Refusing to Sign Off On Others Assessments

[Googlenurse]

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?

[RN_SummerSeas, MSN, APRN, NP]

 

1 hour ago, FallingSkies said:

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.

I get that its the principal but its also the death of someones loved one. That should come first in that instance. Like I said, I wouldn't work there when there are so many jobs right now, go where you are treated well and appreciated.

[Gratefulbutnotstupid, ASN, LPN, RN]

Signing off an assessment generally indicates you are taking responsibility for it.  Are LPNs allowed to do assessments in your state?  If yes, they should be signing them.  In my state LPNs are not allowed to do assessments.  LPNs can gather information that has to be reviewed by a RN.  LPNs also have to be supervised by a RN, physician, NP or PA (whomever is on site).

  It does sound as though you are being given the lion’s share of the work and the responsibility without the pay.  I have been a LPN and a RN.  LPN 27 years, RN 18 years.  I was always assigned a RN to cover me (do assessments and other tasks that were not in my scope of practice and supervise me).  Note* I said in my scope of practice.  As an LPN I gathered data on patients and reported them to the RN I was assigned.  I essentially assessed them, but was not allowed to indicate that. The RN could then follow up on them.  As an RN I assigned LPNs their case load for the shift and I did the assessments.   I would suggest you become familiar with the scopes of practice for a LPN in your state, you might decide that it’s just not worth the risk and get a different job.  I wish you the best in all your endeavors.

[Googlenurse, ASN, BSN, RN]

18 hours ago, TheAnguishedNurse said:

I agree it only takes a few minutes. That’s why I’m not understanding asking someone to do the med pass. 

It takes a few minutes to pronounce,but are you also counting the time it takes to walk to the other room,make the necessary calls,do the paperwork etc?

That takes time away from my patients,and I will end up being late with my own med pass. 

[RN_SummerSeas, MSN, APRN, NP]

2 hours ago, Googlenurse said:

It takes a few minutes to pronounce,but are you also counting the time it takes to walk to the other room,make the necessary calls,do the paperwork etc?

That takes time away from my patients,and I will end up being late with my own med pass. 

All you would have to do (because yes I have done this) is make the pronouncement and fill out the form. The calls, the rest, the LPN can do. I have pronounced for LPN's in facilities I didn't work for because a hospice patient passed and there was not one RN in the house that day shift.  It is a compassionate choice. Med pass can be 15 minutes late for someones dignity. Like I said before, you should get a new job.  You sound upset that you aren't supervisor and aren't getting paid what the agency nurses are so why stay?  I will never understand why anyone stays at a job that they don't love when there are jobs galore right now. The only one who can decide this is you, either you accept the job for what it is, including the LPN supervision or you move on, whatever you do, good luck and I hope it gets better.

[feelix, RN]

There is no RN signing off on an initial assessment at least in Texas. The initial assessment has to be done by an RN. Your company is pulling a fast one by asking you to sign off.

An LPN is not a professional nurse in the legal sense (not trying to downplay their skills or abilities). Some LVN/LPN programs don't even have an assessment course. In Texas they can gather data but not assess or work without a supervising RN.

https://www.hhs.texas.gov/sites/default/files/documents/doing-business-with-hhs/providers/long-term-care/qmp/scope-of-practice-for-nurses-RN-vs-lvn.pdf
 

Please pull your state’s Nursing Practice Act or consult a lawyer.

If your states allows you to pronounce death and you are the only RN in house, you may be fired for refusal (depending on policy). Death is an emergent situation like a code. You cannot refuse CPR to a patient if their nurse won’t return the favor. You could even lose your license over something like that.

[Gratefulbutnotstupid, ASN, LPN, RN]

Sounds like my state.  LPNs technically collect data, RNs assess.  I agree, you should not refuse to pronounce a death if your the only one allowed to, nor should LPN s be supervising.
As I wrote in my last comment.  Know the LPNs scope of practice.  And Felix, RN is right, check to see how if you need a lawyer.

Sorry feelix (spell check strikes again)

[Nurse Beth, MSN]

The facility knows that LPNs cannot perform an assessment, that's why they have the RNs "sign" and assume the risk. That way they can save money by hiring LPNs.

[Googlenurse, ASN, BSN, RN]

OK,so while at work last night I clarified a few things. 

Since I will be the one pronouncing,I would have to do the paperwork and call the family,funeral home,etc. Which would take a good chunk of time especially if I am in the middle of med pass. But the DON clarified that I can ask the supervisor to take over the med cart. 

As far as signing off on assessments,the new RNAC will do that. 

[Gratefulbutnotstupid, ASN, LPN, RN]

Well that settles that.  I hope the LPNs are not supervising you.  They should not be supervising a RN that holds a higher level of education and licensure then they do.  How could they legally.  When I was a LPN I started IVs, but I could not start an IV if the RN covering me was not yet trained to because she/he could not supervise me starting them.  Makes sense.
I am glad that you can turnover the Med pass to the LPN.  I would ask the DON to be sure the LPNs know this.  I am also glad they have a new RN to do assessments.  Good for you for hashing this out with the DON and getting positive results.