Question

A licensed practical nurse (LPN) employed by a nursing personnel agency worked one evening shift at the Veterans Administration Hospital in a major city. She cared for a patient who had recently undergone hip replacement surgery. Since his surgery, the patient had consistently spiked significant temperatures, and his temperature generally responded well to oral Tylenol, 500 mg, 2 tablets, every 4 hours as needed. The change nurse explained to the LPN that the patient was to continue on vital signs every 4 hours, including temperatures, and that he was to be medicated if his fever increased, even if only at low-grade levels. During the evening that she worked, the LPN obtained the patient’s temperature at 4 p.m. and again at 8 p.m. He had a low- grade fever at the 4 p.m. hour and his temperature had risen to 102 degrees orally at 8 p.m. At both intervals, the LPN administered Tylenol as ordered. The charge nurse did not assess the patient during the evening, nor did she inquire about the patient’s condition. The nurse caring for the patient at midnight noted that his temperature was still elevated (102.4 orally). When notified, the attending physician ordered blood cultures, additional treatment for his ever-increasing fever, and a change in antibiotic therapy.

            Despite this aggressive therapy, the patient developed a fatal septicemia and the patient’s family sued for wrongful death. At trial, the court determined that the charge nurse had been derelict in her duty to supervise this patient and assessed partial liability against the LPN and the charge nurse.

• Did the nurse manager have a responsibility to supervise the care of the patient?
• Was the care of this patient appropriately assigned to the LPN by the charge nurse, or could the charge nurse have delegated this patient's care more appropriately?
• If the charge nurse assigned the care of the patient to the LPN, did she retain any supervisory responsibility that would result in her liability in this case?
• How do the principles associated with delegation and supervision figure into this case?
• How would you decide this case?

Answer 1

The nurse manager responsible is supervising nurses in hospitals. they should also supervise patient care for creating a safe environment and support the work of the health care team and involve in patient engagement.
charge nurse should hand over standard duty to the LPN. LPN can check patient vitals and monitor and administer medication and observe the reaction and if any alteration can report to the supervisor or physician.
when charge nurse assisted work for LPN, it is important that the charge nurse should supervise LPN patient care. In this case, the charge nurse did not assess the patient during the evening and fail to enquire about the patient's condition.
Principles associated with delegation and supervision figure, in this case, are not providing culturally sensitive, safe, timely, effective patient care. nurses' knowledge and critical thinking skills provide evidence-based care for the patient. LPN's inadequate knowledge about patient temperature elevation made harm to the patient. charge nurse delegate task should be with avoiding potential harm for the patient and stabilize the patient's condition and aim for a good outcome.
This case belongs to professional negligence and the theory of personal liability behavior for nurses. As a nurse manager and LPN their response to adhere to governing patient care providing safety for the patient. Delegate patient care based on staff strengths and weaknesses and provide additional orientation and supervision of patient care to improve patient care skills.