Neglect...LPN was fired, RN was not

Nurses General Nursing

Published

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?

Specializes in medical, surgery/ob-gyn/urology.

I would think the RN would be at fault also..... technically she is still in charge of overseeing the lpn and that the patients needs/etc are being met.... I agree though being that I am currently working as an LPN on a medical floor, that sometimes it is very hard to get to all of your patients every hour .... some of the patients we get are insanely hard " dressing changes in isolation with trach's, total cares, etc" and they take time.... on the other hand, I don't know if being the rn, delegating a patient with a GI bleed would have been the best either to give the lpn. depending on the severity of the case... although I have to admit I get them all the time! I would think though that the RN should be at fault also...........

B :coollook:

I am an LPN, 15 yrs. worked in most(or many areas)Experience brings alot. Any, GOOD>if ANYONE, does not feel comfortable doing something, then to protect the PATIENT there is no alternative. Thats what supervisors are for.BUT-the nurse needs asep by step introduction,(physically be watched a few times) she/he cant abuse the-the "oh I'm not comfortable"--GET EXPERIENCE OR GET OUT.Really. But its the way the facility sets up things I disagree with.

Tale care----

cj

comic sans5red

"Once upon a time...."

{just kiddin :p }

I was a Director of ICU. I had a nurse on night shift who refused to take an IABP patient even though she had had 2 inservices on baloon pumps.

The next day when I was informed of this I was told, "the nurse said she was not comfortable with the assignment." I haughtily laughed this off and remarked, "If she wants something COMFORTABLE, go be a librarian."

I then related the incident to my Boss, the Director of Critical Care Services. He had a lil different slant on it. He said, "Just for kicks call the State BoN and see what they say." Which I promptly did.

Here is what the BoN told me.

"If a nurse states that he/she is uncomfortable with an assignment and you give them the assignment anyway. Then YOU become the party responsible should any problems develop with this patient."

End of story.

the moral?.........

You CAN refuse an assignment !

Love and Peace,

loerith

I am getting too tired so will just say, "I would rather lose my job than my patient or license!

The Kentucky "assignment under Protest" (in a previous post0 is a great way to document that the management was informed of an unsafe assignment. With unity like the rehab unit had refusing an unsafe assignment while waiting (and the previous shift continues care) has worked great. At least i have been told that.

Thank you Brownie for the information. Here's more:

http://www.calnurse.org/cna/np/

and for those in California there are classes. These CE classes are fun, inexpensive, and you get breakfast and a nice lunch.

"Staffing Standards by Scope, Ratios and Acuity: How to Promote Safe Patient Care Assignments".

Below are the dates and locations of the classes, Download the full brochure for class times, details and registration form.

http://www.calnurse.org/cna/ce/

I can't find where a registered or practical nurse must accept any assignment in New York.

I do know in California a nurse must accept the assignment, establish a nurse- patient relationship, and sever the relationship without giving adequate notice for ABANDONMENT to occur. Taking report does not establish the relationship. Introducing yourself to the patient or beginning care does. Then what is reasonable notice?

http://www.emsc.nysed.gov/rscs/chaps/Laws-Regs/Health_Services/Nurse_Practice_Act-full.htm

To reply to your post.

At my hospital we team up with 9 patients with either 2 lpns and a tech or 2 rns and a tech or one of each and a tech. The lpn is totally responsible for her/his patients. They do not work under an Rn except the Charge but so do the other rns. I feel that the lpn should have been fired. Why was he dead for 3 hours! Don't you do 2 hour checks???? :angryfire I get soo heated when I see that people aren't doing their job! The Rn is luckey she just got a warning but if she had any fault in this then her day will come soon too. :)

"Once upon a time...."

{just kiddin :p }

I was a Director of ICU. I had a nurse on night shift who refused to take an IABP patient even though she had had 2 inservices on baloon pumps.

The next day when I was informed of this I was told, "the nurse said she was not comfortable with the assignment." I haughtily laughed this off and remarked, "If she wants something COMFORTABLE, go be a librarian."

I then related the incident to my Boss, the Director of Critical Care Services. He had a lil different slant on it. He said, "Just for kicks call the State BoN and see what they say." Which I promptly did.

Here is what the BoN told me.

"If a nurse states that he/she is uncomfortable with an assignment and you give them the assignment anyway. Then YOU become the party responsible should any problems develop with this patient."

End of story.

the moral?.........

You CAN refuse an assignment !

Love and Peace,

loerith

Of course we can. We DON'T have to just blindly accept whatever the facility dishes out to us.

Supervisors and charge nurses try to bully nurses into taking assignments in the way described...but we don't have to take it. Refusing an unsafe assignment and/or refusing to take shift report/responsibility ( even leaving the premesis if they try to force us) may lose us a job and a good reference, but we DO keep our license and we make a point very strongly. Our choice to do so and I have done this. Every situation is different and we must make our own best call. Understand your state's abandonment laws well before you try this though...to avoid legal problems yourself.

If nurses do not feel competent to accept the asignment it can be seen as our professional DUTY to refuse. If a nurse chooses to ACCEPT the unsafe assignment they had better have filed a Safe Harbor (or your state's version) for protection. Because if something goes wrong, the facility will quite likely try to turf the liability to the nurse. I've seen it happen too many times, and the nurse is railroaded, framed, fired...so the facility showed how they dealt with the 'problem'.

Don't count on your facility having your back, nurses.

matsmom you are so right that the facility will hang you out to dry without a seconds thought---but just how long can the other nurses in a unit cover for someone who refuses to pull their own weight...if you are uncomfortable or you feel you cannot use certain equipment or care for certain type of pts then move on to another area where you can use your own particular talents and let the someone else who can fit in do the other job...no reflection on you maybe they would not be able to do your job....

matsmom you are so right that the facility will hang you out to dry without a seconds thought---but just how long can the other nurses in a unit cover for someone who refuses to pull their own weight...if you are uncomfortable or you feel you cannot use certain equipment or care for certain type of pts then move on to another area where you can use your own particular talents and let the someone else who can fit in do the other job...no reflection on you maybe they would not be able to do your job....

Well this is a different issue. I agree if a nurse wants to work/float frequently to ICU for example but refuses to care for basic ICU patients she is likely going to be a drain on the others...and I have worked with this type. They need to get out of ICU I agree.

Float nurses are a whole 'nuther problem, but some hospitals will bully them into floating to areas they are not comfortable in, and this makes it hard on regular staff who have to work 2-3 times as hard to cover for them. If this happens frequently it can be impossible liability. If regular staff agrees with this except for a rare ocurrence it can become 'business as usual' and a regular staffing policy.

One has to look at the whole picture of the unit that shift and decide on an individual basis whether it is safe or not...we all have our comfort zones. I've had directors pull uncomfortable medsurg nurses with limited experience into my ICU and want charge to assume responsibility and 'supervise' their basic medsurg care, as the only one with critical care knowledge. Its each nurses' own call if we want to accept this liability, whether its once in a blue moon or routine practice..

There are too many hospitals in my area that run their critical care units in this way and I am no longer comfortable doing charge/staff there anymore. Personal decision. I do agency work now and just take 'my own' patients now...much easier. :)

It seems the problem started with the assignment of 12-14 patients, one of which being the GI bleeder. That's waaayyyy too heavy of a load. I'd have to know what the LPN was doing during that time...if they could show they were tied up with a code, etc., that might alleviate some of their responsibility. But if they weren't, then I hold the LPN 70% responsible, the hospital 10% responsible, and the RN 20%. Most of the problem, assuming the LPN was not tied up with an emergent situation, is directly a result of their action. The RN is responsible for not adequately keeping track of work flow, and the hospital set it up with the bad assignment.

I hate to be a nag, but this is another example of why it's so important to carry your own liability insurance. Does anyone reading this believe that the hospital is going to lift a finger to defend either of the nurses? The LPN who was fired could now be sued for malpractice by the family, and she isn't even employed by the hospital anymore, SO .... No help there! The hospital was attempting to minimize its own liability by firing her. The RN who hasn't been fired could also be sued, and, if she's (he's?) expecting any support or defense from the hospital, I've got some swamp land in AZ that I'd like to sell her ...

I notice that a lot of people who have debated against carrying your own insurance on this BB often seem to assume that people only sue out of some cagey, calculated determination of who has the money ... It's not that simple -- some families just sue because they loved their family member and perceive that the health professionals caring for them dropped the ball in a big way. It's not always about money; sometimes it's about justice ...

Amazingly, it IS possible to carry medical malpractice and not realize it. Honest, it's true.

One of my reasons for not carrying my own MM insurance was because there are a great number of people that will only sue those with the pocketbooks. If you have insurance, you are sued. I was talking to my Dad about this years ago. It wasn't a huge in-depth conversation, just a side comment.

I didn't know until after he died a few months ago that he had been maintaining a MM policy for me for the past 15 years. It was cheap, like $200/year. But the evil skank he was married to explained that he felt if something were to happen, I would be covered. But if I honestly answered that no, I had no MM insurance the chances of my being sued would be much less.

I have assets, but one wouldn't know what kinds of assets I had via assumption. My S/O is an MD and we've been together for 17 years. Assumptions are amazing... thinking I am a single RN leaves less reason to sue me. Knowing my S/O is a doc and the stakes are suddenly raised.

Specializes in ORTHOPAEDICS-CERTIFIED SINCE 89.

Please note this thread is over a year old.

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