Shocked...Confused...& Terminated=SAD "(

[NrsLucky]

i would like to start off by stating that i have never been terminated from any job position i have ever held...until today. i have always had a great reputation at work and never had any issues at any of my jobs...including this specific job. i am going to be very brief and vague in my description in order to avoid possibly giving to much information. with that said...i am just going to briefly give a description of my actions which apparently led to this termination in order to hopefully recieve feedback and some direction. here goes...

today only 30 minutes into my shift at the immediate/urgent care facility i work at part time i was interrupted in the middle of carrying out an order by the physician which was to apply a wet to dry dressing on a patient. i didn't even start applying the dressing yet when the medical assistant barged into the room screaming for me to hurry up and follow her. i asked my patient if she would be okay in waiting here and had her sit completely back on the exam table before leaving. as i followed the ma out of the room i ushered for another ma who was standing in the hallway looking at me to stay with the patient and make sure she was okay until i returned. as i followed the ma down the hall i began asking her to tell me what was wrong. all she kept repeating though was "i have no idea what happened i left her alone for only 5 minutes." when i entered the room the patient was slumped in her chair with one other ma and a receptionist propping her up. she obviously had a vasovagal response to something. i immediately had the ma's assist me in laying her down flat on the floor as i elevated her feet and pulled an ice pack from the drawer to place behind her neck/head. i told the receptionist to go and get the np or md and she stated the np was at lunch and the dr. was doing an exam. i reassured her that it would be okay to politely nock on the door and let him know what was happening. she hesitated before departing. i than grabbed an ammonia tab and had an ma begin waving it under the patients nose in order to try and awake her. i than did a rapid assessment. the patients airway was patent with no signs of obstruction. breathing was normal and even with no shallow or labored breaths. patient was perl. her bp and pulse were low. there were no physical signs of trauma or of a potential allergic reaction. the dr. entered the room, assessed the patient, asked me what happened, and than had me start an iv. he had an ma retrieve the atropine and than gave me the order to administer the medication. i asked if he meant im but he was clear that it was through the iv. i politely refused as this was not in my scope of practice. he looked at me as if i had spit in his face. i tried to explain myself but he rebuked me and asked me to leave the room. i went back to my patient completed my order and continued with my work. i was called into his office 45 minutes later and was informed that i was being terminated for insubordination with a possibility of neglect. there was a huge debate that followed but i will not get into that. it ended with the office manager and the np stating to me once the dr. left the room that they were sorry and that i did nothing wrong. they even said that i can use them as a reference and they would both call around to other urgent care's who had an opening.

i have been there 1 1/2 years. never have i been written up or anything. i am so sad. i have no idea what i did wrong. on a good note; i already was offered a job at a small private urgent care by a pa who partially owns the clinic. in addition i also currently work for my local hospital part time. he was contacted by the np at this job.

i want to know if i should have done something different in these circumstances in order to have avoided this outcome. i admit i am not the most experienced in dealing with situations like this so i know my former coworker who is an rn probably would have been more helpful...but i did what i could... any feedback would be appreciate.

respectfully,

nrselucky

[nurseprnRN, BSN, RN]

"in my area, hospitals only hire rns. we lpns can do everything they can do, except hang blood, admin chemotherapy, do push meds (heparin is ok) and pronounce a person's death. "

i used to hear this from my cna and lpn students enrolled in the adn program. "i can do everything an rn can do, i'm just here for the credential." no, you can't. let us not confuse tasks with nursing; we teach tasks to lay people all the time.

this task-oriented view of nursing is rightfully the purview of the lpn/lvns, and to some extent, cnas. fine. but there are of course responsibilities that rns have as part of their scope of practice which are not in the lpn/lvn sop, namely, responsibility for assessment and care planning and delegation and supervision at the rn level.

back to the op: i hope you've gotten satisfaction, or at least are on the way to it! let us know how it all turns out.

[Silverdragon102, BSN]

OK guys, enough of the bashing and remember we are all licensed nurses whether LPN or RN and all have a role to do within the healthcare envionment. Every state or country that has LPN's as well as RN's have their own rules on what each can do or not do.

Let me tell you in the UK when they had their equivilant of LPN known as Enrolled Nurses they could in most cases do everything a RN could do except manage a ward. Initially we, yes I was one who late bridged to RN, could not do IV access and take bloods now theose that are left because they didn't want to bridge across can do these things now I am not sure about giving IV boluses but we certainly could check blood products with a RN and hang the product up on our own. We certainly did not bash each other because one could do something that the other couldn't. TEAM WORK is the answer and good TEAM WORK means a good team means good support among all

Off soap box and as we all support each other and try to keep to the role of the thread

[nursel56]

☛reply to off-topic post removed ☚

[Altra, BSN, RN]

The young woman came in for a cold (appropriate) and began to feel faint and dizzy, an incidental occurrence.

The scenario described could happen in any private doctor's office, clinic, ALF, LTC, or homecare environment where (I'm assuming but I probably shouldn't) you believe it is safe to hire LP?s.

Not quite.

Though you correctly note that the incident took place in an office practice setting ... per the OP, the patient was syncopal, hypotensive, and bradycardic. An ammonia capsule was used to stimulate her to alertness.

Per the OP, the patient's heart rate was around 50, (after she was once again alert) and the MD wanted Atropine administered for symptomatic bradycardia.

Yes, this could happen anywhere. But if the health care workers present are not prepared to or able to proceed with an appropriate response to an emergency, then EMS should have been promptly activated.

IMO, this scenario is not about LPN vs. RN vs. MA ... it's about appropriate response to emergent situations. And a jackwagon of an MD.

[nursel56]

☛reply to off-topic post removed ☚

[nursel56]

Not quite.

Though you correctly note that the incident took place in an office practice setting ... per the OP, the patient was syncopal, hypotensive, and bradycardic. An ammonia capsule was used to stimulate her to alertness.

Per the OP, the patient's heart rate was around 50, (after she was once again alert) and the MD wanted Atropine administered for symptomatic bradycardia.

Yes, this could happen anywhere. But if the health care workers present are not prepared to or able to proceed with an appropriate response to an emergency, then EMS should have been promptly activated.

IMO, this scenario is not about LPN vs. RN vs. MA ... it's about appropriate response to emergent situations. And a jackwagon of an MD.

EMS should have been promptly activated. If they expect people to do more than that (plus BLS), they should be trained and equipped to do it so everyone isn't running around in and out of exam rooms and asking the MA to retrieve the atropine, etc. and NrsLucky unsure what needed to be done.

I don't think we know enough to judge or make a diagnosis, because Nrs Lucky made it clear there was a concern about providing details. I've seen clinic doctors freak out on many an occasion, this guy is abusive and has Borderline Personality Disorder - I feel very comfortable diagnosing that over the internet. ;-)

[bjaeram]

I think the LVN did an excellent job! She got the doctor, got the patients feet up, got an IV, got a bp and hr....she even wanted to call medics. It think this was all perfect emergency response.

The MD on the other hand is an idiot. He refused medics....um if it's a true emergency this chick needed a hospital. He wanted to push atropine...ummm HR 50 in a young healthy doesn't indicate this, especially for a simple vagal. He assaulted the LVN. He fired her because she followed her scope of practice and now he is threatening her.

Kudos to the nurse!

I would love to hear how this turned out. Did you go to the meeting?

[danarooo, BSN, RN]

You did the right thing, you are a strong nurse who clearly knows your boundaries and you should be proud. You protected yourself and your license. Be proud of yourself for being so strong!

Sorry you lost your job over this, it really sucks that you were punished for doing the right thing. That doc is an ass!

[suanna]

That's just downright insulting.

I'm sorry for those who feel insulted by my post. I didn't say LPNs/LVNs aren't able to provide effective care, equal to that of RNs in non-acute care enviornments. I just think is is in the best intrest of the companys profits, not the patients, to have a staff member who isn't licenced to provide many of the interventions and tasks that may be part of the patient population they are serving. This wasn't a LTC facillity where the patients conditions, problems and likelihood of crashing are known. It wasn't home care where skilled care can be provided but without the need of a STAT cart. Unless I missed it in the post this was a provider that could expect at least SOME acute patients to come in who would be in need very aggressive acute care management. The LPN was placed in a job where she would have to make choices daily about exceeding her scope of practice or providing less than optimal care. I don't find that fair to her or the patients they were seeing.

[nursel56]

Urgent Care centers rarely hire any (in my state anyway) licensed nurses and refer emergencies to the ED. There's another thread about that going on right now. Homecare patients are often adults and children with trachs and vent dependent. The fact that most people don't have a STAT cart in their homes makes it even more important that we stay on top of possible emergent situations. Those are just the facts for people who may not know that. I don't wish to argue.

[CloudySue]

[quote=grntea;6124121

i used to hear this from my cna and lpn students enrolled in the adn program. "i can do everything an rn can do, i'm just here for the credential." no, you can't. let us not confuse tasks with nursing; we teach tasks to lay people all the time.

this task-oriented view of nursing is rightfully the purview of the lpn/lvns, and to some extent, cnas. fine. but there are of course responsibilities that rns have as part of their scope of practice which are not in the lpn/lvn sop, namely, responsibility for assessment and care planning and delegation and supervision at the rn level.

laypeople and cnas do not have licenses to protect. lpns do. in pennsylvania, the four skills i had stated previously were those which are not within the lpn's scope of practice, under any circumstance, including an md standing there telling us to do it anyway. in my practical nursing program, i was fully trained in assessment, care planning, nursing dx, pt education, supervision, and delegation. it's not like all we do in school is practice administering enemas to big plastic disembodied butts.

different institutions can certainly institute policies which put limits on their own lpns' responsibilities. for example, in my company, an lpn can educate and orient a new nurse on a case. in other places, only an rn can train/orient. with proper training and in some cases extra certifications, we lpns are qualified to do quite a bit. i have been lucky with my work environments insofar as that i have never been treated less than a full-fledged nurse by any of the rns. strangely, the only time i ever feel minimalized as a healthcare professional is here on an.

[shawna.k]

I'll get my fire extinguisher out 'cus I bet I get "flamed" but you just illistrated the argument I've always had for eliminating LPN/LVNs in acute care. Pushing atropine is an appropriate intervention and could easily have been life saving but the doctor has to figure out not only what is wrong with the patient, how to treat it, but who is or isn't the right flavor of "nurse" to carry out this intervention. As far as a "MA" I'm not sure in your state what thier scope of practice is, but the title "Nurse" should mean the same something whenever it is used. My opinion- an LPN/LVN shouldn't be working in an area where emergancy interventions/ verbal orders/ IV meds are likely to be happening. I would go as far as saying we may need a new title for those serving as a VN/PN in todays health care. I feel badly for everyone involved. It isn't your fault, but the facillity shouldn't be placing the doctor and the patients in a position where there is no skilled, licenced care giver present that can legaly follow the doctors instructions in the event of a crisis.

I agree that staffing should appropriately reflect the type of care provided. Having said that, I'm an LPN in Georgia. Our scope of practice has few limitations compared to that of an RN. To address another point...I'm a nurse...and that's that! It's not enough that I do the same work as the RN's I work with for much less pay? Now, I need a different title? I work med-surg and I love it! I don't fret about the pay, but I wouldn't give up proudly calling myself a nurse without a fight. I do think you have a great point for eliminating LPN/VN'S in acute care settings...in states where the scope of practice is more limited.