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?
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..
Often, they do not. I am often in the middle of med pass when they are doing their initial assessments. Time is the big issue. We each have 8 or 9 patients.
Specializes in Med/Surg,Geriatrics, Pediatrics, and Family Med..
Your DON or Charge should be an RN and reviewing and signing off on assessments. I’ve been both an LPN and RN, never did the floor nurse need to review my assessments, you are tied up with your own load. In regards to signing off, I would never delay that and it takes little time to confirm. I know you’re at your wits end but that’s someone’s family in there; confirm so they can get the other processes going.
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?
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?
I can't disagree with you there. I worked LTC for many years and one of the LPN supervisors would always have me sign off on her assessments, however this was an LPN I worked with for years and I fully trusted her work so I had no problem with it.
I have refused to sign off on assessments for other LPN's that I don't know well enough to trust, just told them to leave it in the unit manager's or DON's mailbox with a note for them to sign it off. Same as you, except in very limited cases of total trust in that LPN I'm not signing something I didn't do.
As for pronouncing a death,, I don't live in a state where RN's other than Hospice nurses can pronounce but if I could I wouldn't refuse on that. For the sake of the deceased and their family that's something that needs to be taken care of right away when it happens.
Specializes in Med/Surg,Geriatrics, Pediatrics, and Family Med..
On 11/24/2022 at 6:58 AM, klone said:
Can LPNs even do initial assessments?
In LTC yes. They do the admission usually it’s the ADON or DON that would go in the Next day. Review everything and maybe notate more details. MDS/Care Plan Nurse reviews charts as well.
Specializes in Med/Surg,Geriatrics, Pediatrics, and Family Med..
5 minutes ago, kbrn2002 said:
I have refused to sign off on assessments for other LPN's that I don't know well enough to trust, just told them to leave it in the unit manager's or DON's mailbox with a note for them to sign it off. Same as you, except in very limited cases of total trust in that LPN I'm not signing something I didn't do.
I meant to put signing off on a death, in my last paragraph.
The issue w is the timely notification of the family, the funeral home etc. It doesn't take but a few minutes to pronounce, assuming it was anticipated (as many/most are in LTC). I check heart and respirations for 1 minute, even if I have used the electronic vital signs machine (with my second hand watch). The LPN can then do the notification and call the funeral home.
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..
So they would have to do the assessment, I would never sign off on an assessment I did not also do to ensure it was correct. That would mean she would be doing the job of the supervisor without being the supervisor. They are trying to screw them into doing the work of a supervisor without the pay.
I would have handled the death differently. I would have stated to the supervisor as soon as they are free to do my med pass let me know and I will go pronounce.
Specializes in Med/Surg,Geriatrics, Pediatrics, and Family Med..
45 minutes ago, NutmeggeRN said:
The issue w is the timely notification of the family, the funeral home etc. It doesn't take but a few minutes to pronounce, assuming it was anticipated (as many/most are in LTC). I check heart and respirations for 1 minute, even if I have used the electronic vital signs machine (with my second hand watch). The LPN can then do the notification and call the funeral home.
I agree it only takes a few minutes. That’s why I’m not understanding asking someone to do the med pass.
Specializes in Post Acute, Home, Inpatient, Hospice/Pall Care.
First, I would be finding another job since nurses are in short supply and this job sounds awful. Second, no I wouldn't sign an assessment I did not do, the RN/DON can do it in the a.m. The death I would do as soon as I was between patients because there is a lot that goes on and it can be devastating for families, especially if they are there. If you are insistent on staying I would address this with your leadership team and get some things ironed out. Good luck!
I agree it only takes a few minutes. That’s why I’m not understanding asking someone to do the med pass.
I think in this case it's a principle of the matter, not the matter itself. The RN is asked to do extra work, is never offered assistance, and is expected to take on some supervisor tasks without the benefit of supervisor pay, and insulted them with $1/hr to do it when they gladly pay LPNs $10/hr.
Googlenurse, ASN, BSN, RN
165 Posts
Often, they do not. I am often in the middle of med pass when they are doing their initial assessments. Time is the big issue. We each have 8 or 9 patients.