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?

[Tweety, BSN, RN]

I do understand your argument. But I wouldn't count on it. I've been involved in four lawsuits both in state and federal court. If you even try to tell a judge you're not responsible, and law says you are, good luck. Game over, IMHO. I wouldn't want to even try to make that case. You're essentially counting on discretion that even the most sympathetic authorities probably can't provide, even if they wanted to, under the law.

I realize these kinds of cases don't happen every day and that it's rare. But all it takes is one bad case to ruin a career. The family is going to want to blame someone and, it sounds like they have a great case in this particular instance.

All I can say is that I'm glad to have learned this information and will definitely keep it in mind for the future.

No I don't count on it, which is why I try to stay within the guidelines of the Nurse Practice Act. It's one area that I vehemently oppose, but like it or not, that's the way it is. I'm responsible for ALL outcomes, when it should be a case by case basis. I'd hate to think that if an LPN doesn't follow the 5 rights of medication administration and has a bad outcome, I'm going to loose my license while I'm happily trusting that nurse. Scarey.

[MandyInMS]

~sighs~

This thread is giving me a headache..lol

I just don't understand how another nurse requardless of title can be held accountable for EVERY action of another.And, if a nurse isn't capable of working in any given area under his/her own liscense why are they even allowed to work in that area.

I'm an LPN...If I give pt X the incorrect med..that's MY error.

I'm an RN...If I give pt X (LPN's pt) the wrong med..that's MY error.

All this does make ya think..huh?

[gij1]

1. Do not give high risk GI bleed patient to LPN. That is drilled over and over in nursing school, prioritizing patients.

2. The man was not checked for 3 to 4 hrs!! GI bleed! Come on, that is just pure neglect. Just because it is night shift you must be aware of what is happening with your patients.

3. Do not agree to work in unsafe environment. Patient/nurse ratio not safe, quit, go somewhere else. Just say No!!!!!!!!!!!!!!!!!!!!

[Brownms46]

Depends on what is the established ratio for the unit. Again, I have only my own perspective and how LPNs are utilized here, which is basically as total care providers with an assignment of their own. Our ratio on nights is six. We don't do teams, but as the nurse practice act dictates, all patients are to recieve an RN level of care, so there is an RN assigned to each LPN. Usually it's the charge nurse. So that RN has his six patients and the LPN has his six patients, that's 12. 12-14 patients for two licensed profressionals is not unusual here for med-surg. I agree it's not necessarily the safest of ratios.

It is the hospital's responsibliity to maintain competencies, so say an LPN floats to me that I've never met or worked with before. I'm not going to refuse the assignment because I don't know him. I'm going to have to trust he's passed all his competencies, and holds a valid LPN professional license. Where my job comes in, "is this a safe assignment", most of the time med-surg patients can be handled by an LPN, so usually it's not much of an issue.

Do we know if the original OP's assignment was safe and the nurse was competent? Ultimately we don't really know. Often we don't really know until we get into the assignment what's going on. But if I delegate you to do the care for a group of patients, I'm delegate that you round on them q2h or however often their condition dictates. I'm not going to take care of my six patients, and the LPNs too. Until I know of a problem, then I feel I don't deserve the same kind of punishiment.

It does get a little shakey when the LPN makes a fatal error or is incompetent. But if RNs were being dismissed or disciplined for every LPN error, or every fall on the floor, we'd be in trouble.

I wholeheartedly agree the safety of the assignment should be investigated. Perhaps the RN should have taken the GI bleeder because of the potential for trouble. We can always second guess ourselves, I do it all the time when there's a bad outcome on my unit. Drives me mad.

So I still maintain that the RN shouldn't have recieved equal "punishment" for the LPNs negligence. The key word being "equal".

Tweety I agree with much of what you have posted. However...the BON in each state has deliberately placed the burden on the RN. And unfortunately....the rules they make up...are made up to meet the whims of TBTB!

And I don't blame you for not wanting to take care of another licensed person's assignment, but that is how BON has set up the rules. Fair NO! But that is the way it is.

As you say...you don't know how competent a person is, until you get into the assignment. Well...then this means, you must continue to assess. Assessment doesn't end when you make the assessment, assessment is an ongoing process.

Accountability

The last and surely not least step of delegation probably causes nurses the most concern. After the delegator has assessed patient needs, assessed qualifications of the personnel, made the assignment and granted authority, the delegator's role has just begun. The delegator must supervise the personnel to validate that the care was performed as was delegated and according to the established policies and procedures within the agency. The process of supervision is necessary in order for the delegator to maintain accountability for the nursing care.

Take a little gander at this link, as I found it very interesting. I feel it really drives the point I'm trying to make about, delegation, and accountability.

http://caring4you.net/delegation.html

[Brownms46]

BTW, thanks for this link as well Brownms46. Very informative.

http://www.calnurse.org/102103/teamissues.html

You are very welcome lizz:)!

[Tweety, BSN, RN]

~sighs~

This thread is giving me a headache..lol

I just don't understand how another nurse requardless of title can be held accountable for EVERY action of another.And, if a nurse isn't capable of working in any given area under his/her own liscense why are they even allowed to work in that area.

I'm an LPN...If I give pt X the incorrect med..that's MY error.

I'm an RN...If I give pt X (LPN's pt) the wrong med..that's MY error.

All this does make ya think..huh?

Gives me a headache too. But the nurse practice act is very clear. The RN is responsible for ALL OUTCOMES.

[NannaNurse]

This nurse made a very grave mistake, not doing rounds and tending to the needs of her/his patients. The fact that it's a LPN doesn't bother me, she is a nurse too..........same argument, different thread.........

This is a growing trend in all medical facilities across our great nation.......over loading ALL nurses and expecting us to handle the constant stress and we are expected to wear that 'secret S' under our scrubs!! Well, personally I'm sick of it. Fewer people are going into the nursing profession and we wonder why?? :chuckle The pay sucks, the hours stink, the paperwork causes brain damage and what do we get??? More patients than we can adequately care/provide for, BS from the higher ups and always told to '....deal with it' or '....just do the best you can'........Is anybody else fed up with this crap?? I work Acute Rehab.....I walked into work yesterday and was met with...."have a nice day, one of your patients just died".....we get patients who are SICK and NOT ready for Rehab.....we are doing blood Tx, 1:1 nursing supervision, elopement checks every 15 min .......AROUND THE CLOCK, skin care tx that take >1hr, suctoning q 15-20 min, vent pts pt that require 4-6 assist......I wish the nurses of this country would pick a day and EVERY SINGLE NURSE WHO CARRIES HIS/HER LIC. PROUDLY WOULD CALL OFF D/T SICKNESS.......sick and tired of not being heard.

........sorry for the 'soapbox' here, but I'm just mad :angryfire

[NannaNurse]

Oh Yeah...........I think the RN should have recieved a write up for this. He/She was to ensure the LPN was 'doing his/her job'..........sad enough to say since we are over-loaded as it is...........

Just my opinion

[Tweety, BSN, RN]

Tweety I agree with much of what you have posted. However...the BON in each state has deliberately placed the burden on the RN. And unfortunately....the rules they make up...are made up to meet the whims of TBTB!

And I don't blame you for not wanting to take care of another licensed person's assignment, but that is how BON has set up the rules. Fair NO! But that is the way it is.

As you say...you don't know how competent a person is, until you get into the assignment. Well...then this means, you must continue to assess. Assessment doesn't end when you make the assessment, assessment is an ongoing process.

Take a little gander at this link, as I found it very interesting. I feel it really drives the point I'm trying to make about, delegation, and accountability.

http://caring4you.net/delegation.html

Again, I'm not saying the RN is an innocent bystander in this case, just that the "punishment" should take the RN and the LPN separately and should be appropriate to violations each incurred.

I didn't mean to say I didn't want LPNs in my assignment. Daily I'm assigned one, if not more LPNs and I accept it.

What bothers me about the RN being responsible for every outcome is when I've been off several days I know nothing about anyone in my assignment. The assignments are made by the charge nurse from the shift prior. And the way we use LPNs is as total care providers not teams, so literally my license is dangling on the line every day, since it may be way into our shifts that I realize that an assignment might not be appropriate, or what the LPN is and isn't doing.

Once I was working with an LPN who decided to let a patient sleep through his 4AM vitals. The patient went into septic shock and it was only then that I was aware of the situation. Sigh..........sometimes makes me crazy.

Anyway good discussion, even if we don't agree on the fine points. :)

[Tweety, BSN, RN]

1. Do not give high risk GI bleed patient to LPN. That is drilled over and over in nursing school, prioritizing patients.

The patient was on med-surg, surely LPNs can take care of GI bleeds. I don't remember in nursing school reading what patients LPNs can and can not take care of on med-surg. Every patient has the potential crash. Every patient is a potential fall risk. Every patient is "high risk".

But yes, it's drilled into us..........make appopriate assignments!

If the patient was unstable, as wasn't indicated in the op, what was he/she doing on med-surg?

Agree with the rest of your post! :)

[Tweety, BSN, RN]

This nurse made a very grave mistake, not doing rounds and tending to the needs of her/his patients. The fact that it's a LPN doesn't bother me, she is a nurse too..........same argument, different thread.........

This is a growing trend in all medical facilities across our great nation.......over loading ALL nurses and expecting us to handle the constant stress and we are expected to wear that 'secret S' under our scrubs!! Well, personally I'm sick of it. Fewer people are going into the nursing profession and we wonder why?? :chuckle The pay sucks, the hours stink, the paperwork causes brain damage and what do we get??? More patients than we can adequately care/provide for, BS from the higher ups and always told to '....deal with it' or '....just do the best you can'........Is anybody else fed up with this crap?? I work Acute Rehab.....I walked into work yesterday and was met with...."have a nice day, one of your patients just died".....we get patients who are SICK and NOT ready for Rehab.....we are doing blood Tx, 1:1 nursing supervision, elopement checks every 15 min .......AROUND THE CLOCK, skin care tx that take >1hr, suctoning q 15-20 min, vent pts pt that require 4-6 assist......I wish the nurses of this country would pick a day and EVERY SINGLE NURSE WHO CARRIES HIS/HER LIC. PROUDLY WOULD CALL OFF D/T SICKNESS.......sick and tired of not being heard.

........sorry for the 'soapbox' here, but I'm just mad :angryfire

I hear ya Nanna, med-surg and rehab patients are sicker and sicker. When they get sick we're expected to privide a higher level of care while we wait many hours for a higher level of care, or to simply stablize them.

Then there's the old assignments are made by number of patients rather than the acuity of those patients.

[meownsmile, BSN, RN]

I have to wonder if this facility has a written falls program with guidlines for criteria, intervention, and monitoring. We do, it works very well, and the patients that meet the criteria(as this guy definately would have) are moved to a room closer to the nurses desk as soon as one is available, checked visually q1 hr, and are toileted, turned, repositioned q2. The guidelines are implemented day and night.

Would be interesting to see what the charting looked like on this guy. That may have been the deciding factor in who got fired. If the Rn had done her required charting, and the LPN did little or no charting it kind of leaves the LPN out there for the liability.