Refusing to Sign Off On Others Assessments

[Googlenurse, ASN, BSN, RN]

So as I’ve written before, the facility I work for, I am the only RN on duty at night.

The rest of the nurses are LPN's, and to make matters worse, 90% of the LPN'S are agency.

Even the LPN nursing supervisors are agency. My company would rather pay outside agencies to supervise than pay me $6 extra an hour to supervise. They only wanted to give me an extra $1/hour. The agency supervisors get paid $10 extra. 

It’s not a question of experience either. These nursing supervisors told me they only have 5 to 3 years experience to my 20 years. 

So here is where things get sticky. I have my own assignments. When someone else gets a new admit, the LPN supervisor will do them, but the supervisors can’t sign off on them. Of course I get asked to sign off, and I refuse to. I will not sign off on something I did not assess. I also was asked to pronounce a death, and I refused to.

They then go into this whole argument and write me up. I really don’t care though.

If I have 12 vent/trach /feeding tube central line patients, I don’t have time to do things that are not in my assignment. 

So I guess this more of a rant than anything else, but can I get in trouble for refusing to pronounce a death or refusing to sign off on an assessment?

[klone, MSN, RN]

I guess you could get fired for insubordination. I don't know. I'm sorry that's happening.

Why do you refuse to pronounce a death (assuming it's legal in your state for an RN to do that - I know laws vary)?

[Googlenurse, ASN, BSN, RN]

34 minutes ago, klone said:

I guess you could get fired for insubordination. I don't know. I'm sorry that's happening.

Why do you refuse to pronounce a death (assuming it's legal in your state for an RN to do that - I know laws vary)?

I know in this state I can pronounce death, but I just refused because the  Lpn supervisor wasn’t going to help me with my own medication pass. I would have had  to stop in the middle of med pass. I know I am wrong, but it’s in principle. 
 

I have to do other things that have nothing to do with my patients. I feel like I am taking on the supervisor’s work(without getting paid for it)

 

ETA- Can an Lpn fire an RN for insubordination?

[hppygr8ful, ASN, RN, EMT-I]

On 11/21/2022 at 6:52 AM, Googlenurse said:

I know in this state I can pronounce death, but I just refused because the  Lpn supervisor wasn’t going to help me with my own medication pass. I would have had  to stop in the middle of med pass. I know I am wrong, but it’s in principle. 

I have to do other things that have nothing to do with my patients. I feel like I am taking on the supervisor’s work(without getting paid for it)

ETA- Can an Lpn fire an RN for insubordination?

That would depend on your facilities policies and procedures. 

[beachynurse, ASN, BSN]

So here is where things get sticky. I have my own assignments. When someone else gets a new admit, the Lpn supervisor will do them, but the supervisors can’t sign off on them. Of course I get asked to sign off,  and I refuse to. I will not sign off on something I did not assess. I also was asked to pronounce a death, and I refused to.

They then go into this whole argument and write me up. I really don’t care though.

If I have 12 vent/trach /feeding tube central line patients, I don’t have time to do things that are not in my assignment. 
So I guess this more of a rant than anything else, but can I get in trouble for refusing to pronounce a death or refusing to sign off on an assessment?

---

From a management standpoint, if there is no one else that is able to pronounce a death, and you refuse, who is going to pronounce? I can see this as insubordination if you are the only one to pronounce and you refuse. 

As far as the assessments, you need to see what your state's practice act says about it. I know is some facilities here an LPN can admit as long as the RN co-signs after reviewing the information. I understand your feelings about not signing something you didn't do, I certainly would not.  But, by co-signing the assessment, you are stating that the paperwork is correct, you are not signing that you did the assessment.

[Googlenurse, ASN, BSN, RN]

On 11/22/2022 at 8:26 AM, beachynurse said:

So here is where things get sticky. I have my own assignments. When someone else gets a new admit, the Lpn supervisor will do them, but the supervisors can’t sign off on them. Of course I get asked to sign off,  and I refuse to. I will not sign off on something I did not assess. I also was asked to pronounce a death, and I refused to.

They then go into this whole argument and write me up. I really don’t care though.

If I have 12 vent/trach /feeding tube central line patients, I don’t have time to do things that are not in my assignment. 
So I guess this more of a rant than anything else, but can I get in trouble for refusing to pronounce a death or refusing to sign off on an assessment?

---

From a management standpoint, if there is no one else that is able to pronounce a death, and you refuse, who is going to pronounce? I can see this as insubordination if you are the only one to pronounce and you refuse. 

As far as the assessments, you need to see what your state's practice act says about it. I know is some facilities here an LPN can admit as long as the RN co-signs after reviewing the information. I understand your feelings about not signing something you didn't do, I certainly would not.  But, by co-signing the assessment, you are stating that the paperwork is correct, you are not signing that you did the assessment.

I do not want to sign off on something I did not do. 

How would I know if the paperwork is correct if I did not assess the patient?

[beachynurse, ASN, BSN]

7 minutes ago, Googlenurse said:

I do not want to sign off on something I did not do. 

How would I know if the paperwork is correct if I did not assess the patient?

You do go and meet the patient, it's not blind. Is the paperwork filled out completely? Does it look like anything might be out of place? Were the vitals OK? Was a skin evaluation done, and if there is breakdown noted, you need to look at the wound, hopefully the LPN would have called you when she observed the breakdown so the patient isn't disturbed twice. If they had surgery, was the surgical site looked at? and the list can go on..

[JKL33]

I'm with the OP on the particular aspect of "signing off." Our system might be set up this way but that doesn't make it not bull. It is bull. We all know there is not time to adequately review someone else's assessment. If the expected signor is not afforded the means (eg TIME) to review adequately then it's all BS that is in favor of everyone other than the patient and the one expected to sign.

I agree with the OP; "adequately" does indeed mean more than checking to see if paperwork is present and if the issues ~you are afforded the courtesy of knowing about~ appear to be properly addressed on paper...to say nothing of the issues you may not know about because you didn't assess the patient. The whole reason, in theory, that an RN would be required is because the RN is going to do something that any random paperwork-checker can't do.

I was in this position in my first nursing job, thanks to "team nursing." 12 patients acute care. I was required to sign off the LPN's assessment and charting. So I assessed/re-assessed every patient, not because I didn't trust the far more experienced LPN who was usually on my team but because of my beliefs about what I was attesting to. There is nothing anywhere that says the only thing you are attesting to is that the LPN filled out the right paperwork. That idea would be pummeled in a flash about the time that someone signed off on a seriously inadequate assessment that lead to harm.

[Nurse Beth, MSN]

I would want to know (in policy) exactly what "signing off" another nurse's assessment means.

Worst case scenario you hurriedly sign Your Name, RN to an inaccurate assessment that later becomes part of a lawsuit. It's very likely you'd be responsible for what was written.

[klone, MSN, RN]

Assuming deaths aren't a daily occurrence, if you as the RN are the only one there who can pronounce the death, you should just do it. That is part of being an RN, and being the only RN in a facility. It has nothing to do with being a supervisor nor is it something they should be paying you more for, as it's just part of the scope of the RN.

[Wuzzie]

5 minutes ago, klone said:

Assuming deaths aren't a daily occurrence, if you as the RN are the only one there who can pronounce the death, you should just do it.

Agreed but if she's in the middle of a med pass, as she stated, the LPN supervisor should not have refused to take over for her until she was finished with the pronouncement. We all know the next thing that will happen is she'll get dinged for giving her meds late. 

[Googlenurse, ASN, BSN, RN]

23 hours ago, Nurse Beth said:

I would want to know (in policy) exactly what "signing off" another nurse's assessment means.

Worst case scenario you hurriedly sign Your Name, RN to an inaccurate assessment that later becomes part of a lawsuit. It's very likely you'd be responsible for what was written.

The assessment has a line for "RN signature" at the end of the assessments.

The RN signs that the information is correct.  I think that is what the fine print says. I would need to look at it when I am at work

But the Lpn can sign on other pages on the assessment.