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?

[JKL33]

I disagree that ignoring others' gossip has any more likelihood of those outcomes than engaging them does. And I personally have found it to be less likely, that's why I choose that option. With the added benefit of avoidance of a wholllllllllle bunch of malarkey. Life is too short.

I didn't say it to sound nice.

It's a very purposeful manner of handling this that I have chosen with great success and personal benefit.

[Ronnie]

Your clinical decision as an RN can only be affected by what YOU do. Even if that supervisor was an RN, if a patient's situation necessitates calling the Doctor, that is YOUR own clinical judgement. You cannot claim in ANY court that the LPN asked you not to call the provider for a B/P of 88/50, if the code status does not indicate such. That statement "to not bother the doctor" is alarming! This situation did not even need a critical thinking skill. Just simple clinical sence. The provider is paid at night to take urgent calls. If this is NOT urgent enough, the nurse taking care of the patient is responsible to face the consequence, Not the supervisor.

Even is the patient is DNR, if the life sustaining order does not exclude them from treatments and hospital transfer, the provider is the one to decide if to initiate treatment in-house (PICC line ready, transfuse fluid or whatever) or at most, transfer to hospital.

Finally, the LPN scope of practice is limited, in nursing, you were told the RN is the "manager of care". Yes some LTC still have the practice of having LPN supervisor. But an LPN is not responsible for the clinical judgement of an RN. The supervisor at most gets terminated, but the RN may lose her license! Bad decisions may be costly!

Protect your license!

[Spiker, ASN, RN, EMT-P]

Key words: LPN, RN, didn’t “let” her call MD.  First of all, I have never worked in a system that allows LPN’s to outrank RN’s!  Of course, I’ve never worked anywhere except an acute care hospital, & only the 1st 5 (of 40) years on a surgical floor.  The remaining 35 yrs in the OR.  But still, my training, my degree, state law, all say I’m responsible for that patient & it’s my duty to advocate for him/her!  Read up on the premise of Negligence: you have a duty to act (care for) that patient; you failed to act to your level of training; the patient suffered (in this case, for 2 days until transferred to a hospital!!??); and your not calling the MD resulted in that suffering.  
mom not one to “pull rank” often, but come on……if an LPN doesn’t agree with my judgement, I’m still reaching for that phone!  

[abbnurse]

On 10/13/2022 at 8:20 PM, JKL33 said:

I disagree that ignoring others' gossip has any more likelihood of those outcomes than engaging them does. And I personally have found it to be less likely, that's why I choose that option. With the added benefit of avoidance of a wholllllllllle bunch of malarkey. Life is too short.

I didn't say it to sound nice.

It's a very purposeful manner of handling this that I have chosen with great success and personal benefit.

AMEN !  Well said   ?

[feelix, RN]

Courts have held registered nurses responsible for carrying out faulty doctor’s orders. You are a professional and will be held responsible for your own judgment. This, however, does not mean you should create a song and dance event about you holding a higher license. Just do what you deem necessary and face the results.

I would always choose my license over a job and would not work under the supervision of an LPN.

[ppfd, BSN, EMT-P]

I respect the hell out of the LPNs I work with and ask them a million questions a shift. 1. they have been where we work longer than me. 2. They are not stupid.

But yeah, nobodies telling I can't call a doc.

This sounds like something my sister in law would do. She is actually an LPN supervisor in a nursing home. My mom will keep her kids and sometimes when she gets them, she will come in stethoscope around her neck, ID badge dangling, telling her tales of life saving and woe? My mom is like "the girls had dinner" and her uncle bought them nerf crossbows ?

[feelix, RN]

On 10/4/2022 at 2:45 PM, Davey Do said:

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".

Now whether a CNA can decide whether to take care of a patient or not is not a matter of clinical judgment. It is part of staffing policy. Your license does not entitle you to make staffing policies.

Leaving an assigned patient after accepting an assignment without agreement of the supervisor is patient abandonment.

On the side: it is good policy to allow workers to take decisions within their scope of practice. A patient and caregiver who do not want to work with each other should not be forced to.

[feelix, RN]

If yu read your state’s nursing practice act, it should state something like: An LVN/LPN would work under the supervision of an RN. It can never be the other way if both are working in capacity of being a nurse. It may happen that the LVN could be an RN’s supervisor in a non-nursing position, such as administrator, where the LVN is not using their nursing license.  In some organizations, the supervising RN may not be present physically when the LVN is working, but still is the supervisor.

[1056chris]

I went from working med/surg in a hospital to working at LTC facility.  I worked on the skilled unit.  That place was huge and 4 months after being there I was supervisor on one weekend.  I ended up sending 4 people to er for various reasons.  I got great input from the LVNs involved in their care.

There was only 1 patient that me and LVN agreed should.  I sent all 4.  3 were admitted, one returned to be monitored.

If they didn't t need to go..no harm done.  If they stay and should have gone it could be a different story.

Assess the patient and situation and do what you think is best for the patient.  It is hard when you are new.  Sometimes I ask myself if this was my family what would I want done?"

Goodluck

 

[Davey Do]

On 10/19/2022 at 9:03 PM, feelix said:

Now whether a CNA can decide whether to take care of a patient or not is not a matter of clinical judgment. It is part of staffing policy. Your license does not entitle you to make staffing policies.

Leaving an assigned patient after accepting an assignment without agreement of the supervisor is patient abandonment.

On the side: it is good policy to allow workers to take decisions within their scope of practice. A patient and caregiver who do not want to work with each other should not be forced to.

Obviously, and with all due respect, Felix, you don't know what you're talking about.

As the RN in this LTC facility, I made the assignments, and assured the responsibilities in servicing the residents were carried out. If a CNA did not fulfill the responsibilities of their assigned tasks, I followed through accordingly and appropriately dealt with the situation.

It is not patient abandonment if another RN, in this case the DON, assumes responsibility for the residents. I played my card, letting the DON know that if she would not support me when the CNA was blatantly insubordinate, then I would not work under those conditions, and she would need to take over my duties.

In the IDES adjudication process, there was no mention of "patient abandonment" by the DON, therefore, it was not an issue.

To make erroneous nonconsensual statements with a limited knowledge of the situation based on a subjective parochial perspective indicates delusional reasoning. The definition of a delusion is a firm fixed belief in spite of evidence to the contrary, so I don't expect a delusional individual's mind to be changed with actual facts.

[feelix, RN]

Thank you for making an informed diagnosis on my mental condition.

You had omitted to say it was an administrative matter, unrelated to clinical judgment or scope of practice.

[Davey Do]

20 hours ago, feelix said:

Thank you for making an informed diagnosis on my mental condition.

After nearly fifty years of working as a professional caregiver, mostly in bevavioral health, I've learned that "If it walks like a duck, quacks like a duck, then it's probably a duck".

20 hours ago, feelix said:

You had omitted to say it was an administrative matter, unrelated to clinical judgment or scope of practice.

If we can find someone to blame for our mistakes, then we don't have to do any sort of self-evaluation.

We can just go complacently on our merry way, comfortable in the fact that we are not wrong, and the fault lies with another.