the OP that this is new change of condition for the patient; possibly a life threatening problem if not treated very promptly, that certainly warrants a call to the physician at 0200 to report the change of condition.  For me, that is my duty of care as a nurse to my patient.  My state regulations/Nurse Practice information most definitely expects me to call/inform the physician timely when a patient experiences a change of condition.

As already stated, as nurses we are the Patient's Advocate.  No-one is suggesting responding inflexibly.  I certainly didn't suggest in my earlier post that one should put concerns about losing one's license before the patient's needs.  However, it is a fact that if a nurse fails to report a significant change of condition (I am assuming from the OP that this is a significant change in condition for the patient, not knowing anything more about the patient than what the OP has posted in their OP) and harm results to the patient as a result of the nurse's actions or inactions that are below the standard of care, a nurse could lose their license as a result, and they also could be sued for negligence; these aren't things I take lightly.  Of course a nurse shouldn't suspend their critical thinking when assessing a patient and call a physician simply because they fear losing their license, and I was certainly not suggesting a nurse should do that.

 

[Daisy4RN]

I would never (and I mean never) allow anyone to stop me from phoning the MD if I felt it was necessary. I have also had many people over the years tell me it wasn’t necessary (who of course had no horse in the race) but you just need to go by your own gut and do what is right. Let them do what they feel is right for their pts and you do what is right for yours. There is a reason that you, the RN, is present. LVNs do not have the assessment skills that RNs have, except in some rare cases, but you are still the one with the RN license. Next time call if you feel it is necessary and document it. If they don’t like it, tough.

[Guest1198722]

You should have asked the Supervisor her critical thinking on why she thought to NOT call the provider and then made the judgement on what to do. As an RN, as previously stated, an LPN CANNOT clinically supervise you.

[VNurse30]

When does any supervisor (LPN, RN, or whatever) have the right to be the decision maker here? You have a license to protect. The pt is hypotensive with altered mental status. Call the provider for additional orders, then call the supervisor to let them know what was done. In acute care would you call the manager before the provider? No. 

[Googlenurse, ASN, BSN, RN]

14 minutes ago, VNurse30 said:

When does any supervisor (LPN, RN, or whatever) have the right to be the decision maker here? You have a license to protect. The pt is hypotensive with altered mental status. Call the provider for additional orders, then call the supervisor to let them know what was done. In acute care would you call the manager before the provider? No. 

No. I would not call a manager if I was working acute care.
But, there was a meeting and the administrator said we were sending too many patients to the ER and they wanted to cut those visits down, hence the collab with supervisor 

[kbrn2002, ADN, RN]

2 hours ago, Googlenurse said:

No. I would not call a manager if I was working acute care.
But, there was a meeting and the administrator said we were sending too many patients to the ER and they wanted to cut those visits down, hence the collab with supervisor 

During a day shift when other RN's are in the building if I had a maybe I should call the doc, maybe not resident I would certainly seek another opinion before making that call. At night though, with limited resources available if the resident declined quickly and I was on my own I lived by the mantra "if in doubt ship them out". 

I'd much rather deal with management saying we were sending too many residents to the ER than deal with even one situation that ended badly because I chose not to have them seen by a provider.

[JKL33]

3 hours ago, Googlenurse said:

But, there was a meeting and the administrator said we were sending too many patients to the ER and they wanted to cut those visits down, hence the collab with supervisor

NEVER make decisions about what is best for an individual patient's situation based on things like this. The above directive is directly related to a business interest of administration. Your duty is to your patient.

[Wuzzie]

3 minutes ago, JKL33 said:

Your duty is to your patient.

This ^

And I'll further add that no one in a low-level, quasi-supervisory role is going to tell me how to execute said duty. 

[Googlenurse, ASN, BSN, RN]

Thanks to all. I really appreciate all your comments. I may have to look for another job, though I really wanted to make it for at least a year.  I feel this place is “anti RN” if that makes sense. I overheard a conversation the supervisor was having with the other nurses last night (all Lpn) and they were saying “Why would an RN with a BSN work here, they need to go work in a hospital where they belong. 
They were also discussing the other RN on day shift and how they have more skills than her even though she has been a nurse for 25 years.  I do know most of her career was spent in psych. 

[Guest1198722]

There are many expressions, such as "stay in your own lane", etc. By going to an LTC, you "swerved out of your lane". The LPNs apparently resent RNs in "their lane". You are an invader. I personally don't understand why someone would stay a LPN in these days and times. I know that LPNs have typically run LTCs/SNFs, staffed doctor's offices, etc. in the past, but I'm seeing more and more job offers for RNs for those positions. It is probably a matter of time before the death knell sounds for LPNs.

[JKL33]

12 hours ago, Googlenurse said:

I overheard a conversation the supervisor was having with the other nurses last night (all Lpn) and they were saying “Why would an RN with a BSN work here, they need to go work in a hospital where they belong. 
They were also discussing the other RN on day shift and how they have more skills than her even though she has been a nurse for 25 years.  I do know most of her career was spent in psych. 

Just be kind to all as much as possible and avoid conversations like this. It's possible that you even being within earshot was motivation for them, given the topic of conversation.

There is more work than can be accomplished in any nursing setting these days. Absolutely no time for this, and no good reason to let these kinds of things take up space in your head anyway. Life can get pretty miserable if you start paying too much attention to certain behaviors and opinions of others. Be kind and go do your work and if they don't like that it's on them.

[Guest1198722]

8 hours ago, JKL33 said:

Just be kind to all as much as possible and avoid conversations like this. It's possible that you even being within earshot was motivation for them, given the topic of conversation.

There is more work than can be accomplished in any nursing setting these days. Absolutely no time for this, and no good reason to let these kinds of things take up space in your head anyway. Life can get pretty miserable if you start paying too much attention to certain behaviors and opinions of others. Be kind and go do your work and if they don't like that it's on them.

This sounds nice, but there is an underlying and pernicious issue; complacency affecting patient care perhaps due to resentment of the "BSN RN".  Ignoring problems in the workplace leads to exacerbation with the potential for escalation of untoward behavior.