Who Must "Take the Fall?"

Specialties Geriatric

Published

I have wondered for many years about who is ultimatly responsible when a nurse who works in LTC has something tragic happen to her patient. Most nurses who have worked in LTC understand that they are "set up" to fail. Not because mangement nessesarily wants them to fail, but because of corporate greed,mangement caving in to demands of administration, for whatever reasons, work conditions prevent the nurse from doing her job "by the book".Im talking Policy and Procedure book here, the holy of holys.Mangement if the truth were to be told KNOW the nurse cannot HUMANLY do her job by the book.

So now the "worst" has happened,the family is suing, the nurse finds herself trying to explain what happened on that fatefull night when she was working short,was in the middle of the 2 hour med pass, all the call lights were ringing off the hook, Mrs so and so had just fallen and broke her hip, Mr so and so was tearing his room apart, two CNAs were yelling at each other at the nurses station, and Mr. So and so had just eloped, wander guard malfunction. The supervisor was also swamped because she had to take the other floor because of a call in.The meeting with the HR person,the DON, the ADON , the Admininstrator and of course the nurse is over, the nurse is escorted to the door and wonders what just happened?

WHO is to blame here? Who will take the fall? Who should take the fall? Does management ever take the fall along with or even instead of the nurse? What would be an ethical resolution to this scenario? And by the way, this DID not happen to me personally, but it could happen to you or maybe has.

I might be the first to answer this by saying, RUN, RUN for the hills! But what IF there is nowhere to run, what if this happens in all LTCs?

Specializes in TCU,ICU,OHRR,PACU,5Solid Organ Transplan.

Tough question. It's really got me thinking. At my facility errors and sentinel events are treated as system errors. Initially. We work to look at the root cause and how to fix it. This is a long, painful process but when done correctly, it works well.

I work in a non-profit acute care facility. Do corporations actually believe they can make a profit? Are they buying LTC facilities for tax loss?

Running a health care facility regardless of type, is a multidisciplinary approach. Think about it, environmental services, maintenance, lab, radiology........all the way up to VPs,CEOs and The Board. I think the problem occurs when the nonclinical "higher-ups" do not place trust in their health care workers. I understand that finance is important. I must work to eat.

I do hear horror stories abut the conditions of LTC facilities. Those of you who work it because you love it command my utmost admiration and respect. We (society) do terrible things to each other. We treat our elderly worse than our pets. That is pretty bad.

i have wondered for many years about who is ultimatly responsible when a nurse who works in ltc has something tragic happen to her patient. most nurses who have worked in ltc understand that they are "set up" to fail. not because mangement nessesarily wants them to fail, but because of corporate greed,mangement caving in to demands of administration, for whatever reasons, work conditions prevent the nurse from doing her job "by the book".im talking policy and procedure book here, the holy of holys.mangement if the truth were to be told know the nurse cannot humanly do her job by the book.

so now the "worst" has happened,the family is suing, the nurse finds herself trying to explain what happened on that fatefull night when she was working short,was in the middle of the 2 hour med pass, all the call lights were ringing off the hook, mrs so and so had just fallen and broke her hip, mr so and so was tearing his room apart, two cnas were yelling at each other at the nurses station, and mr. so and so had just eloped, wander guard malfunction. the supervisor was also swamped because she had to take the other floor because of a call in.the meeting with the hr person,the don, the adon , the admininstrator and of course the nurse is over, the nurse is escorted to the door and wonders what just happened?

who is to blame here? who will take the fall? who should take the fall? does management ever take the fall along with or even instead of the nurse? what would be an ethical resolution to this scenario? and by the way, this did not happen to me personally, but it could happen to you or maybe has.

i might be the first to answer this by saying, run, run for the hills! but what if there is nowhere to run, what if this happens in all ltcs?

ingelin....i was discussing this with a friend of mine who does work ltc and she said what you are describing is verrrry plausible. she told me that on her wing she manages the care for 36 "skilled" patients,..."skilled" meaning these patients are dialysis patients or patients that have extensive wound care needs etc etc....and we all know what comorbidities go along with those type patients. patients on dialysis that have extremely high k+...or maybe they return from dialysis and have had too much fluid pulled off...they can crump on ya pretttty quickly. she has to do the assessments and give the meds...all the charting etc etc. i can not imagine that...it is difficult to see how that job can be done and assure that all the patients needs are safely being met ..ya know.and ...you are correct that instead of doing root cause analysis when things go awry and a patient potentially suffers as a result....the finger gets pointed at the nurse. however, ironically....when the nurse points out potentially unsafe staffing ratio's to the healthcare facility ...what happens? can anyone remember barry adams?- bc he is an example of what happens.

also...what about california? i know they have staffing laws there to address safety...like icu patients max 2 pts to 1 nurse and general care i believe is a 4 to 1.....but what about ltc patients did they address those patients and mandate a safe staffing ratio for them?:deadhorse

Ive been off this LTC forum for a while, surprised to see more discussion on this posting. I am at the point now that I think that NOTHING will be done to improve this travesty for quite a while. Until we can vote people into the position to make change happen, we are screwed.This last 6 years has been wasted when it comes to healthcare reforms and actually has gotton even worse. Think HARD about who we vote into office, DEMAND EXCELLENCE from these candidates, hold their feet to the fire if they dont deliver on campaign promises. Contact Nursing Home Reform Advocacy Groups, they can point us into the right direction. As for now, all you nurses and in LTC, I salute you.

it is my understanding it is illegal to copy and keep any staffing lists - to do with the other personells privacy breeched - just what i have heard - correct me if im wrong cause ill start copying in a heartbeat of i am wrong :)

If I am going to get nailed for situations that were out of my control and had no power to change and/or correct, I am going to take down ALL OF THE INDIVIDUALS WHO HAD THE POWER TO CHANGE IT AND MAKE IT SAFE. I don't give a hoot what is illegle and/or what isn't it. I will do/collect.make copies of what ever is in my power to accomplish this, and gather everything and anything that supports my allegations. I would rather indict them and deal with the ramifications of what I obtained and/or made copies of. Besides, don't you think that the public would rather be safe when these unsafe situations were made public, then deal with the possibly fatal results of short staffing, insafe situation, etc?

Remember, THEY WILL COLLECT WHAT EVER THEY CAN TO DISCREDIT YOU, EVEN IF IT WAS ILLEGLE FOR THEM TO OBTAIN IT.

They will only find out what you obtained, and how you obtained it, when the $#&** hits the fan, and it will look like retaliation on their part.

I know what the others have said concerning calling/writing JCAHO, Department of Health, etc. and getting no results. I am personnally planning on writing to Lou Dobbs of CNN, and see if I can get a response, or even Jack Cafferty of CNN. They seem to have an interest in "digging up dirt", and this kind of stuff is right up their alley. I am in the process of writing a book, and have an rough outline done so far. I will keep you posted if I have any success with it.

Lindarn, RN, BSN, CCRN

Spokane, Washington

Lindarn, way to go girl, let me know if you need any help, my case against my employer is still in litigation, I have alot to spill my guts on. As far as the oversight agencies, this is laughable, there needs to be a huge investigation there also. Read "Patients, Pain and Politics" by Mary Richards Rollins RN BSN, former state surveyor of WI. This tells a sad tale of our oversight agencies.NO WONDER the LTC has not improved, the oversight agencies are not ENFORCING the laws that regulate LTC.You are so RIGHT when you say the LTC corporations wont hold back from doing ANYTHING legal or not to prove their case, and they spend thousands on lawyers to defend themselves.

Specializes in Day Surgery/Infusion/ED.
What Cape Cod Mermaid said is getting quite distorted.

She helped them. She is not required to feed - which happens to be my only hated part of nursing. She fed anyway so that the floor nurses could catch up. That put her behind while they sashayed out on time even though they would have been paid for staying. CapeCodMermaid, as management, does not get paid anything for extra time put in. I would have been annoyed, too.

But as a nurse in a mgmt. position, she can also probably leave early/come in late/leave during the day for a phys. appt., etc. Try doing that as a staff nurse.

And since when is it a crime for a staff nurse to get out on time? I'd be willing to bet dollars to doughnuts that the nurses there get out late frequently, then get disciplined for not getting out on time.

Specializes in Day Surgery/Infusion/ED.
Thanks Suesquatch. To the other poster who intimated that I only cared about getting out on time....cripes!! Get the point...the point is, it is NOT my job to feed and yet because we were short staffed, I did....the staff nurses whose job it IS did not. That is the point. Another point...you all like to call management pencil pushers. If we don't push our pencils no one gets paid....why must the staff continually holler at management when it is their friends and coworkers who constantly call out??? I'm there....they are there....their friends have called out and somehow they think it is the fault of management....oh so easy to blame others instead of looking to yourself. And face it...some nurses are slugs...some are slackers...not everyone is a wonderful nurse who is just 'overwhelmed with all the work management expects of them'......

Gee, I don't know...maybe because as a manager it's your responsibility to deal with problem employees. Are the staff nurses supposed to take that role on too? What would that exactly leave you to do?

Two words of wisdom "". It's a necessity in LTC. It's like CPR certification you never want to use it, but it helps to be prepared. Let the legal professionals figure out "who's going to take the fall". Staffing ratio's, resident acuities are definite factors. AND BTW if MGT is not open to the calls of their staff for change its not the the place to be. Nursing staff must realize that we have the power to change things. We do it everyday. We warn others to avoid certain facilities, avoid certain healthcare professionals, and even alert mgt when a particular Nurses judgement is questionable. All potentially harmful situations are reportable to the OMBUDSMAN.

Specializes in NICU, ER, OR.

I said it before, and I will say it again. Nursing is a sucker position.

I curse the day I stepped foot into nursing school.

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