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?
That's why you go from LPN to RN........more responsibility, more money, ect...........so therefore you are more responsible if something goes wrong because you delegate........you can only delegate to someone you "know" will be able to do the job................if not, do not delegate to them even if they are the only one left..............NOT ME......NOT ME...........NOT ME.....wasn't that in a Family Circus cartoon in the Sunday paper.......apparently at your hospital there are a lot of "not me's" running around!!!!!!!!!!!!!!!!!!!!!!!!!!
QUOTE=jkaee]Just my opinion....
When I worked Med Surg (12 hr nights) it was not unusual for me to have anywhere from 10-12 pts, with the ability to accept admits, so I don't think the pt. load is really an issue, as that's the standard ratio in most places I have heard about (whether or not that's acceptable standard of practice is debatable, but not an issue in this case).
Also, working in LTC and subacute care, I have been in situations where I'm the only RN in the building, acting as supervisor, and working as a floor nurse on top of that. There is NO way that I can supervise every LPN and every resident. I count on my LPN's to give competent care and to let me know when there's a problem. If they don't tell me, I'm sure as h*** not going to be held responsible JUST because I'm the RN. LPN's are held to their own standards to act as competent responsible nurses. It is not the RN's job to "babysit" LPN's or any staff for that manner.
To give an example, I worked with an LPN that "forgot" to tell the RN super if there was a problem with a low blood sugar. In this instance, the pts BS was 40. She did not tell me this when she checked it. I found out about it as I was getting report from all the nurses towards the end of the shift. When I asked her why she didn't call me, she said she just gave him some juice and didn't think it was a big deal. I assessed the resident, who thankfully responded and had normal levels, and talked with the DON. She was subsequently disciplined, although that was not the first time this had been addressed with her.
Now, if the resident died from hypoglycemia, or wasn't rechecked, would that be on my head? I had my own wing to give meds to and work on, and if the LPN didn't report it, how was I to know that there was a problem? That's 145 residents that I'm responsible for.....and it's ALL LEGAL staffing ratios, so I can't "refuse" anything, if I do, it could be considered patient abandonment, and I could be reported to the state. It most certainly wouldn't be on my liscence, because the LPN is responsible to call an RN for any changes in pt. status. If she doesn't, or she neglects a resident in any way, that's not on me. I can't supervise a 145 bed facility plus staff every single second of my shift. LPN's, CNA's, techs, etc all have the responsibility to report to an RN for problems. It's their job, and they should be held to it.
I think the appropriate action was taken in this situation. The patient died from NEGLECT on the part of the LPN. She had her own assignment, and she was responsible for providing competent care. She didn't, simply put. On the floor for 4 hours??!! Unacceptable conduct! The RN had nothing to do with that. Like I said.....we are NOT babysitters!
B. CMR 3.02 Responsibilities and Functions-Registered Nurse which states, "A registered nurse (.e.g., Directors of Nursing), within the parameters of his/her generic and continuing education and experience, may delegate nursing activities to other registered nurses and/or health care personnel, provided, that the delegating registered nurse shall bear full and ultimate responsibility for the outcomes of that delegation"... "and make informed judgements therefrom as to the specific problems and elements of nursing care mandated by a particular situation." Responsibilities and Functions also state a registered nurse will "collaborate, communicate and cooperate as appropriate with other health care providers to ensure quality and continuity of care" and will "serve as patient advocate.'
First the assignment shouldn't have been accepted, especially if RN could not adequately ensure the appropriate care was given:
Great reply. Now, has anyone thought of this? Why was ANYONE fired? Hello, pts die in surgery, have MIs in the nite,suddenly choke....yes, it is unexpected, and it should have been caught earlier, but was she reponsible for the pt's death?????I don't think so.We had a similar event occur at my hospital A psych pt was found dead, cold and in rigor by the nurse going into draw blood. Supposedly, there are q 15 minute checks being done.Yes, it is shocking and sad, but no one was fired in this case! There was no malice, no neglect....should the LPN have been given the pt? Probably. The Lpn is best at the bedside, giving pt care. The RN was responsible to oversee her assignment, and that should have included doing an assessment, at least.
No one was at fault. It was an unfortunate, unpredictable event. It could have happened at home, just the same. The nurse should have been counseled and assignments should be looked at more closely. But, fired? No.
Great reply. Now, has anyone thought of this? Why was ANYONE fired? Hello, pts die in surgery, have MIs in the nite,suddenly choke....yes, it is unexpected, and it should have been caught earlier, but was she reponsible for the pt's death?????I don't think so. No.
So true...'shyt happens' and patients die...we can't always prevent it. But...if someone dies and it MAY have been prevented...whole different ballgame.
The facility made the LPN the scapegoat is the simplest answer. I would have to know hospital policy to comment on whether it was truly a fireable offense....if policy states rounds must be made q hour the LPN broke policy.(fireable offense) The finding of a cold body dead many hours also implies negligence. The facility is trying to lessen their own liability by finding an appropriate scapegoat. This is business as usual in healthcare facilities where nurses make easy targets.
[ :angryfire WHAT IN GODS NAME IS THIS? THE GOD**** INSTITUTION is at fault for setting up such ashoddy team plan. there are no players, no team mates. An LPN with the same responsibilities as an RN? Why be an RN? they took DIFFERENT EXAMS! It should be a team, RN the head, then LPN, CNA"S. F====== CRAZY. You all should strike,lest it happen to you.
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?????????????????????
Actually, I have more education so that I can take complete care of my patient. And have never wanted to "delegate" anything.
Unfortunately corporate American has other, CHEAPER ideas.
The RN responsible for 12-14 med surg patients with one LPN?????......... I would have hoped to have found a new job ASAP. I also learned in nursing school that the RN is the one ultimately responsible.
Dead with rig set in........I can't believe that someone did not do at LEAST hourly charting
The RN responsible for 12-14 med surg patients with one LPN?????......... I would have hoped to have found a new job ASAP. I also learned in nursing school that the RN is the one ultimately responsible.
Dead with rig set in........I can't believe that someone did not do at LEAST hourly charting
Sweetness, I will forgive you because you went from nursing school straight to the ER. But med-surg nurses do not do hourly charting. In fact if anything at all needs to be done q1h, then they are not med-surg, they should be in critical care or intermediate care. :)
Specializes in Gerontological Nursing, Acute Rehab.
That's why you go from LPN to RN........more responsibility, more money, ect...........so therefore you are more responsible if something goes wrong because you delegate........you can only delegate to someone you "know" will be able to do the job................if not, do not delegate to them even if they are the only one left..............NOT ME......NOT ME...........NOT ME.....wasn't that in a Family Circus cartoon in the Sunday paper.......apparently at your hospital there are a lot of "not me's" running around!!!!!!!!!!!!!!!!!!!!!!!!!!
QUOTE=jkaee]Just my opinion....
NO, Kirstie, that's NOT why I am an RN....I did not become an RN to delegate, or be responsible for other nurses actions....I became an RN to take care of people, and be responsible for my actions.
Since you quoted my post, I assume that's what you were responding to, and let me clarify a few things.........the LPN's where I work aren't delegated by me to pass meds, do assessments and treatments, etc. THAT IS THEIR JOB. They are hired knowing full well what they will be taking on. If there is a problem, it is THEIR responsibility to report it to the RN. I'm an RN, and if there was a problem with one of my residents, I'd STILL report it to the RN supervisor, who after all is in charge, even though we have the same "responsbilities" and duties. The scenario that I presented was not meant to pass the blame on to someone else......but the fact still remains that if I am not told about a problem by an LPN, RN, CNA, housekeeping, the Pope, WHOEVER, then how can I be responsible for it???? I am talking about LTC and Sub acute/skilled nursing, which is completely different than the hospital setting. If, as a supervisor, I don't check on a critical resident, as well as the LPN not reporting to me any changes or declines, then we are both responsible. If, as a supervisor, I assess the resident, and they are stable, and I ask the LPN (or another RN) to report any changes to me, if she doesn't report to me and I go back and find the resident injured or dead, then that is HER responsibility, and the fault should be on her alone.
And, as a side, how do you "know" for sure that you can safely delegate responsibilites to another nurse? What if you've never worked with them before, what if they are a float nurse, or an agency nurse.....or what if they were always a competent nurse before, but just had a really crappy day and made a mistake? You are putting way to much on RN's, my friend, and that is a very dangerous mistake....for the patients, nurses and administrations everywhere.
When I worked Med Surg (12 hr nights) it was not unusual for me to have anywhere from 10-12 pts, with the ability to accept admits, so I don't think the pt. load is really an issue, as that's the standard ratio in most places I have heard about (whether or not that's acceptable standard of practice is debatable, but not an issue in this case).
if the LPN didn't report it, how was I to know that there was a problem? That's 145 residents that I'm responsible for.....and it's ALL LEGAL staffing ratios, so I can't "refuse" anything, if I do, it could be considered patient abandonment, and I could be reported to the state. It most certainly wouldn't be on my liscence, because the LPN is responsible to call an RN for any changes in pt. status. If she doesn't, or she neglects a resident in any way, that's not on me.
I agree you can't know what is not reported to you and you can't personally check on each pt when you have so many.
We are talking about an acute setting and team nursing with far fewer patients than 145.
As for it being "legal assignment" there is only one state that has laws covering staffing ratios. So, in effect any assignment is legal in other states including yours.
You have been talking to the wrong people about what you can and can not do. Facilities especially LTC love to intimidate nurses with the line that,"you have to accept the assignment because it is within leagal staffing ratios and we will report you for abandoment if you do not."
One LTC pulled this on me when I left without accepting my assignment. Here is the outcome. The BON determined there was no abandonment because I had not yet accepted an assignment. It would be abandonment only if I accepted the assignment and then left.
You can always and are legally obligated to, refuse an assignment you deem unsafe for any reason. Another nurse may feel just fine handling a certain patient mix. You may not due to the difference in your experience, education, physical, emoational or psycological limitations. You are responsible to know what your limitations are. Not all RNs are equal nor are any 2 people equal.
Just because an RN (or LPN) is "supposed" to be able to do something does not mean you always can. It is up to you to know that. Maybe you are running on empty and you know you can't handle what you usually can then you are responsible to speak up. If you take the assignment and do not object you are responsible for the results.
You do not have to accept add ons to an assignment that you already accepted without protest. Lets say you have a full patient load and later they want you to take an admission and you know this would jepordize your other patients. You can refuse to take the additional patient.
Some times you end up with a bad assignment anyway. As you said s*** happens. But doing so without formal and written objection is fool hardy.
Yes you can refuse "legal" assignments. Those "legal" ratios are only guidelines and cannot and do not pretend to cover ever situation.
I wanted to get everyone's opinion on a heated debate at my workplace. ....?
I believe it was the LPNs resposibility to care for this man. She was assigned to him. His care was within the LPN scope of practice. The RN, unfortunately is resposible for the actions or inactions of the LPN/s she/he works with, but come on.
The LPN was not given a pt that a reasonable and prudent LPN could not have cared for. The idea is not that LPNs only be given healthy patients to care for but to know how to car for seriously ill/injured people. To know when to call for help and to CHECK ON THOSE PEOPLE AT LEAST QH. Yes, accidents happen. A man fell and hit his head. If he had been found in a reasonable length of time, I would bet she would not have lost her job. She did not get fired because a patient fell and died. She got fired because hours went by and she was not doing her job!
I've worked at hospitals that were so busy and so short staffed that our CNA walked around, stopped in every room and made sure everyone was breathing easily (as easily as possible, and as they were the hour before) no monitors or pumps were alarming and everyone was securely in bed. If something was not right, she either took care of it or called the appropriate nurse to the room. We as a group, two nurses and the CNA, made it a point to look in on the patients in the two adjoining rooms every time we came out of a room. A habit just this simple kept our eyes and ears on all of our patients every night.
Little things make a big difference and "blaming" it on someone else, in this case the RN is just wrong. The LPN was assigned. That pt was ultimately her responsibility. Yelling, "it was the RNs responsiblity" is why so many RNs think LPNs to be useless. LPN school does indeed provide instruction and the boards also ask questions about GI bleeds. It's a very common med/surg problem. If she passed the boards, she can not say she didn't know how to take care of him. And even if she didn't know how to take care of him... he lay dead on the floor for 4 hours! No excuse.
I believe it was the LPNs resposibility to care for this man. She was assigned to him. His care was within the LPN scope of practice. The RN, unfortunately is resposible for the actions or inactions of the LPN/s she/he works with, but come on.
The LPN was not given a pt that a reasonable and prudent LPN could not have cared for. The idea is not that LPNs only be given healthy patients to care for but to know how to car for seriously ill/injured people. To know when to call for help and to CHECK ON THOSE PEOPLE AT LEAST QH. Yes, accidents happen. A man fell and hit his head. If he had been found in a reasonable length of time, I would bet she would not have lost her job. She did not get fired because a patient fell and died. She got fired because hours went by and she was not doing her job!
I've worked at hospitals that were so busy and so short staffed that our CNA walked around, stopped in every room and made sure everyone was breathing easily (as easily as possible, and as they were the hour before) no monitors or pumps were alarming and everyone was securely in bed. If something was not right, she either took care of it or called the appropriate nurse to the room. We as a group, two nurses and the CNA, made it a point to look in on the patients in the two adjoining rooms every time we came out of a room. A habit just this simple kept our eyes and ears on all of our patients every night.
Little things make a big difference and "blaming" it on someone else, in this case the RN is just wrong. The LPN was assigned. That pt was ultimately her responsibility. Yelling, "it was the RNs responsiblity" is why so many RNs think LPNs to be useless. LPN school does indeed provide instruction and the boards also ask questions about GI bleeds. It's a very common med/surg problem. If she passed the boards, she can not say she didn't know how to take care of him. And even if she didn't know how to take care of him... he lay dead on the floor for 4 hours! No excuse.
First of all how do you know the pt was "reasonable and prudent"??? Where you there?? And for your info LPNs are not always saying "it's the RN's responsibility! I have had to hear and read how "RN's are respnsible for the LPNs...etc..etc..etc..!! And there are definitely as many USELESS RNs as LPNS! GEEEEEEEEEZE!
Had a GI bleed the other night...and guess what after the RN had to come in and give FFP...constant VS after his B/P started to drop...placed on tele...with freq ectopy...I again began to wonder just how stable the GI bleed this LPN had!
And the fact that this RN thought nothing of going to at least put an eyeball on the pts. she as per the BON states that SHE is utimately and legally responsible for...not to mention..morally...I believe she was at least one of the useless! Geeeze people sure know a lot about a subject for which they weren't even there for.. :angryfire
Kirstie
17 Posts
That's why you go from LPN to RN........more responsibility, more money, ect...........so therefore you are more responsible if something goes wrong because you delegate........you can only delegate to someone you "know" will be able to do the job................if not, do not delegate to them even if they are the only one left..............NOT ME......NOT ME...........NOT ME.....wasn't that in a Family Circus cartoon in the Sunday paper.......apparently at your hospital there are a lot of "not me's" running around!!!!!!!!!!!!!!!!!!!!!!!!!!
QUOTE=jkaee]Just my opinion....
When I worked Med Surg (12 hr nights) it was not unusual for me to have anywhere from 10-12 pts, with the ability to accept admits, so I don't think the pt. load is really an issue, as that's the standard ratio in most places I have heard about (whether or not that's acceptable standard of practice is debatable, but not an issue in this case).
Also, working in LTC and subacute care, I have been in situations where I'm the only RN in the building, acting as supervisor, and working as a floor nurse on top of that. There is NO way that I can supervise every LPN and every resident. I count on my LPN's to give competent care and to let me know when there's a problem. If they don't tell me, I'm sure as h*** not going to be held responsible JUST because I'm the RN. LPN's are held to their own standards to act as competent responsible nurses. It is not the RN's job to "babysit" LPN's or any staff for that manner.
To give an example, I worked with an LPN that "forgot" to tell the RN super if there was a problem with a low blood sugar. In this instance, the pts BS was 40. She did not tell me this when she checked it. I found out about it as I was getting report from all the nurses towards the end of the shift. When I asked her why she didn't call me, she said she just gave him some juice and didn't think it was a big deal. I assessed the resident, who thankfully responded and had normal levels, and talked with the DON. She was subsequently disciplined, although that was not the first time this had been addressed with her.
Now, if the resident died from hypoglycemia, or wasn't rechecked, would that be on my head? I had my own wing to give meds to and work on, and if the LPN didn't report it, how was I to know that there was a problem? That's 145 residents that I'm responsible for.....and it's ALL LEGAL staffing ratios, so I can't "refuse" anything, if I do, it could be considered patient abandonment, and I could be reported to the state. It most certainly wouldn't be on my liscence, because the LPN is responsible to call an RN for any changes in pt. status. If she doesn't, or she neglects a resident in any way, that's not on me. I can't supervise a 145 bed facility plus staff every single second of my shift. LPN's, CNA's, techs, etc all have the responsibility to report to an RN for problems. It's their job, and they should be held to it.
I think the appropriate action was taken in this situation. The patient died from NEGLECT on the part of the LPN. She had her own assignment, and she was responsible for providing competent care. She didn't, simply put. On the floor for 4 hours??!! Unacceptable conduct! The RN had nothing to do with that. Like I said.....we are NOT babysitters!
Sorry for the rant!