seems like the union isn't doing anything

Pediatric Critical Care Columnist · Jan 13, 2015

I can only speak from what I know about how our union works. I totally understand all of your concerns and sympathize too. We have a document called a professional responsibility concern report that is very similar to the assignment under protest type form you describe. Filing them may seem like a waste of time but what they do is document ongoing problems with staffing and patient safety. One or even several reports over a short period of time don't produce much urgency on the part of the union, nor of administration because those reports could be viewed as representing a short-term staffing shortfall. It's only when reports continue to come in that a pattern emerges. The union will have a process they follow when meeting with admin to discuss these reports and they have to give admin an opportunity to identify the underlying cause and take steps to remedy things. When/if that fails there should be a mechanism for the union to take it higher. Nothing happens overnight. I know it's frustrating and sometimes downright frightening to work in what can only be described as unsafe conditions. But if you keep your resolve, persevere even when it looks like no one cares and continue to advocate for your patients and yourselves, your efforts will make a difference.

In solidarity.

allnurses Guide · Jan 15, 2015

There is an overflow "wing" that consists of 8 beds and 2 nurses that nurses are floated to at my hospital. The nurses are expected to provide full care to telemetry patients (this is in CA), including putting orders in. The hospital is still using paper charting. This is in addition to drawing our own labs, passing trays, and providing basic nursing care. Some of these patients are bed bound, incontinent and unstable with elevated blood pressures and brittle diabetics. We also don't have break relief, so when a nurse goes on break, the other nurse can be accountable for 8 patients. The patients they are supposed to send to us are ambulatory and stable requiring minimal extra care, but this is not always the case. In fact often not. There are forms nurses have been filling out, assignment besides objection that is supposed to cover us if something were to happen to a patient, but I am worried this wouldn't cover anything, we are still accountable. Plus, how can we provide quality patient care this way. We have a union and the pay is good at this hospital with very good benefits, but this unit is unsafe at times. I'm afraid of putting patients at risk and also of possible losing my license. What's the good of union dues if this continues to go on?

Your hospital is in violation of California law unless they provide a competent RN to take report and take over your patients so you can go on your breaks.

Fill out the form each and every time you think staffing and/or equipment and supplies are insufficient. At the very least it will protect your licenses in the event of harm to a patient. Give a copy to your manager of the shift supervisor. Make a copy for all who signed it.

Do you have a committee of nurses to address patient care issues? If so contact the chair of that committee. Put your concerns in writing and state your recommendations. Send it to your CNO, your manager, and any supervisors who are aware that you filled out the form.

If you have contract language request an answer in writing from nursing management within that time line.

Notify your labor representative that there is a risk of adverse events happening to one or more patients. That should give you a start.

Here are regulations that must be followed:

https://govt.westlaw.com/calregs/Document/I8612C410941F11E29091E6B951DDF6CE?viewType=FullText&originationContext=documenttoc&transitionType=CategoryPageItem&contextData=%28sc.Default%29

What a registered nurse must provide for each patient in a California hospital:

https://govt.westlaw.com/calregs/Document/I8612C410941F11E29091E6B951DDF6CE?viewType=FullText&originationContext=documenttoc&transitionType=CategoryPageItem&contextData=%28sc.Default%29

Note that the ratio is the maximum number of patients that can be assigned to a nurse. "At all times" means what it said. The ratio applies for times a nurse transports a patient for a test or goes on a break. The nurse "watching" another nurse's patients then can have as many as twice the allowed number of patients.

There is a requirement to "staff up" for higher acuity patients.

mdfog10 · Jan 15, 2015

We all are the "union". So make sure your reps know what is going on and work together to make change. In my experience , when Nurses are united on an issue and willing to take it on, management pays attention. It is a fight, and will always be a fight, but it is worth it.

tjmrn · Mar 3, 2015

amzyRN ~

I am so sorry to hear the troubles with safe staffing practices at your hospital.

My advice is to do what your conscience tells you regarding protecting your patients, staff and self/license.

Having said that, let me tell you my story. After which, you may choose to disregard everything I've said.

I have been an RN for ~ 28 years. I haven't been practicing for ~ 8, though I've kept my lic. current / active.

I was fired from my per~diem job of 12 years with that hospital for "excessive absenteeism". I had one day over the maximum days allowed. Even though they were requested "1st cancel" days. (My mom was ill with Cancer.) And as per~diem, I was not guaranteed hours nor did I receive benefits.

That's the "official" story.

The story that needs to be told is more complicated and relevant to your post.

My hospital had a "lock ~ down" unit, separate from the Med/Surg unit, where inmates from a local prison were admitted for acute medical / surg care.

That ~ 8 bed unit was included in the bed count of the, physically, separate med / surg unit. So our med/surg staffing covered the lock down unit as well. Though it was physically a different unit and a long hallway with multiple locked doors away.

The general practice was to assign an RN to that unit along with several patients on the med / surg unit. Unless the lock down unit was full and the RN assigned there would be doing primary care, alone, for those inmates.

I always had trouble with this because of the physical distance between patients when the assignment included both lock down patients and med / surg patients.

But I originally never said anything or acted on it.

Since I was one of the most senior / experienced RNs I was often assigned to that unit. And I was often Charge Nurse and so responsible for assigning other RNs to that unit.

I made no complaint, until I had several "incidents" directly related to that staffing practice.

I had a couple of times where an inmate patient got into trouble while I was attending patients on the med / surg unit. Requiring sending those inmate patients to a higher level of care.

After that, I refused to take assignment that included taking patients from both units, simultaneously. Likewise, As charge Nurse, I refused to assign my RNs patients from both units simultaneously.

Administration did not like it.

I was very clear about my concerns. I told them I had no problem taking assignment on either unit, but to assign patients from two physically different units simultaneously, was unsafe and since I'd already experienced the consequence of that, I would no longer accept or assign patient care that way.

It wasn't long after all of this that my supervisors began trying to call me in for conference, without Union representation while doing patient care. Which I also objected to.

They even went so far as to float me to ICU and try to call me in for conference and away from my ICU patient without representation. *note* ... I am ~not~ an ICU Nurse.

Finally, I went in to take assignment one day and was called into the office and given my termination papers without forewarning.

The unit had to scramble to cover my patients and so were short staffed that shift.

My Union reps contacted me to encourage me to contest my termination.

I did so reluctantly. I was pretty fed up with all of it by this time.

But after several "meetings / hearings", my Union rep literally disappeared. And I never heard from them again.

That's how I came to leave Nursing so many years ago.

Safe staffing practices have been / still are ~the~ number one issue for RNs. It is rather disgusting that that is the case, but it is the reality.

And RNs deserve accolades and kudos for working in such difficult "political" environments while displaying the courage it takes to advocate for their patients and colleagues safety.

Kudos to you. I hope you're able to successfully work your issues out without suffering the consequences I did for standing up against unsafe staffing practices.

What ever you do. Do so with great thought and document ~everything~.