An LPN is in her first employment position since graduation. She is working at long-term care facility in the respite unit. In this unit there are 12 beds for respite care as well as clients who live in the facility permanently. This means that respite clients are admitted from the community for short periods of time, perhaps to give family members and caregivers a break, or to allow them to go on holiday. Sometimes, respite allows a caregiver to take care of their own failing health or to have a needed surgery.

The unit is very busy with 2 to 3 admissions and 2 to 3 discharges every day. The LPN has been given four shifts of orientation – 2 days, one evening and one night – working alongside another LPN. After this she starts to work on her own, being placed in charge of the unit and responsible for the supervision of four care aides, one dietary staff at meal times and one rehab assistant. The unit is also supported by an activity aide and a music therapist (for a few hours per week). Residents may go off the unit to attend entertainment activities in the home.

After six shifts in charge, the LPN is looking forward to her days off, starting tomorrow. She feels she is unable to keep up with the pace of the unit and is concerned that she has not been able to complete all of her work satisfactorily. She is aware that she has cut corners during each day and, sometimes, did not have enough time to complete all of the checks she was taught about in school before administering medications to some of the residents. She tells the nurse manager about this situation before leaving for her days off.

  1. What ethical dilemmas is the LPN faced with at this point in her career?
  2. What specific parts of the BCCNP Professional Standards do you believe are under threat in this situation?
  3. As a member of the public or a family member, what would you want the LPN to do at this point in time?

Part 2:

The LPN returns from days off for the evening shift and is told that the unit is “really busy today”. She is already aware of this, because, as she entered the unit, she was approach by at least two new residents asking to go out and meet their family members, and to “let me go home”. She also noticed that the nurse on duty was completing an admission interview with caregivers of another new resident who had arrived just 30 minutes previously. The LPN immediately became immersed in the workload and only had time for a very brief handover from the departing nurse. She senses her anxiety rising as the shift progresses. In the mid-afternoon, the Director of Care pops into the unit for a few minutes, “just to see how the new residents are settling”. She tells the LPN she had received calls from 2 families who told her that no one is answering the phone on the unit. The LPN admits that she had forgotten how to use the phone and had hit the wrong button for a few calls.

  1. What are the ethical responsibilities of the LPN now?
  2. What risks is she running in continuing to work under current conditions?
  3. Would you consider this LPN to be a professional nurse? Why or why not?

 

Part 3:

A week later, the LPN meets with the Director of Care to discuss her progress. At that meeting she raises a number of the ethical issues identified above. The Director of Care explains that the unit is busy and there is a lot of pressure on the unit to take as many respite cases as possible in order to alleviate the pressure on families and caregivers, and to keep dementing people in the community for as long as possible. She realises that this is a high demand position for a new graduate, but she is confident that the LPN will soon settle into the position. She reassures the LPN that she is doing a good job. She tells her just to call when she needs help. The LPN is aware that the Director is not always on site in the evening of weekend. She agrees to give it “a try for a bit longer” to see if she can settle. In her mind she thinks, “Maybe it is just me? I’m new and other nurses on the unit have not complained. At least, they haven’t told me if they have and the Director did not mention it.”

  1. What new issues have arisen from this meeting and how does this change the situation?
  2. Has the LPN addressed her professional requirements, in terms of the BCCNP Professional Standards? Why or why not?
  3. What is your assessment of the ethical conduct of the Director of Care in terms of interdisciplinary collaboration?