An Indiana Licensed Practical Nurse (LPN) has been charged with felony charges of practicing medicine without a license for allegedly removing a resident’s oxygen mask without a physician’s order. The resident died hours after the oxygen was removed.
In April 2020, a resident of a nursing home where the LPN had been employed for 15 years, had been struggling after days of aggressive treatment for COVID-19. In a May 2020 interview with state inspectors, the LPN confirmed that she had removed the man’s oxygen. She told the state inspectors that she had a terrible week, and she was caring for more than 40 COVID-19 patients at the nursing home when she forgot to notify the resident’s physician of the man’s decline. The report states that the resident received no additional treatment and died nearly eight hours later.
Authorities began their investigation after learning that the LPN had posted on her Facebook page regarding removing the resident’s oxygen. The LPN posted, “I asked him on day 4 if he’s tired, he said yes. I said do you want me to take all this off for you, and you go and fly with the angels, and he said yes.” In the same post she wrote, “I took it all off for him. I went in the hallway and cried, and I let him go. He passed away 1 hour and 45 minutes after I left.”
The LPN, who has an active LPN license in the state of Indiana, was terminated from the nursing home in May 2020 after it was determined that she had violated the nursing home’s policy and standard nursing practice by both administering and then removing the oxygen. After receiving a report from Indiana’s Attorney General’s office in March 2021, the county prosecutor determined that charges should be filed against the LPN. The county prosecutor stated, “After reviewing the results of the investigation, it was my conclusion that this nurse was not justified in removing this man’s oxygen without consulting with and getting the permission of the supervising physician.”
If convicted, the LPN could face one to six years in prison and a fine of up to $10,000.
Issue:
All licensed staff must be knowledgeable of their state’s scope of practice act. Practicing outside of their scope of practice guidelines can lead to licensure suspension or termination of their nursing license. A Nurse Practice Act is a set of laws that mandates the scopes of practice and responsibilities for Registered Nurses (RNs) or Licensed Practical or Licensed Vocational Nurses (LPNs or LVNs). RNs can be held responsible for the acts of LPNs, since RNs generally supervise LPNs in nursing homes. Therefore, it behooves RNs to be fully aware of the scope of practice of LPNs in addition to their own licensure scope of practice.
The Med-Net Comprehensive Compliance and Ethics Policy and Procedure Manual provides additional information in Chapter 5 Privacy Plan: PP2.2 Maintaining Resident Privacy; PP2.3 Social Media and Networking; and Chapter 7: Resident Rights RR1.0 – 3) dd F580 Notify of Changes.
Discussion Points:
- Review your policy regarding licensed nursing scope of practice in your facility. The Director of Nursing and the Medical Director should collaborate to ensure that the scope of practice in your facility abides by your state’s mandates for both LPNs and RNs. Review your policy and procedure for use of social media by employees to ensure it addresses prohibition of posting of residents protected health information (PHI) by facility staff. Review your policy that addresses notification of physicians when a resident experiences a change in his or her condition. Update your policy as needed.
- Train all licensed staff on your policy on scope of practice, and train RNs and LPNs on your state’s specific Nurse Practice Acts for each of these categories of nursing licensure. Also provide education to all licensed nurses on the requirement to keep physicians and family members informed of changes in residents’ condition and on prohibition of posting of PHI on social media. Document that this training occurred and file in each employee’s education file.
- Periodically audit licensed staff to ensure that they are aware of their specific scope of practice, and periodically audit medical records and provision of care to ensure that the standard of practice policy is not being violated. Periodically audit to determine that all nurses have active licensure credentials. Review a percentage of medical records and cross check with the 24 hour report to determine that physicians are being notified when residents experience a change in condition.
