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?

[Brownms46]

Ya know, long long time ago when I was young, it was policy for q1h visual checks of each medsurg patient. We on our 'team' shared this responsibility, took a small flashlight and quietly rounded hourly on our medsurg patients to make sure out patients were OK, didn't wake them if asleep, but observed they were in bed breathing normally, etc. Guess this is no longer done anymore but might be a good idea.....if I was in charge I would sure want this done. From a liability standpoint. Finding someone on the floor cold, dead many hours is every nurses' worst nightmare.

I remember walking rounds with a flashlight. One person on one side of the unit, and another person on the other side. But then there wasn't the acurity, or the paperwork there is now either. However, during a shift...I see my pts. a whole lot more than Q1 hrs many times. As those of us who work nights...know that many pts. don't sleep at night. I also remember just about everyone had a sleeper ordered....at least where I worked.

[Brownms46]

Our vitals are done based on the patients condition and what the doctor ordered...

Thanks Ortho_RN, I thought it was just me....:).

[Brownms46]

Our vitals are done based on the patients condition and what the doctor ordered...

Thanks Ortho_RN, I thought it was just me....:).

[Sekar]

Let me also clarify, I'm not in California with a mandated staff ratio, so perhaps this is why I'm not really bothered by the 12 patient assignment between two professionals, because it's so common here.

Moral: Don't move to Florida. :)

I have to agree with tweety here. A Med-Surg floor, 1 RN, 1 LPN, 1 CNA with 12 patients just doesn't seem to be that big a deal. I've certainly covered far more patients with the same staffing on Med Surg floors. I'd find that a problem in an ICU, to be certain, but not a Med Surg floor.

I find it odd that in "team nursing" they each took x number of patients and provided total care to those patients. That kind of negates the idea of team nursing. In true team nursing they would have worked on all of the patients as a team. I don't think that in a true team nursing environment, this incident would have as great a chance of happening as it did in a total care environment. Regardless, the LPN in question accepted assignment for a certain number patients to provide total patient care to those patients. That makes her responsible for those patients, end of discussion. She was sloppy, she failed to check on the patient for 3-4 hours and the patient died because of her failure to do her job. She is, or was, a licensed nurse and fully responsible for her own duties and deserved to be fired. The RN, who certainly has questionable supervisory skills, got reprimanded probably in her permanent record and perhaps even had the incident report to the BON. She deserved the reprimand she got but does not deserve to get fired over the screw up of another licensed nurse. One could easily put two RNs into this story, with one of them being the Charge Nurse. The punishments in that case should be the same as in the stated case. The supervisor does not receive the same punishment as the person who screwed up, PROVIDED that the assignements were made properly. It seems that, given what few facts we have, the assignments were probably correct. The GI bleed patient in question does not appear to be beyond the capabilites or scope of practice of a LPN to handle. Of course, we don't have the facts in this case, so conjecture is going to fill in the gaps.

[Sekar]

Let me also clarify, I'm not in California with a mandated staff ratio, so perhaps this is why I'm not really bothered by the 12 patient assignment between two professionals, because it's so common here.

Moral: Don't move to Florida. :)

I have to agree with tweety here. A Med-Surg floor, 1 RN, 1 LPN, 1 CNA with 12 patients just doesn't seem to be that big a deal. I've certainly covered far more patients with the same staffing on Med Surg floors. I'd find that a problem in an ICU, to be certain, but not a Med Surg floor.

I find it odd that in "team nursing" they each took x number of patients and provided total care to those patients. That kind of negates the idea of team nursing. In true team nursing they would have worked on all of the patients as a team. I don't think that in a true team nursing environment, this incident would have as great a chance of happening as it did in a total care environment. Regardless, the LPN in question accepted assignment for a certain number patients to provide total patient care to those patients. That makes her responsible for those patients, end of discussion. She was sloppy, she failed to check on the patient for 3-4 hours and the patient died because of her failure to do her job. She is, or was, a licensed nurse and fully responsible for her own duties and deserved to be fired. The RN, who certainly has questionable supervisory skills, got reprimanded probably in her permanent record and perhaps even had the incident report to the BON. She deserved the reprimand she got but does not deserve to get fired over the screw up of another licensed nurse. One could easily put two RNs into this story, with one of them being the Charge Nurse. The punishments in that case should be the same as in the stated case. The supervisor does not receive the same punishment as the person who screwed up, PROVIDED that the assignements were made properly. It seems that, given what few facts we have, the assignments were probably correct. The GI bleed patient in question does not appear to be beyond the capabilites or scope of practice of a LPN to handle. Of course, we don't have the facts in this case, so conjecture is going to fill in the gaps.

[fergus51]

I don;t know if anyone has brought this up, but even if the RN is "ultimately responsible" for everything the LPN does, why do the consequences for both have to be the same?

[fergus51]

I don;t know if anyone has brought this up, but even if the RN is "ultimately responsible" for everything the LPN does, why do the consequences for both have to be the same?

[Brownms46]

I don;t know if anyone has brought this up, but even if the RN is "ultimately responsible" for everything the LPN does, why do the consequences for both have to be the same?

Good point fergus51, and it was bought up. I think it was Tweety, and I agreed with him, that maybe the RN shouldn't have been fired...but a verbal/written waring was definitely not enough for such a failure to supervise, and the outcome. IMO And I agree with Sekar...that the way the team was split did negate the team approach. From the last information given by the OP...that the night was awful, and the LPN got hung up with other pts. It was indeed a team approach...maybe it would have been a good idea for the RN to make rounds on the other pts. while the LPN was tied up.

Even if you're not on a team, you can see other staf having a bad night...maybe the RN should have offered to check on the LPN's other pts. while the LPN was dealing with those pts. who were taking up much of her time.

[Brownms46]

I don;t know if anyone has brought this up, but even if the RN is "ultimately responsible" for everything the LPN does, why do the consequences for both have to be the same?

Good point fergus51, and it was bought up. I think it was Tweety, and I agreed with him, that maybe the RN shouldn't have been fired...but a verbal/written waring was definitely not enough for such a failure to supervise, and the outcome. IMO And I agree with Sekar...that the way the team was split did negate the team approach. From the last information given by the OP...that the night was awful, and the LPN got hung up with other pts. It was indeed a team approach...maybe it would have been a good idea for the RN to make rounds on the other pts. while the LPN was tied up.

Even if you're not on a team, you can see other staf having a bad night...maybe the RN should have offered to check on the LPN's other pts. while the LPN was dealing with those pts. who were taking up much of her time.

[Hellllllo Nurse, BSN, RN]

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.

I agree. I was an LPN for seven years. So, I have nothing against LPNs. What bothers me is that as an RN, my responsibilites change when there are LPNs working with me. As an LPN, I had to be responsible for the CNAs, and myself. No biggie. As an RN, I hate being responsible for LPNs. I have worked w/ LPNs who have given PRN meds that they should not have, who have discharged unstable pts, and caused pt's B/P to bottom out by their inappropriate actions, etc. I have been called on the carpet for these actions and I RESENT IT. I am a nurse, not a baby-sitter.

Now- RNs where I work could easily make the same mistakes, and they may have- the difference is that I AM NOT RESPONSIBLE when another RN screws up.

That's why I love my new job in an all RN dept. I am responsible only for my own actions, and that's the way I like it.

[Hellllllo Nurse, BSN, RN]

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.

I agree. I was an LPN for seven years. So, I have nothing against LPNs. What bothers me is that as an RN, my responsibilites change when there are LPNs working with me. As an LPN, I had to be responsible for the CNAs, and myself. No biggie. As an RN, I hate being responsible for LPNs. I have worked w/ LPNs who have given PRN meds that they should not have, who have discharged unstable pts, and caused pt's B/P to bottom out by their inappropriate actions, etc. I have been called on the carpet for these actions and I RESENT IT. I am a nurse, not a baby-sitter.

Now- RNs where I work could easily make the same mistakes, and they may have- the difference is that I AM NOT RESPONSIBLE when another RN screws up.

That's why I love my new job in an all RN dept. I am responsible only for my own actions, and that's the way I like it.

[Farkinott, RN]

12-14 patients between two nurses on a med sug floor are too many patients, even if they do not do total care. The hospital should be facing a law suit and they know it.

The nurses might or might not be wrong in not having protested the assignment prior to accepting it under protest. Personally IMHO the nurses made a poor judgement in accepting such an assignment. (You do have the power to effect change)

A GI bleeder is a very high risk patient. Putting such a patient into this kind of mix is just poor judgement.

The nurses are responsible as they accepted the assignment witout protest.

However, stuff rolls down hill. The hospital will Cover it's own backside at the expenses of the nurses'.

They will always place blame on the lowest level of caregiver first. That enables them to legally distance themselves from responsibility. Firing the LPN was a pre-emptive move to protect thier own liability.

They also cover themselves by slapping the RN's hands.

The LPN should have protested the assignment. But more important the RN should have (being an RN) used better judgement in allowing either of them to take this assignment. As an RN I would not have assigned the the GI bleeder to the LPN (I was an LPN and now am an RN) not at least witout keeping some tabs on this patient myself.

No the hospital is wrong. And the Nurses are wrong especially the RN for accepting assignments like this without protest. The RN carries > responsibility on this aspect because she (legally) has the education to recognze unsafe situations better than the LPN. (notice I said legally, this is not a putdown toward the judgement of the LPN. This is just how the BON and courts would see it, if they were to examine this aspect of the situation)

The LPN holds some responsibility for accepting unsafe assignments but the RN is the role model here. The LPN is responsible for her patients and is responsible for notifying the RN if she is overwhelmed and can't get in to check her patients frequently enough.

The hospital is wrong for it's staffing practice. However, it is the nurses that should be making judgement about that practice and effecting the needed changes. Administators do not care for patients, are not in a position to judge safe levels, are not usually even nurses. Administrations duty is to proved care at the lowest cost and greatest profit. They are resopsible for safty but the bottom line is $$$$ so if they can get away with cutting corners they will. The nurses need to become more pro active (ie get some back bone) in effecting safty. The nurses need to hold administrations toes to the flame.

As I said it rolls down hill and hospital will ALWAYS disapline the lowest level care giver first to distance themselves from responsibility.

See if they can show it was this low level person who "didn't have the education etc." of others higher up then those higher in the chain and the hospital itself are better protected. "It was that dumb girl we hired with out an RN education to help out that screwed up. We would never do that ourselves"

You fire the maid or janitor if you can place blame there. Show that management is not responsible thier only mistake was in hiring a janator who did not know that if you mix bleach and amonia that it created a lethal enviorment.

I know this sounds harsh but when it come to liability situations this is the way of the world. FAIR? ABSOLUTELY NOT. Real? Yes.

I suggest you do not partisipate in the finger pointing blame game. This is a tactic that higher management uses to distract others from the responsibility they carry.

In this case there were many level of people responsible. Everyone is trying to distract attention from themselves.

Use this as a learning tool. Learn how to be a change agent.

With all due respect Agnus your GENDERED response in no way helps the poor souls who have found themselves embroiled in a s**tfight!

I am glad that I do not work with you as I would have NO HOPE of being backed up for any reason at any time as you appear to be the judge and jury!

I am an RN and I only have one more thing to say. In fact it is a direct quote from your ill informed, misguided diatribe! "I suggest you do not partisipate in the finger pointing blame game"

Nuff said.