Who is liable? The nursing home or the nurse?

[ecmst12]

Well, it's not clear that this would rise to the level of neglect that would need to be reported. If it did, a nurse is a mandated reporter and could get in trouble with her license as well as with the law. But changing a dressing once a day instead of twice a day, or once a week instead of twice a week, would not rise to that level. Not changing the dressing for many weeks *might*. But it would also depend on the specific patient, if the dressing was intact and the site looks ok and the wound was not that severe to start with, not changing the dressing for a while might not cause any harm. It would depend.

 

[tranquility]

Well, it's not clear that this would rise to the level of neglect that would need to be reported. If it did, a nurse is a mandated reporter and could get in trouble with her license as well as with the law. But changing a dressing once a day instead of twice a day, or once a week instead of twice a week, would not rise to that level. Not changing the dressing for many weeks *might*. But it would also depend on the specific patient, if the dressing was intact and the site looks ok and the wound was not that severe to start with, not changing the dressing for a while might not cause any harm. It would depend.

I believe the standard of care for a nurse regarding a "specific patient" would not be if the site looks ok or if the wound was not that severe, but to follow the doctor's orders. Failing to do so, without notifying the doctor (and not just not noting it in the chart) would be practicing medicine without a license.

 

[ecmst12]

That's because you know nothing about nursing. And the level of harm which the patient might suffer is CLEARLY important in judging whether the patient is being neglected and needs to be reported to APS. There are some matters that warrent a phone call to the doctor immediately and some that don't. Documenting in the chart is the appropriate action for the nurse in this case.

 

[tranquility]

Before you start getting silly, why don't you research FL law on what could be a criminal or tortous act in similar circumstances?

I'd say a nurse has a legal duty to not only follow accepted standards of care but also to carry out specific care instructions for each patient as determined by a doctor.

My understanding you are training or have trained in nursing. You better review your knowledge.

 

[TheGeekess]

Bedsores are sometimes unavoidable, and sometimes due to insufficient care.

The other thing the nurse should be aware of, is that her employer insures her care as well, so even if she doesn't have private malpractice insurance to back her up, the employer will cover her if she is named in a lawsuit. The nurse will pretty much always be NAMED in any lawsuit, but rarely will be the primary liable party in a suit, because of the scope of practice. They will name every caregiver that participated in the patient's care, but not all of those will remain involved through trial (if it even gets that far).

Just an FYI: When Mom had an active RN license, she and Dad carried a rider on their home insurance to cover her for malpractice. IIRC, that's a pretty standard practice across the US.

 

[TheGeekess]

That's not what's happening here. And if the nurse documents in the chart, attempted to change dressing but was unable due to shortage of XX supplies, informed supervisor of need, with the date and time, every time she is unable to change a dressing on time, she is covered. She is not expected to pay for the supplies out of her own pocket. And either way, she's not "intentionally not following a doctor's order".

I'd like to know what's keeping the OP's friend from contacting the Central Supply/Services of this facility. If they are not keeping items in stock on the unit, seems to me that that would be the first action.

 

[Antigone*]

I'd like to know why the OP's friend doesn't call in an anonymous report to the Dept of Health or the governing body there in Florida to inform them of how poorly the patients are being treated.

If patients are being care for properly, the incidence of bed sores should be relatively low.

This kind of stuff hits close to my heart, and I have to say that my daughter spent four years in a long-term care facility and never had a bed sore. I'm happy to say that she is home now, and her nurses at home have continued the standard of care. They make sure to turn her every two hours and whatever else they do.

 

[ecmst12]

Like I said, some patients are very delicate and even if they are turned every 2 hours, skin breakdown can occur. But of course there are plenty of times in plenty of nursing homes where the patients are NOT turned as much as they should be and that leads to bedsores. If you have a loved one that has to be in a long term care facility, it is best to keep a very close eye on how things are done there. Part of the reason so many places get away with giving substandard care is because the families don't care enough to pay attention to it.

 

[Antigone*]

Like I said, some patients are very delicate and even if they are turned every 2 hours, skin breakdown can occur. But of course there are plenty of times in plenty of nursing homes where the patients are NOT turned as much as they should be and that leads to bedsores. If you have a loved one that has to be in a long term care facility, it is best to keep a very close eye on how things are done there. Part of the reason so many places get away with giving substandard care is because the families don't care enough to pay attention to it.

Come rain or shine, I was there at my daughter's bedside every day. The only time I didn't go spend time with her was when I was sick. What you say is 100% correc, Em. It is imperative for the care of a loved one in a long-term care facility that someone always be monitoring what happens at the facility. I was always on top of things with regards to my daughter's care, and if something was occurring that I didn't like, belive me everyone involved heard from me. In lil Tigi's room was another girl, same age as lil Tigi who never had any visitors, it was clearly evident that the type of care she got was very different from the care lil Tigi got. In fact I used to overstep my bounds quite often to speak for this girl because she had no family to speak of.

I know you're studying nursing Em, and I have to say that you are a blessing and thank you!

 

[ecmst12]

The unit I was on for clinicals last semester had a lot of transfers from nursing homes and it was really obvious which nursing homes provided good care and which were absolute disgraces. I just started this semester but I suspect the unit I'm on now also will have a lot of nursing home transfers but the hospital itself is not quite as nice as the last one I was at. I'm definitely learning where NOT to send my parents someday.

And thank you Tigi!

 

[tranquility]

For a good power point on the changing legal issues related to pressure sores and their care, see:

https://ps.mcic.com/appdocs/lps/Yankowsky_Fife_PowerPoint.pdf

 

[quincy]

The unit I was on for clinicals last semester had a lot of transfers from nursing homes and it was really obvious which nursing homes provided good care and which were absolute disgraces. I'm definitely learning where NOT to send my parents someday.

I think it is important for violas to report the lack of supplies to treat the bedsores and, if she is reluctant to report this to the doctor, she needs to report the nursing home supply shortages to the state.

There have been state and federal investigations into nursing home negligence and abuse for years and, while there has been some noted progress in some areas in some states, the substandard staffing in nursing homes across the country continues, often due to the understaffing of the agencies who are supposed to oversee them. For a look at some disturbing findings, here is a link to the 2006 Office of Inspector General for the Department of Health and Human Services report, compiled after the Office conducted audits and inspections and investigations into nursing home operations: http://oig.hhs.gov/oei/reports/oei-01-04-00340.pdf.

In Florida, in 2009, The Florida Agency for Healthcare Administration investigated complaints of nursing homes and immediately shut seven homes down for severe violations, while 70 more nursing home centers were labeled poor and on a list for closing in the future due to violations that put the residents' health at risk.

This year, a Florida lawsuit against a nursing home (Webb v University Place Care and Rehabilitation Center) resulted in damages being awarded the plaintiffs of $900 million, this when evidence showed the plaintiff suffered pressure sores and infections that resulted in a leg amputation. The operators of University Place Care were found to have put profit above patient care, cutting back on necessary supplies and utilities at the Center.

A similar suit in Florida in 2010, Jackson v Trans Healthcare, Inc, stemmed from a patient's death. The patient had numerous bedsores, the result of which were traced to understaffing.

It is often a sign of neglect in a nursing home if the patients suffer from poor hygiene, a significant loss of weight, bruising, fractures, and bedsores. The neglect can often be connected to poorly trained personnel, poor medical treatment and understaffing at the facilities.

Because violas can be at risk of losing her job and her license whether she ignores the doctor's orders or whether she fails to report substandard supplies which compromise the health of the residents of the nursing home, I advise that she makes a report to the state.

And I add my thanks to Antigone's, ecmst. I know I owe my daughter's life to the nurses in the neonatal intensive care unit. The doctors were great, but the nurses were the ones who provided her essential care. I admire nurses no end.

 

[commentator]

Which is why I get the overpowering feeling that this friend of the OP's is an LPN, not an RN, who would surely have more professional pride and experience than to simply say, "Oh I can't say anything to the admins cause I'm afraid I'd get fired."
As I said before, that's dumber than dirt. Even in third world states like my own, (and Florida, I suspect) with huge powerful nursing home lobbies in the state legislature, the nursing homes know they have anonymous tip lines and complaint lines and there are a good many ways a person could report the situation in a nursing home without being identified, if that were the route they should choose to go. And to be that scared of losing her job, that is just a silly excuse.

 

[ecmst12]

Well, it's not OP, it's her friend. And a lot of LPNs I've talked to are indeed dumber than dirt. I've talked to a few RNs that dumb as well - mostly ones that work in long term care places, because they are pretty much the bottom of the barrel for nursing jobs. Some people do have a love for geriatrics, but for the most part, people work in nursing homes because they can't get a job anywhere else.

 

[commentator]

Our legislature has passed a new law that in our state there is no longer even an LPN required to be on each shift at nursing homes to administer meds, etc. It all can be done by the 2.5 aides (after all they've had nearly whole two months of training!) that are mandated for every so many patients. I am not saying that LPN's are dumb. By no means. And I believe that nursing is a true calling, particularly geriatric nursing.

The nurses who work at these type facilities may a true calling, or they have issues that keep them from finding jobs easily, But for her to claim that she is helpless in this situation, she cannot do the right thing because she is so afraid of losing her job, that's something I've heard about a million times in my career, and the guards were probably using it in the concentration camps, and it stinks every time I hear it!