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Discussion

Scolded WHY?

RN admitted patient to home health the day after discharge from the hospital, LVN assigned to follow up 4 days later and discovers that patient has a wound (skin tear) the dressing has a moderate amount of drainage, but their is no order for dressing change and their is nothing noted from the admit about a wound that the RN likely missed this with the initial skin assessment 4 days ago,patients states happened at hospital, well the LVN calls the doctor he states oh yes I remember that happened the evening before discharge go ahead write the order for tx and fax I'll sign it. LVN cleanses wound changes the dressing goes back to the office faxes the order and reports her findings to supervisor and preceptor and gets the A$$ chewing of her life.

She is told what she did was out of her scope of practice she could lose her license:eek: what was she suppose to do?

agency basically told her she should of ignored it. were they upset that now this is documented that this obviously was missed, what would you of done.

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    Ok, I have to chime in here. I am an RN with home care experience. She did not call the supervisor. That is what she did that was wrong. There is always someone in the office or on call to report to.LVN's can take orders over the phone, but this was an unusual situation. The RN missed it on the skin assessment.The LVN was out of her scope of practice on this. That is why only RNs can open new cases in NY at least. It's about assessment. There is nothing worse than hearing an LVN when something goes wrong say"But I'm not an RN!"

    You make a good point.

    However, if that is the policy, then the LVN should not have been the nurse to open this patient or an RN should have gone with her.

    The patient should be the focus - not this petty "tush chewing" crap.

    If the LVN had called her supervisor, would an RN have been sent out then? Should the LVN have left the patient with an open skin tear? Should the LVN have refused this assignment since the RN does the initial assessment?

    I think the system where this LVN works is broken - and the LVN should not take the brunt of the blame.

    We have to stand up for what is right. Do not let someone treat you in an unprofessional manner - even if you do make a mistake.

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    I'm glad the LVN did what she did. Why is it that there is such a power trip problem in nursing? Even IF what she did was wrong she shouldn't have been scolded as she was. I find that the level of professionalism is lacking in many institutions. If anything the LVN should have been praised for a good assessment.

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    If the LVN had called the supervisor she would have been protected. You can't assume you know what the supervisor would do. Of course the RN has some explaining to do. I have a feeling the LVN got chewed out over her attitude. I don't think anyone would have told her to leave the wound uncovered. There is a protocol for a situation like this. Cleanse with water and cover with gauze, this may vary from state to state. Home Health aides can do this in NY but they have to call the office. It's about communication. and working as a team.a good general rule for RNs and LVNs is this. If there is something unusual, not the norm call the supervisor. It's also about politics.

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    stuff to consider:

    Your supervisors have little experience in nursing/commonsense. I kid you not. Home health and hospice CAN be almost total scams. Look them up on your BON. Your place of employ might have been their only nursing job - ever. Does your place give every new employee a comprehensive orientation/checkoff? If not it is likely your company has nobody in charge who is qualified to be in charge.

    Glassdoor.com, google them. Surprises might be found.

    Over rotating an admission error. Hard to prove it didn't happen while in your company's care. This is why hospitals/LTCs really, really, want to have you do a full check H to H on admission. Skin tears are one of the things highlighted as a big no no. Blame is assigned. Somebody is losing money and has to eat the bill.

    Predjudice. You are working for idiots and this is the first of a lot of childishness to come.

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    • Author
    Ok, I have to chime in here. I am an RN with home care experience. She did not call the supervisor. That is what she did that was wrong. There is always someone in the office or on call to report to.LVN's can take orders over the phone, but this was an unusual situation. The RN missed it on the skin assessment.The LVN was out of her scope of practice on this. That is why only RNs can open new cases in NY at least. It's about assessment. There is nothing worse than hearing an LVN when something goes wrong say"But I'm not an RN!"

    The LVN was their for a follow up visit she did not open the case, she discovered the skin tear with dressing still intact upon assessment pretty hard to miss on front of the arm:eek:, she went back to the office got the signed order, and got supplies notified the case manager and then went back to the patient home and changed the dressing.

    So she was in no way out of her scope, she got an A$$ chewing because now all this is documented an obvious miss by the RN a Real DING DING for survey and a corrective action for the RN.

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    So they basically scolded her for making the RN look bad?

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    • Author
    So they basically scolded her for making the RN look bad?

    Yep, and get this she is being followed by her former preceptor today:uhoh3: Hmmmmmmmmmm

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    The LVN was their for a follow up visit she did not open the case, she discovered the skin tear with dressing still intact upon assessment pretty hard to miss on front of the arm:eek:, she went back to the office got the signed order, and got supplies notified the case manager and then went back to the patient home and changed the dressing.

    So she was in no way out of her scope, she got an A$$ chewing because now all this is documented an obvious miss by the RN a Real DING DING for survey and a corrective action for the RN.

    BeautifulDoeLVN, you hit the nail on the head! Agreed completely. Must have been a hit and run or fast food RN admit assessment. I just hate those!:yeah:

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    that lpn just needs to get the hell out of there asap.

    and, should assert herself to the supervisor stating she WAS acting within sop.

    IF she got fired, she could collect.

    but to me, there's nothing worse than having one's professional role, distorted and diminished.

    seriously, i call bs on this whole scenario.

    leslie

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    • Expert
    Yep, and get this she is being followed by her former preceptor today:uhoh3: Hmmmmmmmmmm

    Certainly she should know that it is now time to find another job. If she doesn't, she will deserve the grief they intend to give her. This is designed to provide a paper trail so they can get rid of her or to encourage her to wise up and leave on her own. There is only so much hostility in the workplace that anyone should be expected to put up with. Another nurse made a mistake, she did the correct action, so now she needs to be watched like a hawk? And what about the RN who only made a mistake? No watching there I suppose. Time to move on down the road.

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