RN delegating?

[HollyWould]

Hello all, first time poster here. Currently, I am working as a RN overnights FT on a sub-acute rehab unit in a SNF in NY. I have been here for almost three years, with five years experience total as a nurse. I work side-by-side with a LPN. She is very good, experienced nurse I would have entrusted my care to. In short, there are usually about 40 patients on the floor which we split down the middle (20 pts each). We do the exact same job unless scope does not allow (such as administering ABT through a PICC, changing wound vacs dressings, etc). When one of us has a patient who seems off or possibly declining we usually ask each other to take a second look and help each other if/ when the situation arises. Other than this, we generally stick to our split assignments. Because it is just us two, we are responsible for picking up all orders, administering all meds & treatments, etc. For the past three months, the nurse who works (Fri-Sun) has been extremely distracted, lazy, and outright negligent at times. She has gone from being someone I count on and admire to fearing for the safety of our patients. Without getting too detailed, I am aware of some trouble she is having at home and has many extracurricular commitments among other things. I have been trying to empathize with this, since we all go through rough patches in life. Since the beginning of August, there has not been one night we have worked together in which she did not sit on her phone at the nursing station (AND even her AM med pass!), whine about being exhausted from extracurricular activities, and vent about trouble at home (all while not looking up from her phone, seriously!) Obviously, like most work environments, phones are prohibited. Personally, I keep mine in my locker because I have an intense disdain for phone zombies and avoid social media ever since a successful NYE resolution 3 years ago. At first, I thought maybe it was just my phone pet peeve bothering me and was trying to not allow my personal bias affect my attitude toward her. A few weeks ago, a CNA approached me & discussed similar concerns with me such as telling this nurse a pt needs pain medication 3-4 times before she goes into the room, and also refusing to assist in tasks that require two people (while on her phone & visibly not busy). Nurses from other floors have recently also approached me regarding meds/tasks she had signed for were not done (one of which the DOH discovered last week). Increasingly, her focus has gotten worse by the minute. For example, back in September there was a patient on her assignment with a PICC ABT due at midnight-his PICC was DC'd & a PIV placed. I told her twice before midnight it was due at midnight & she would be giving it from now on. Both times she responded to me in what I thought was an appropriate/acknowledging way. At 1:45am, she decided to see if there were any midnight meds due on her assignment & discovers the IV dose we spoke about twice (which I stupidly assumed was hung)! That particular night there were two further (separate) incidents that resulted in both of us clocking out two hours late. It has gotten to the point where I do not think even simple medications & tasks are getting done. Because I have a (theoretically) equal workload, I am unable to literally monitor her every movement while effectively performing my own work & pt care. As dumb as it sounds, I have not directly said, "Please get off your phone." I have indirectly made many comments regarding my feelings about phones, and have shut down all personal conversations altogether with simple "yes/no" answers anytime she begins to complain about her wife, being exhausted, migraines, acid reflux, cramps, on and on! (Before recently, we were buddies & would chit-chat all night WHILE working! I went to a few BBQs over the summer at her house, and went to see her perform in a theatre production.) She can clearly see I am very closed off around her now, I get up and move to a other area when she blasts Netflix shows with constant full-volume text alerts every 45 seconds or so, and make frequent floor rounds just to keep my temper in checkI have always had trouble with delegation in both my personal and professional life, have a pathological need for people to like me, and am younger than the majority of the nurses/staff in the facility. I briefly spoke to my manager (whom admittedly favors both me and the nurse mentioned) informally about this about a month ago who seemingly agreed with me, but simultaneouly mentioned everything aforementioned nurse "has on her plate right now". (This makes me a bit resentful because I'm fairly certain no one cares what I have on my plate, especially my patients dying of cancer or suffering from a nasty wound infection.) How do I address this before it's too late?

My question is what can I be held accountable for as the RN on the floor, legally, as a result of an LPN mistake/neglect. For example, if her patient is on neuro checks, she knows how to do them, documents (falsely, possibly) the findings & signs them, and does not report any abnormalities to me, how & why can I be liable? Or using the IV example--let's say she says it was given & complete & signs off on everything, that should be sufficient, no? Am I supposed to search through the garbage like a psycho? How far along does ensuring patient care & assigned tasks go, reasonably?

[iluvivt, BSN, RN]

LVNS cannot practice independently in that they cannot develop or change nursing care plans, perform triage or perform nursing assessment.or make a nursing diagnosis.They can:

Administers most types of medications and immunizations and blood (with additional training).

Provides bedside nursing care in hospitals and residential health care facilities.

Observes, measures, records, and reports data relating to a patient's health status.

Performs clinical procedures, such as urinary catheterizations, oral or tracheal suctioning, sterile dressing changes, and starting a peripheral IV (with additional training).

Supervises unlicensed care staff, such as certified nurse aides (CNAs) in nursing homes.

Identifies patient goals for consideration by the RN for possible inclusion in a patient's care plan..........Now as far as your issue. You could be held liable since you are supervising her and your are aware she is providing substandard care.You have a moral and legal responsibility to take action to correct this.You are going to have to rock the boat and she may not like it but your livelihood is at stake!