Neglect...LPN was fired, RN was not

[KacyLynnRN]

I wanted to get everyone's opinion on a heated debate at my workplace. I work in a large hospital's Med/Surg unit. Usually 8-9 patients are lumped together as a "team" with an RN, LPN and CNA on each time. At night, it can be 12-14 patients, often with only an RN and LPN. Usually you 'split' the team with the LPN taking some patients, the RN taking some patients, and each person doing total care for their patients. One night about a month ago, an RN and LPN had 'split' their team. One of the LPN's patients was found dead on the floor at about 5am, they called a code but he had been dead awhile and rigor mortis had already set in. The patients was in his 60's and a GI bleeder, he was being prepped for a colonoscopy the following morning. I heard through the grapevine the hospital had done an autopsy and the patient had fell on the floor, hit his head, and died as a result. He had been dead about 3-4 hours before he was found. As a result of this, the LPN who was responsible for this patient was fired. The RN on the team recieved a verbal warning, but otherwise she was not disciplined. A lot of people at our work complained to our manager, and she said the LPN has a license too, and therefore she is legally responsible for her patients just like the RN is. I am an LPN but am also a full-time RN student and will graduate in 11 months with my RN. The LPN's at work have been bad-mouthing the RN and our manager, saying that the RN is over the LPN, and she should have been fired too. I personally agree with our manager...I feel that while I am not an RN, I am an Licensed nurse and with that comes personal responsibility for my nursing actions. A lot of my LPN peers disagree, so I have kept my opinion to myself for fear of my coworker's backlash. It is really a HOT topic at work now. What do you all think?? Am I right in my opinion?

[SmilingBluEyes]

work an all RN floor where I am too. When and if an LPN is floated up, it almost becomes more work than its worth to have him/her. I have to still do all the assessments and sign off on his/her chart. SO not worth it to me. Give me an RN please. Til LPNs can be held similarly and individually accountable for their own patients, it's just not helpful to have them on the unit. NOT a knock against LPNs, as many of them can run circles around RN's in assessment and nursing skills. I just hate being held overall responsible for OTHERS' work as well as my OWN patients. It's just too much.

[Kalico]

This may or may not have a lot of relevance to this thread but I will say it anyway. I worked as a CNA on an ortho/neuro floor for six months before I wass fired. During my time there I was assigned up to 28 pts at a time. B/c I worked nights I did not have to give baths however I was the one doing the vitals on every patient including those getting blood transfers. In addition to that I was responsible for turning pts q2h, answering call lights, changing pts, etc. The reason I was eventually fired was because I went to m charge several times with concerns about pts not getting pain meds on time, not being able to turn a pt safely without help, etc. My charge reported to our manager that I was not wanting to do any work and that I would sit around all night and not do anything. My point here is that what happens on night shifts is generally bs. No one ever checked to see if this was the case with me even though the day that I was fired I had two depts, ER and Peds, call my manager and request me to be transfered to their units to work. In my opinion some, and I emphasize some RNs are not interested in giving good patient care, they are only interested in covering their own a$$. Most of the other RNs that I worked with were great and helped out by doing their own vitals, fingersticks, etc. My point here is that there needs to be more accountability for charge nurses on nights. I had absolutely no recourse and was unable to work on either peds or er b/c I was fired.

[Robinette]

It seems clear to me that the LPN is subject to the State LPN Practice Act, and therefore is the one and only responsible. State Nurse Practice Acts don't say that an RN has automatic supervisory and practice responsibility for an LPN. I mean, think about that. That would be a logistical and practical nightmare.

[Robinette]

"Here is another case of a nurse being held responsible for the actions of another-

I have an RN relative who works at an inpt lock-down psych unit.

An LPN there was passing meds. One pt refused his meds, so the LPN mixed them in w/ the pt's food, which he then ate. Afterwards, the LPN told the pt what she's done. The pt got a lawyer and is suing for violation of his rights. The charge RN on duty that day (who did not even know what the LPN had done) is being held accountable by the hospital for the actions of the LPN.

Totally unfair."

This just totally staggers me!

[Brownms46]

The practice act says the RN is ultimately responsible.

However, LPN in this case was primarily responsible. The LPN failed to provide minimal care. The LPN appears to be guilty of breach of duty.

The RN was not assigned to the pt who died.

If either nurse is sued, perhaps they can use the Aiken Study as evidence of the hospital being responsible for the pt's death, due to inadequate staffing.

I have recently transferred to an all RN dept where I work. It is such a relief not to be responsible for the actions of others anymore!

In my old dept (hemodialysis) I worked w/ an LPN who discharged a pt to go home w/ a B/P of 49/29. Somehow, this pt had managed to stagger to his truck and get in. I ran out to his truck, and stopped him just as he was trying to put the key in the ignition.

I drug him back inside and stabilized him. He was stable enough to leave about an hour later. This LPN is very agressive and insubordinate. She is one of the reasons I left the hemo dept. She did not understand why I did what I did. She actually said "You need to assess the pt based on what is normal for him, not what is normal for you." (the pt's baseline B/P is low).

I tried to explain to this mental giant that a B/P of 49/29 is not normal for anybody. But, she wouldn't hear it. Ignorance combined with arrogance is a dangerous combination in a nurse.

She is currently flunking out of her RN prereqs. But, she is chomping at the bit to be charge nurse of the unit, which requires an RN.

I'm sure she will get her RN eventually. I wonder how she's going to like being responsible for the actions of other nurses. I hope she doesn't have to work w/ another LPN like herself. Hmmmm.... or maybe I really hope she does. She could use a taste of her own medicine.

Here is another case of a nurse being held responsible for the actions of another-

I have an RN relative who works at an inpt lock-down psych unit.

An LPN there was passing meds. One pt refused his meds, so the LPN mixed them in w/ the pt's food, which he then ate. Afterwards, the LPN told the pt what she's done. The pt got a lawyer and is suing for violation of his rights. The charge RN on duty that day (who did not even know what the LPN had done) is being held accountable by the hospital for the actions of the LPN.

Totally unfair.

Being an LPN does not excuse one from being competent and providing minimal care.

I don't believe you have read anywhere...that an LPN isn't responsible for their own competent, and the care he/she provides! LPNs didn't make the rules, nor are they the ones going around repeatedly stating:"the LPN works under my/our (RN) license...and "It's MY/OUR license on the line"! Which many LPNs have heard constantly over the years/months...on here, in the work place...and elsewhere!

However, when the craps hits the fan...suddenly folks are saying...that the LPN has a license...bah bah...bah..yada yada.

And for those who say they would rather..work without an LPN...Bravo...then go right ahead...and knock yourself out! I don't blame you at all...however, I get sooo tired of hearing this...and how the LPN can't do this, and the LPN can't do that! But let me or any other LPN working with some RN, who wants you to do this or that...and is PISSSSSSSED because you can't! And then have to show the RN the P&P...which she/he should've been aquainted with prior to this incident! If you don't want to do what comes with the terrority...move on and let someone who does!

Also incompetent is definetly not the sole property of the LPN...or any other classification for that matter! I could fill up page after page of incidents I, and others have encountered with an RN, who did this or that...and wondered how they got a license to practice.

But that isn't the purpose of this thread. To me ...the purpose is to state was or could the RN have been responsible in this incident. And per the NCSBN, and various other entities...including BON....state the RN is responsible for the outcome of the delegations they make. And it is their duty to continually supervise the assignments they give, and retain accountability for what they delegate! Unfair...or not...that is how it is!

[Brownms46]

3) The registered nurse shall provide periodic and regular evaluation and monitoring of the individual performing the delegated tasks. (4) The registered nurse delegating the task may, at any time, suspend or withdraw the delegation of specific tasks to the patient's designated caregiver. (5) The registered nurse is accountable and responsible for the nursing care delivered to patients under the nurse's jurisdiction. Author: Alabama Board of Nursing.

A professional nurse shall be responsible both for the nursing care directly provided by the nurse and the care provided by others who

are under the professional nurse's supervision. AZ Nurse Practice Act

7.7.1.2 "Delegation" - Entrusting the performance of selected nursing duties to individuals qualified, competent and legally able to perform such duties while retaining the accountability for such act.

7.7.1.3 "Supervision" - The guidance by a registered nurse (RN) for the accomplishment of a function or activity. The guidance consists of the activities included in monitoring as well as establishing the initial direction, delegating, setting expectations, directing activities and courses of action, critical watching, overseeing, evaluating, and changing a course of action.

7.7.1.4 "Accountability" - The state of being accountable, answerable, or legally liable for actions and decisions, including supervision. Delware NPA

And the beat goes on.....

[susanmary]

Great thread with no easy answers to this question as each state board dictates what an RN/LPN's scope of practice is. Therefore, there is much room for interpretation; also, there may be facts regarding this case that have not been made public.

[Tweety, BSN, RN]

I think more and more hospitals over the years have put RNs at risk for violations of the NPA. As they've added more responsibilities to the LPN, and the LPN has taken the over, such as taking their own assignments, pushing IV meds, starting IVs, giving blood etc, the RNs responsibility has become too great.

Hospitals that split assignments, give LPN assignments, have too few RNs on the unit using LPNs in the role of primary patient care provider are providing potential liability for the RN.

There are many times when there are two LPNs on my unit. They are doing their own thing, and I'm am "Entrusting the performance of selected nursing duties to individuals qualified, competent and legally able to perform such duties while retaining the accountability for such act." Sometimes when I think about it I get very bothered at the risk to my license that I'm having to work under.

Again, fortunately here, although while an RN is responsible for the errors of the LPN, I don't see many RNs going down because of an LPN's mistake or incompetence. Doesn't mean that it doesn't happen. When push comes to shove the hospital is going to defend themselves, not me. Better renew that Liability Insurance. :)

[Agnus]

LOL! Good one, BrownMS. Both individuals were responsible and so was Management (12-14 patients????). They may have fired the LPN but if the family was to find out about the WHOLE situation. I doubt the LPN would be the only one sued (honestly, with no job right now the family would go for the corporate giant!).

Actually (my friend a personal injury lawyer. Actually 3 of them who are personal friends) Would tell you they go after the hospital. They sometimes name others but it is the deepest pockets they go after. As far as finding out you have insurance. That usually end up being self revealing and comes out pretty early. Lawyers don't even have to run a search to discover it.

For the most part though they are not interested in going after individuals they are after the deeper pockets. Even with your $3 million liability coverage your pockets are very shallow to personal injury cases.

[Tweety, BSN, RN]

Also incompetent is definetly not the sole property of the LPN...or any other classification for that matter! I could fill up page after page of incidents I, and others have encountered with an RN, who did this or that...and wondered how they got a license to practice.

But that isn't the purpose of this thread. To me ...the purpose is to state was or could the RN have been responsible in this incident. And per the NCSBN, and various other entities...including BON....state the RN is responsible for the outcome of the delegations they make. And it is their duty to continually supervise the assignments they give, and retain accountability for what they delegate! Unfair...or not...that is how it is!

To me the purpose of this thread was should the RN have been fired, not whether or not the RN was responsible. But I've already stated how I feel about that.

Good post. In the years I've been around, I've seen many more incompetent RNs than LPNs. I mean that sincerely, some RNs scare me. What's bothersome is that I'm accountable for the LPNs incompetence, not the RNs.

I willingly accept working with LPNs and all that goes along with it. But if you think I'm not going to I'm going to quietly accept my lot when the **** hits the fan, you're mistaken.

Take the med error scenerio. You have a safe assignment, blah blah blah and draw up 50 units of insulin instead of 5 and kill a patient. When the Nursing Board comes to me and says I'm responsible for the outcome, don't think I'm not going to get angry and resentful and question the whole situation. Yes, I know that's the way it is, but I'm going to fight it tooth and nail when the **** hits the fan, yes I am. :)

[Brownms46]

To me the purpose of this thread was should the RN have been fired, not whether or not the RN was responsible. But I've already stated how I feel about that.

Good post. In the years I've been around, I've seen many more incompetent RNs than LPNs. I mean that sincerely, some RNs scare me. What's bothersome is that I'm accountable for the LPNs incompetence, not the RNs.

I willingly accept working with LPNs and all that goes along with it. But if you think I'm not going to I'm going to quietly accept my lot when the **** hits the fan, you're mistaken.

Take the med error scenerio. You have a safe assignment, blah blah blah and draw up 50 units of insulin instead of 5 and kill a patient. When the Nursing Board comes to me and says I'm responsible for the outcome, don't think I'm not going to get angry and resentful and question the whole situation. Yes, I know that's the way it is, but I'm going to fight it tooth and nail when the **** hits the fan, yes I am. :)

You're exactly correct, as to the purpose of this thread...was should the RN have been fired. And I can't blame...nor do I, your not wanting to take heat for someone who should be competent enough to do the assignment delegated.

I'm glad to know that you have no problems working with LPNs, and I don't blame you for fighting the unfairness that comes with your position. I realize it's an awkward...and stressful position. You shouldn't have to worry ability of someone whom you have no choice in working with. I know that having such a responsibility would make me nervous, and very cautious.

I recently started a new contract....and I have been lucky enough to work with an RN who also willing to work with LPNs. In fact on the whole unit, I have seen no conflicts between RN, LPNs, or CNAs. I feel lucky to be on a unit, where I am not only wanted, but treated with respect.

I have great respect for all those I have worked with on this unit. I told the RN and the NM, that if I was to have hand picked her, I couldn't have picked a better partner to be with! I know my assignment will be fair...and that she has my slack...and I her's. But I seriously doubt if she ever has any slack, as she is very much on the ball:)!

This RN constantly supervised the assignment she had delegated to me, and as she saw that I could handle things, she backed off. But she still maintained her supervision. She didn't just walk away....and only check on her pts. And I didn't mind one little bit...that she was checking on things, as I understand her need to know, that what is supposed to be done, is being done....correctly. For she felt obligated to ensure the quality of care that all of the pts. assigned to us received. (Which by the way was only 7, and one had a sitter.) We both ran all night....but we ran together!

She, you and other RNs who work with LPNs, and CNAs as a team....to me are the best ways for safe care in the understaffing, and shortage of RNs. It is units like this, that brings back the joy of working on the floors. Too bad that all aren't like this. Too bad there are RNs, LPNs, CNAs...RT's...MAs...etc...etc, who believe they can just do the bare min....or take too many shortcuts...push their responsibilities off on someone else...and expect to have no ill effects to come out of it.

Shame on them....and shame on a system...that allows them to bring harm to their pts, and/or their team members...because they are allowed to practice...for the want of a warm body sometimes.

[smk1, LPN]

just a student with a question.... is it legal to use just lpns (no rn on staff at all) in any facility? or does at least 1 rn have to be on staff for the "license and delegation" stuff. could a Doctor or NP be used or just strictly an RN? Just wondering because I remember working at assisted living and the Rn was only in the building 1 day per week. Judging by the responses here that seems like a huge liability for her if something were to go wrong. I too have heard RNs refer to the lpns "working under my license" and just wondered if that is the only way and lpn can work or can they work without an RN on the payroll?