Neglect...LPN was fired, RN was not

janetndhlovu · May 4, 2004

I agree that the LPN is responsible for her own patient and the decision not to fire the RN was an appropriate one. It seems unfair to fire someone for someone elses reposibility. There is apparently a bad staffing problem with this particular faciltiy. I can not imagine not checking a patient in such a long length of time. I feel bad for the LPN also.

mattsmom81 · May 4, 2004

Actually, I thought Agnus' response was a realistic view of how *administration* will tend to react in a particular situation to minimize the facility's exposure. Please re-read it and consider it from that standpoint.
To quote Agnus from the post:
FAIR? ABSOLUTELY NOT. Real? Yes.

Me too. Her explanation accurately portrayed how administration deals with things (in my experience.)

Nurses need to be realistic: the facility will make a nurse the scapegoat to cover their backsides in a New York minute.

Brownms46 · May 5, 2004

No, you misunderstood. It was 14 patients to ONE nurse. 27 on the floor, one nurse had 14 the other had 13. That is too many.

14 ....13???????? You have GOT to be kidding!!!!!!!!!

CarolineRn · May 5, 2004

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?

First off all, hats off to all the med-surg nurses. They all deserve recognition for being expected to pull off the impossible. It must be physcially as well as mental demanding stuff. If it was my only option in nursing, I'd be a walmart greeter. :rolleyes:

Do LPN's have to work under the supervision of an RN? I don't think so, otherwise why so many in DR's offices, etc. So I'm thinking the LPN took responsibility for this pt, and sadly enough, it fell under her license, not the RN's. BUT aren't RN's responsible for delegating care of the pts to the otehr team members? That should make the RN also at least partially responsible. What gets me though, is why nobody had checked this pt in over 3 hrs? That seems to be a staffing issue, as its clear the LPN and RN had many other pts who they considered less stable than the pt who untimately died. (still no excuse for the man to not have been checked on at least once an hour) There should be an investigation done here, and it should focus on the nurse-pt ratio. This hopsital is trying to do "damage control" and the best they could come up with was firing the poor LPN. She should go to the media with this, especially if her license in now in jeopardy!

CarolineRn · May 5, 2004

:angryfire
Nursing seems to be the major backbone for the hospitals and the major scapegoat as well. If you feel the assignment is unsafe, then you can legally refuse to take the assignment BEFORE YOU TAKE REPORT. Once you take report, you have already begun to establish the patient-nurse relationship and then it could be termed abandoment, if then you decide to refuse.
Once, where I worked, the day and evening shift got together to unify and start refusing assignments before the shift would start. I would work days, and stay on OT while the 3-11 shift is with administration demanding more help. At this time we were caring for 10-12 patients with one CNA to help. This was a sub-acute rehab. and the patients werent agile, and some still sick.
You could never get out on time, and the big-wigs would harrass you for having OT. Also, taking care of 12 patients, with one cna and having about 2 admits, and all the iv's and central lines.... it got over-bearing! I worked mostly with LVN's (same as LPN in california), and we were all overworked the same.
So we were fed up and decided to refuse assignments if the numbers didn't look good, or deem safe. All in all, powers in numbers,we had our way for about 3 weeks, then slowly it went back to the way it was. No staff, and more to do. So, after that I went per-diem and then studied and went into critical care.
I think finally people are realizing the dangers of short staffing of nurses, and how it impedes care and makes the patient stay longer in the hospital.
All divisions of nursing is short staffed. Especially critical care~! Hospitals better start realizing that nursing is what makes or breaks them, and start making the profession better to work in, not harder!
California right now is the only state to mandate safe staffing ratios. They are safe numbers, and hopefully more states will follow.
oh my my.

Excellent thoughts! I wonder why hospitals dont do more to help not only reruit but retain nurses? Great starting salaries (At least 20.00 an hour) for new grads as inticement to join the profession, and advanced salaries for the nurses who have more experience. (The more experience you have, the more compensation you recieve) It would be so easy to do-- more people would join the ranks of nursing, more of our experienced RN's would recieve better compensation for more skills and knowlege, and ultimately the shortage would ease. JMHO. :)

rosieseattle, RN · May 5, 2004

I was in a similar situation one time years ago in Texas. I was an agency nurse, put in charge of a hectic med/surg floor as the only RN with an LPN to split the patient load with me. I documented to the house supervisor that I was not capable or qualified to step into the facility for the first time and accept the responsibility and requested that they find another RN to be charge. She refuted and "wrote me up" and sent me home. The agency still paid me for a 12 hour shift, and the DON of the facility met with me on a later date and arrested the house supervisor's untruth about my attitude.

I say, know what your responsibilities are and be honest with yourself. If you cannot abandone your patient assignment, you make immediate documentation and alert the supervisor.

CarolineRn · May 5, 2004

I was in a similar situation one time years ago in Texas. I was an agency nurse, put in charge of a hectic med/surg floor as the only RN with an LPN to split the patient load with me. I documented to the house supervisor that I was not capable or qualified to step into the facility for the first time and accept the responsibility and requested that they find another RN to be charge. She refuted and "wrote me up" and sent me home. The agency still paid me for a 12 hour shift, and the DON of the facility met with me on a later date and arrested the house supervisor's untruth about my attitude.
I say, know what your responsibilities are and be honest with yourself. If you cannot abandone your patient assignment, you make immediate documentation and alert the supervisor.

Thanks for the tip rosie! If I ever find myself in this situation, I'll remember your words. Glad it worked out for you in the end, but it must have been one hellish night.

plane · May 5, 2004

It depends on what was going on at the time. What condition were the other patients in. Did the RN delegate appropriately. There are too many unknowns-especially with the facility it self. Was the staffing appropriate? All of the nurses do their best with little pay for the liability. It sounds like the facility needs to find out where they went wrong. Firing the nurse was placing blame and a quick fix to something that may have been full of internal problems. Possibly the nurse needed fired. I doubt this was enough of a response long term.

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?

*nightshift* · May 5, 2004

The patient had been dead 3-4 HOURS? They both should have been fired in a team nursing situation!!

Agnus · May 5, 2004

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.

Huh?

(Actually "Huh?" is my response but this board won't let me post with less than 10 chacters. Why I don't know. The mysteries of the internet and computing)

Kirstie · May 7, 2004

Exactly...........RNs oversee LPNs........period!!!!!!!...that's how it is.....you have more schooling, ect......you are in charge when it is beneficial to you and not, when it is not?????????????????????

fergus I know you didn't mean LPNs are incompetent, and really I don't blame any RN who doesn't wish to delegate to an LPN. I have nothing against anyone doing what they feel comfortable with.
On my first night to one hospital, I had an RN come in and watch me give insulin, do a blood draw, and an ekg. I had no problem with that, as that was her right to do so! And yes...I uderstand some RN preferring to work with an all RN staff, and don't blame them one little bit.
However...this is the way the system is set up, and I have heard, and read many an RN state how we work under them, and that they are responsible for what we do...or don't do. Now all of sudden... no one is saying that.
What I am saying is....you can't have it both ways. Either you are or you aren't responsible, and LPNs are responsible for their own actions/inaction. I mean I have also read on here, how LPNs work under the RN's license..etc...etc. So I am just trying to figure out...which is it?

plumrn, BSN, RN · May 7, 2004

That's what stinks about team nursing. I can barely oversee the care on 5 pts, much less be responsible for 10 or more.