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Discussion

Seniority rules right?

I should have trusted my gut about this place and left after the first day but I didn't. I've been an LPN 4 months and 10 days. I work in long-term care in the evenings (4pm-12am). It is a 70 bed facility and I have 35-37 residents. It seems like every evening when I get there that place is full of chaos. One evening in particular the CNAs told me a resident was hurting in the leg or hip. The resident is immobile and requires full assistance. I told them to hang on a second I would be right there. Before I could look in her chart for her dx they ran to the other nurse on the other hall and called her to the resident's room. When I entered the room the other nurse had both of her hands under the resident's thighs. After she finished her assessment she gave the lecture on the resident's dx and that it could be the possible reason for it. Then she turned to me and asked if I felt the difference. Now to fast forward. It turns out the lady had a fractured femur. The other nurse denies she said anything to me but does admit entering the room and examining the resident. She also said she walked out of the room immediately upon my entering it. This nurse is a persistent liar and blames anything and everything off on everyone she possibly can. The point is this has turned into a state issue for obvious reasons. She has been a nurse 5-7 years and I have been a nurse 4 months. Neither of us documented examining the resident. This went on for 2 weeks b/f it was discovered to be a fracture so it has passed through many hands including the ADON. They are all blaming me. My question is don't the senior personnel share the blame? Shouldn't they have vetoed my decision? I am stuck. Advice? Thoughts? Comments?

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    • Featured Replies

    • Experts
    My question is don't the senior personnel share the blame?

    No, seniority does not always prevail. Since you were the patient's primary nurse when the complaints of pain first arose, it was up to you to take the course of action that any other prudent nurse would do, which is to notify the MD of the change in condition.

    It doesn't matter how new of a nurse you are. It doesn't matter if your managers and administration team may have more experience and fancier degrees. You are still expected to practice in accordance to an established standard of nursing care.

    Once the physician has been notified (and documentation is present to back up your assertion that you notified the MD), your behind would have been covered. However, a fracture was allowed to go unnoticed for two weeks because the buck appears to have been continually passed.

    Many people are to blame in this situation, but all eyes will be focused on the primary nurse who cared for the resident when the complaints of pain first surfaced. Always remember that if it wasn't documented, a shady coworker can lie and say it never happened. After all, she's basically saying, "I made the patient's nurse aware that there was a problem. The ball was in her court."

    Good luck to you and keep your chin up.

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    "Neither of us documented examining the resident."

    And here lies the problem.

  • Quote
    • Experts

    Let me understand. This patient complained of leg/thigh/hip pain for 2 weeks before it was addressed? Were you, and the other nurse, the initial nurse who looked at her with her complaint of pain? How ;long after that day did the patient have her complaint addressed and it was found to be fractured?

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    • Admin

    I'm a little confused as to why you would first go to the chart rather than check the resident. Assessment of the patient with a change in health status would, to me, be the priority. Then notifying the physician of the change in status. Then document, document, document. If it wasn't documented, it didn't happen. Yes, there are multiple people at fault, but you aren't exactly innocent here either. Hopefully you will come through this and have learned from it to boot.

  • Quote
    I should have trusted my gut about this place and left after the first day but I didn't. I've been an LPN 4 months and 10 days. I work in long-term care in the evenings (4pm-12am). It is a 70 bed facility and I have 35-37 residents. It seems like every evening when I get there that place is full of chaos. One evening in particular the CNAs told me a resident was hurting in the leg or hip. The resident is immobile and requires full assistance. I told them to hang on a second I would be right there. Before I could look in her chart for her dx they ran to the other nurse on the other hall and called her to the resident's room. When I entered the room the other nurse had both of her hands under the resident's thighs. After she finished her assessment she gave the lecture on the resident's dx and that it could be the possible reason for it. Then she turned to me and asked if I felt the difference. Now to fast forward. It turns out the lady had a fractured femur. The other nurse denies she said anything to me but does admit entering the room and examining the resident. She also said she walked out of the room immediately upon my entering it. This nurse is a persistent liar and blames anything and everything off on everyone she possibly can. The point is this has turned into a state issue for obvious reasons. She has been a nurse 5-7 years and I have been a nurse 4 months. Neither of us documented examining the resident. This went on for 2 weeks b/f it was discovered to be a fracture so it has passed through many hands including the ADON. They are all blaming me. My question is don't the senior personnel share the blame? Shouldn't they have vetoed my decision? I am stuck. Advice? Thoughts? Comments?

    What I can't understand is why YOU didn't document. Or call the MD. It doesn't matter what the other nurse did or didn't do -- YOU were the nurse in charge of the patient at that time.

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    The short answer is-NO.

    YOU have a license and a duty to assess/data collect and report your findings to the physician; and document.

    This resident could have been treated weeks ago; now you have a delay in treatment occurrence that happened on your watch.

    Hope you have malpractice insurance. :blink:

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    • Author

    Welp, I learned from that situation. Resident recovered fully. I quit that job and got another one paying more money and working with less shady people. As it turns out there were some problems with her day charge nurse and she tried to pawn it off on me but everyone couldn't get their lie together. Yes, yes, yes, I should have documented but I did not. It's over now. :)

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    • Experts

    Thank you for returning to provide an update. I am glad you found another job. Good luck to you!

    Welp, I learned from that situation. Resident recovered fully. I quit that job and got another one paying more money and working with less shady people. As it turns out there were some problems with her day charge nurse and she tried to pawn it off on me but everyone couldn't get their lie together. Yes, yes, yes, I should have documented but I did not. It's over now. :)
  • Quote
    Welp, I learned from that situation. Resident recovered fully. I quit that job and got another one paying more money and working with less shady people. As it turns out there were some problems with her day charge nurse and she tried to pawn it off on me but everyone couldn't get their lie together. Yes, yes, yes, I should have documented but I did not. It's over now. :)

    It will never be over as long as you have this mentality...

    "My question is don't the senior personnel share the blame? Shouldn't they have vetoed my decision? " Professionals are responsible for their own actions.

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    • Experts

    You were very lucky. Glad you got another job and learned from this. In contrast to your results, a nurse who was my former DON, had a similar incident charged against her when she was working at a different facility as a staff nurse. She was fired and her license was disciplined. She had stipulations placed on her practice for several years in order not to have her license revoked. This nurse had a decade or three of experience before this happened to her. People are not always as lucky as you were in this case. Make certain that this never occurs on your watch again. Best wishes.

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