Who is to blame

[Finallydidit]

SCENE SET-UP: Unit 1 = 60 Residents, 2 LPNs, 1 RN, 4 CNAs. Split into two halls..

TIME: 10:30pm (30 minutes before shift change)

RN setting at desk,

LPN #1 charting restocking cart,

LPN #2 on phone with Pharmacy trying to get pain meds (that were supposed to be delivered 6 hours ago) for new admit. (Been playing phone tag with Dr. Pharm most of the evening) Family present and very upset.

CNAs doing last dry round

CNAs for LPN #2 come and say LPN #2, Resident X has fallen of the bed and hit her head. RN and LPN #1 go to evaluate Res. X, because LPN #2 is on the phone.

RN and LPN #1 agree Res. has to be sent out, due to hitting head. (LPN #2 still on phone) RN calls EMS and does paperwork to send to E.R. with asisstance from LPN #1. 10:45 EMS arrives, (LPN #2 still talking with pharmacy trying to get pain meds.) RN handles the transfer, gives EMS report etc. Res. leaves the building.

11pm CNAs, RN and LPN #1 go home. LPN #2 hangs up with pharmacy at 11:10, her whole crew had left, she leaves at 12:30 because she due to being behind because she had been trying all evening to get pain meds for new admit.

3am Res returns from ER diagnosis UTI !!!!! Res. didn't even have head looked at... No one called report to hospital, prior to transport!

8am family showed up and is not happy that a c/t scan wasn't done at hospital, ADON goes to look at nurses note just to see what happened, and nothing was documented anywhere. Who was at fault for this?

LPN #2? Although she was busy with another Resident, and basically had no knowledge of what happened, other then something happened, although it was her Resident that got sent out.

RN ? Her role on evening shift is to asisst LPNs when they get behind, and she left without reporting to LPN #2 what had happened and what needed to be done.

according to the ADON, to appease the family, someone has to be fired! Who would you fire? RN or LPN #2 or both?

I'll tell you the outcome after I get a few opinions...

[kids]

according to the ADON, to appease the family, someone has to be fired! Who would you fire? RN or LPN #2 or both?

I'll tell you the outcome after I get a few opinions...

I didn't scroll forward- I'll do that after I post my opinion...

If someone absolutely has to be fired it should be the RN.

Her roll is to assist the LPNs if they get behind and from the original post she took the lead in getting the patient transported.

LPN #2 was occupied at the time the fall was discovered, the RN and LPN #1 (acting as good team members) stepped in to assess the patient then made the treatment decisions. It's all on them at that point.

Regardless of whose patient it is they took action and failed to document their actions.

I've been the RN in a very similar scenario and would have expected to be at the very least written up if I failed to document.

[MAISY, RN-ER, BSN, RN]

While I agree that the RN takes the position knowingly that she is in "charge", I also have to say that if LPNs are wearing the moniker of nurse; then documentation is all of their responsibility. No one should be fired.....or then again, maybe the DON should be fired due to jellified backbone.

Geez.....

[Finallydidit]

WOW lots of replies while I was at work...

So the outcome was LPN #2 got fired as it was her patient PERIOD!

RN and LPN # 1 didn't even get a write up

No I am not part of the group, I work on the other unit, and she was/is a great nurse and she was really trying to satisfy the new admits family, The reason it was taking so long to get the narcs is it was unclear on the hard script if it was oxycodone, or oxycotin. (looked like oxycod and the D was crossed, followed by a scribble) So therefore she pharmacy wouldn't give permission to pull from the back-up box, and wouldn't send meds without a faxed hard script. Family was furious to say the least, and I agree RN should have been handling that from the get go.

RN did do transfer papers and talk to EMS, SO one would think that EMS would have known the reason for the transfer. But she didn't call the ER and give report.

The Resident was fine no injury, no blood, just an unwitnessed fall with head hitting the floor... Protocal is that they have to be sent out.

As far as the family and the DON appeasing them... Its all local polotics nuff said!

LPN #2 is going to school now for her RN has an 8 yr old to support and is now jobless, and unlikely to find another job that will work with her school sched. and I just feel really bad for her. She really thought the RN would take care of the transfer and paperwork.

I guess the lesson is as we have all been told many many times

ALWAYS COVER YOUR BUTT!!!

[caliotter3]

Thanks for the update.

[MAISY, RN-ER, BSN, RN]

Perhaps you should send this thread anonymously to your DON and RN and LPN1.

That firing is ridiculous!

[nursel56]

Discipline the RN, warnings to LPNS, fire the pharm doc. He's clearly incompetent. Waiting 6 HOURS for meds, and they're still not there?

That's what I was going to say! It's very curious to me why the nurse was on the phone with the pharmacy for 40 minutes. Seems to me that either the pharmacist is really dense or she was repeatedly put on hold while he phone tagged the PCP. I go bonkers when I'm on hold for more than three minutes.

[SuesquatchRN, BSN, RN]

While no one should have been fired, as the RN and therefore the supervisor it is my fault. Period. As I accept the higher pay I accept the higher responsibility. I can't imagine walking out on such a scenario without having made certain that I had dotted the is and crossed the ts.

[GHGoonette, BSN, RN]

I'm still trying to find the words to respond to this. Obviously I can't type in what I said when I first read the outcome, AN would have banned me until I disinfected my PC!

Right; deep breath.

The RN was responsible for what happened on her shift. This has been pointed out repeatedly in other posts, and for that reason she should have been taken through the disciplinary process.

LPN#1 carries no blame that I can see, so it makes sense that she was not written up.

LPN#2 did not prioritize and should have handed over the phone either to the RN or LPN#1; this is an issue that calls for counseling, possibly a written warning and possibly in-service training regarding time management. It is not a firing matter and I really hope that some of the Union firebrands pick up on this thread. As for family members dictating who shall be fired.... And now here's a good nurse with small children to support kicked out of her job because family demanded it? Polite words fail me.

Pharm doc receives a prescription signed by an MD; if I take a prescription to a pharmacy which the pharmacist cannot read, he or she contacts the prescribing doctor and queries it. It is not my job to clarify it, it is the pharmacist's responsibility to make that call. So why wasn't that call made 6 hours previously?

OP, I hope your (now former) colleague lands on her feet. If she can just find other work, she's probably well shot of that place anyway.

[imintrouble, BSN, RN]

WOW lots of replies while I was at work...

So the outcome was LPN #2 got fired as it was her patient PERIOD!

RN and LPN # 1 didn't even get a write up

No I am not part of the group, I work on the other unit, and she was/is a great nurse and she was really trying to satisfy the new admits family, The reason it was taking so long to get the narcs is it was unclear on the hard script if it was oxycodone, or oxycotin. (looked like oxycod and the D was crossed, followed by a scribble) So therefore she pharmacy wouldn't give permission to pull from the back-up box, and wouldn't send meds without a faxed hard script. Family was furious to say the least, and I agree RN should have been handling that from the get go.

RN did do transfer papers and talk to EMS, SO one would think that EMS would have known the reason for the transfer. But she didn't call the ER and give report.

The Resident was fine no injury, no blood, just an unwitnessed fall with head hitting the floor... Protocal is that they have to be sent out.

As far as the family and the DON appeasing them... Its all local polotics nuff said!

LPN #2 is going to school now for her RN has an 8 yr old to support and is now jobless, and unlikely to find another job that will work with her school sched. and I just feel really bad for her. She really thought the RN would take care of the transfer and paperwork.

I guess the lesson is as we have all been told many many times

ALWAYS COVER YOUR BUTT!!!

LPN # 2 was in a no win situation. I feel so bad for her. I don't agree with the outcome, not one bit. I don't think I'd agree with any outcome from this situation but this seems particularly unfair.

Thanks for the update.

[caliotter3]

LPN # 2 was in a no win situation. I feel so bad for her. I don't agree with the outcome, not one bit. I don't think I'd agree with any outcome from this situation but this seems particularly unfair.

Thanks for the update.

Totally agree with this. When the supervising RN took charge of the situation LPN#2 thought she was covered, but as in many similar cases, she was proved wrong. She was clearly scapegoatted, and all involved should learn from her misfortune.

[JacknSweetpea]

Always, always CYA and never trust management and families!!! Trust me, when **** hits the fan, they will want your blood!!! It doesn't matter who is at fault!!

[Oprn54]

Its obvious by your account that the RN basically took charge of the transfer. As the RN, and supervisor she should have made sure the transfer was complete which includes a report called to the ER especially with a possible head trauma. She also should have documented the assessment and the transfer, and waited until lpn 2 got off the phone to give her a report on what was done with her resident. The RN could have delegated some of this to the LPN that was assisting, but still should have followed up to make sure everything was done before she left. In the long term care setting the RN is always the supervisor, and unless someone with more authority was present and involved the buck stops with the RN.