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]

I believe this was solely the responsibility of the LPN in this situation. She had her pt's and the RN had hers.

I worked step down in a hospital right out of nursing school. The RN charge nurse for the shift sometimes had to take pts herself, at times, when census was lower, she didnt take them and could help the other nurses...however, when u have ur own set of pts, u dont have time to go around to make sure the others are doing what they r sposed to do.....our RN in this situation, who would take the pts...she still had to make her charge rounds once per shift and get her sig on every chart. After that, she only had to help the other nurses and take up slack.

If this RN had not had her own pts, i think she should have had to face more discipline, but that wasnt the case.

Also, as some one pointed out.....how could that pt lie there on the floor for that long? Rounds are sposed to be made a minimum of q2h.

just my opinion..

Just because she didn't have time, doesn't make her any less accountable! And YES how could the pt. lay there that long, without being checked on...by EITHER NURSE! So the RN delegate, and then walks away??? Unfortunately ...I have seen this waaaaay too often! I think people need to take their responsibilities a whole lot more seriously!

[fergus51]

Well Brownie, that's why I like working with an all RN staff. I don't need to worry about an LPN not noticing her patient has been dead for hours and me being held accountable for that. If you can't even trust someone to do their checks, I would rather not work with them. To me, delegation means delegation it doesn't mean I stand there and supervise. She wasn't asked to perform brain surgery. I would think an LPN would be insulted if I said "Did you check your patients? Are you sure you did? Are you sure they are breathing? Maybe I should watch you check them just to make sure. In fact, maybe I should do all your work because I can't trust you to do it"....

[symmy]

The lpn ultimately knows her responsibility and neglected 2 do rounds and the cna should hav been fired. I hav worked medsurge and psych. it is obsurd that a nurse of any degree would 3-4 hrs. s eyeballing their pt.

[lastkiss32]

I am an LPN, ChargeNurse for 36 LTC residents(3rd so no RN) and my CNA's do rounds q2hrs but I still check on my residents and can not imagine a patient lying on the floor that long and no one knowing it-I have also had GI Bleeds, VS drop-call MD immediately. Even if doing patient care, do 1, check on the rest(at least look at them) and then go on to next one and repeat.

I would say this one is on the LPN, the RN evidently had faith in her enough that she didn't feel she needed to watch over her shoulder. Makes me wonder what the LPN was doing for that long of time to have not at least checked on this patient, even with that many patients which is not a good thing, that is almost half a shift with no one checking on a critical patient. Scares me.

[amoymak]

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.

that's 6-7 patients each which is magnificent where i'm from. when i worked as an lpn i had up to 9 pt's on a med surg floor- who i did everything for. i would love to work wherever you are.

[Brownms46]

Well Brownie, that's why I like working with an all RN staff. I don't need to worry about an LPN not noticing her patient has been dead for hours and me being held accountable for that. If you can't even trust someone to do their checks, I would rather not work with them. To me, delegation means delegation it doesn't mean I stand there and supervise. She wasn't asked to perform brain surgery. I would think an LPN would be insulted if I said "Did you check your patients? Are you sure you did? Are you sure they are breathing? Maybe I should watch you check them just to make sure. In fact, maybe I should do all your work because I can't trust you to do it"....

You know what fergus, I don't care who I work with, as long as they work! This LPN was totally wrong in not checking on this pt. sooner! However... I have read on here, and heard many a nurse state, how they were so busy with a couple of their pts. that none of their other pts. ever saw them! I KNOW this has happened to many! I feel the RN, "should" have made rounds on everyone, especially if the LPN had more assigned pts. And even if she didn't! And that still does not excuse the decision making on the part of this RN to accept the assignment, and to assign this pt. to the LPN to care for.

But I also know that it is NOT because this was an LPN, that this pt. didn't get seen! I have worked with a few RNs, who I have wondered where they head was. Worked with two recently, who must have forgot where they were, because they definitely weren't concentrating on what they were supposed to be doing! Too many errors made..as one was too sleepy to have even been at work!

Negliegence comes in all titles...all the way up to MD!

No matter, because I guess I won't be reading on here, that the "RN is ultimately responsible" anymore. Because obviously from the responses, and the outcome of this event...that is not neccesarily so:D!

[amoymak]

ok agnus, i agree with the protesting bit- been there done that . a nurse cannot however, decide to not accept an assignment because if you refer to your nurse practice act, negligence is outlined in great detail.

[Ortho_RN]

I do think the RN is responsible for her patients. But if this floor allows them to split teams of patients like this, then the RN can't possibly be responsible for doing everything for all of them. If she is, then what is the point of even having LPNs? If a facility allows delegation by RNs to LPNs that means they are competent and able to do the job without an RN standing behind them. The question to me is who was responsible for checking that patient? If it was the LPN's patient, then I assume it was her. An LPN doesn't need an RN to hold her hand while she checks to see if someone is still breathing.

If an RN can't delegate to an LPN within their scope of practice, what's the point of having LPNs? Is the RN responsible for everything the LPN does? If that's the case, then it seems like the LPN is working on the RN's lisence and as far as I knew LPNs have their own lisences.

I have to say, this is one reason I prefer primary nursing.

I agree 100%.... We can give our LPNs patients but we must chart behind them... What is the point.. If I'm gonna have to take care of my pts and hers then why not just give me all of them.. LPNs have licenses they should want to be responsible and do the job correctly, and not look for a coattail to hide under when things get rough( and let me add that is is not ALL LPNs, I am talking about the way things run at the hospital I work at, so everyone don't get all uptight over nothing)...

[lastkiss32]

So true on some of the RN's and the LPN's generally do get the most blame even if they do a better job than some of the RN's. I don't beleive the RN should have had to check on the LPN's progress in this situation, the LPN knows here job and should be capable of doing it. But, as the say the door swings both ways. An RN should be able to trust her LPN to do her job and if she can't then seek the RN's help.

The shortage of working nurse's per patient at some places is scary at best, but all know thier job(I hope) and should be able to do it. If not then refuse and never put a patients safety at risk(make them get you help or call the state/Jahco).

I can only imagine what was going thru this patients mind as they lie there on the floor dying

[Brownms46]

I agree 100%.... We can give our LPNs patients but we must chart behind them... What is the point.. If I'm gonna have to take care of my pts and hers then why not just give me all of them.. LPNs have licenses they should want to be responsible and do the job correctly, and not look for a coattail to hide under when things get rough...

LPNs don't look for a coatail to hide under, and definitely not from one who just got pressed! Seemed to me the LPN took her lumps, and the RN ran for cover! But I am sure when this goes to civil court, and I am sure it will, I wonder whose coat the RN will hide behind! Probably the same RN was one of those running around talking about how it's her license this, and her license that! :chuckle! Won't make a bit of difference though.

And Cherish...you are totally right...admin had a hand in this too...and should, and probably will be held accountable:D!

[symmy]

New RN? I'll run circles around u any day of the week.

[lastkiss32]

I have been told if you don't take report you do not have to accept the assignment is this true or is it a state to state thing?

Also where I worked before I did the charting/ the RN would read it and sign behind my name- I would then think that the RN would check to make sure all that was written was done-because then it would be her liscense also.

I never run from my responsibilites, if I mess up I admit it, if it was not me and they try to blame me and it was the RN then the DON(supervisor) know's it to.