Two weeks ago one of the local hospital's has decided now that all orientee's will be counted in the staff numbers including CNA and HUCS. This is all over the hospital including ICU where there is CRRT and Fresh hearts which now are no longer one on ones by the way. If you have 8 patients the matrix would call for a Charge nurse and 4 nurses and a HUC and the other day they had a huc training and shorted them a nurse because they had too much staff. So the staff had to take 3 patients a piece. I walked into work last night to get report on a CABG that had come to ICU at 14:30 still on drips and vent, issues with blood loss got 2 U of PC and issues with HTN, this nurse who was giving me report who has not even been out of school a year had that patient plus two more. Very unsafe. The policies have not been changed but we were all notified by email of the new changes. It is all about budget cuts. We were told the hearts and CRRT's, Balloon pumps are no longer going to be one on one. Resignations are starting to come in this week. Very unsafe and putting our nursing license on the line. We have been told if you feel it is unsafe not to accept report but now that is no longer the phrase...you have to accept or it is pt abandoment. If you can't take care of the patient load what are we suppose to do. Are any of you all have this happening at your hospital.

They're lying. Not accepting an assignment is not patient abandonment. You have the right not to accept an assignment that you feel puts your patients and license at risk. They are using scare tactics and threatening your license with patient abandoment to frighten and bully all of you into accepting. Disgusting. Call your BON and ask them to send you something in regards to patient abandonment. You might even be able to call it up on their website.

They're lying. Not accepting an assignment is not patient abandonment. You have the right not to accept an assignment that you feel puts your patients and license at risk. They are using scare tactics and threatening your license with patient abandoment to frighten and bully all of you into accepting. Disgusting. Call your BON and ask them to send you something in regards to patient abandonment. You might even be able to call it up on their website.

There have to be standards to be met. If anything happens to the patients because the hosp refused to comply to staffing standards, they would also be held liable.

Also maybe a note to risk management as this is hugely dangerous for the pts,they might want to know about how many lawsuits to anticipate.

Sorry I know that's not very helpful but it really makes me angry what they're doing now. They keep precious few nurses on staff and threaten them with whatever if someone speaks up. It's "turn and burn" nursing still. That and they continue to perpetrate the myth of nursing shortage to keep new nurses coming out so they just figure they'll hire someone else who will do it when the nurses there resign.

It's very discouraging,something is going to happen on par with what happened to the banks to straighten this out. There are people still raking in a lot of money(not the shareholders) and they're trying to sqeeze out every last bit before they're caught.

As for the OP,if you feel you have to take an assignment you feel is unsafe fill out an incident report and see if the others who are placed in this situation do it too. Try not to be the only one doing something as that makes you a target. All the best :redpinkhe

It will get better.

First, I must say that I am so sorry to hear this is happening to both you and your patients.

What they are asking (telling) you to do is ridiculous.

When I have been in similar staffing ratio situations, I felt like I was colluding in patient abuse by accepting the assignment. These aren't nursing jobs, they are butcher jobs.

You will not loose your license over abandonment if you refuse an assignment, but you may if you leave after you have taken report.

Management knows what they are doing, they just don't care. If I were you, I would look for another job (in any field) ASAP

If your colleagues agree perhaps it would be effective to have all or most sign a letter to management spelling out that this is not safe effective care are required by your practice act. Give examples of what could happen to an IABP patient who needs the timing changes, sits up, or gets out of bed while you are caring for another patient.

Ask the cardiologist and/or surgeon to help. Stress that one nurse cannot be in two places at one time.

Maybe two or three of you can make an appointment to discuss it and give the letter.

The supervisor seems to be acting as a nurse whose behaviors are inconsistent with the safe practice of nursing and may be charged with being in violation of KRS 314.091(1)(d)...

Harm to a patient will be on his or her conscience after your warning.

If the letter doesn't work you may want to copy the assignment despite objection form used in Maine. It can protect your license and be evidence in court. Your management may pay attention and staff safely.

Kentucky BON on abandonment - http://www.kbn.ky.gov/NR/rdonlyres/D4B9A697-EA89-4F29-8B44-665499330206/0/aos24.pdf

Nurses throughout the USA are working together for our patients and for each other:

http://www.calnurses.org/media-center/in-the-news/2007/november/nurses-from-across-nation-join-solidarity-caravan-in-support-of-striking-kentucky-rns.html

As some others have already stated, management is attempting to distort information in order to get you to take an unsafe assignment. If you feel the assignment being given to you is unsafe, do not take report, fill out an incident report or whatever form of documentation you can, and follow the chain of command. You may lose you job, but your license and your conscience should be safe. Contact your BON as soon as possible to determine their position given your scenario. Only your BON can determine what the implications for your specific situation would be, and you may very well be called upon to defend your position at some point; however the situation as you presented it is unsafe and should not be tolerated.

I was just told this week by our accreditation department at my hospital that if we feel there are safety issues that are not being resolved by management (could be anything from a leaky ceiling to unsafe staffing) that we are now able to call Joint commission and let them know about it with out being worried if our management hears it was us, we won't get fired. We supposedly can call either anonymously or tell them who you are. I have a feeling a call or two to Joint might get your VERY unsafe staffing issues resolved pretty quickly! Good luck... I hope your staffing issues get fixed soon... I can't imagine counting our orient's in our staffing numbers!

Here is the link to Joint's webpage where you can place a complaint...

http://www.jointcommission.org/GeneralPublic/Complaint/

I was just told this week by our accreditation department at my hospital that if we feel there are safety issues that are not being resolved by management (could be anything from a leaky ceiling to unsafe staffing) that we are now able to call Joint commission and let them know about it with out being worried if our management hears it was us, we won't get fired. We supposedly can call either anonymously or tell them who you are. I have a feeling a call or two to Joint might get your VERY unsafe staffing issues resolved pretty quickly! Good luck... I hope your staffing issues get fixed soon... I can't imagine counting our orient's in our staffing numbers!

Here is the link to Joint's webpage where you can place a complaint...

http://www.jointcommission.org/GeneralPublic/Complaint/

Just a little something... Joint commission won't do anything most likely,, unless someone dies. I filed a very detailed and accurate complaint on some very VERY unsafe practices going on at a previous place of employment,,, never heard from them,, besides the automated reply email. So the unsafe crap kept going on,, I ended up leaving. That was the best thing I could have done. I wasn't the only one who left either. Many people left.

The bad part about that is,, they are just finding other unsuspecting nurses to fill the positions,, to go through the same crap that we went through,, all over again. In the end, the patient's are still unsafe. SO,,,I don't know.....

I will give my usual mantra- keep some detailed notes about any and all close calls, what patient care was not accomplished, how patients suffered due to short staffing, etc. You get the picture. Go ahead and contact Risk Management, and provide them with copies of all of the incident reports you are going to write every day.

Make an appointment with the senior partner of the law firm who represents the hospital. Go to this meeting with another nurses from your unit. Detail what is/has gone on- new orientees being counted as staff, not being provided with proper supervision, the notes (make sure you have the originals), and the incident reports.

Make it clear that if there is any litigation against the hospital due to patient deaths, bad outcomes, etc, that you are taking all of your notes, incident reports, etc, (make copies of all incident reports- they will disappear if there is trouble), to the paper, Joint Commision, the plaintiffs attornies, etc, and you will hang the hospital in court. You might also get some help from the State Bar Association. They have a health care section- lawyers who litigate malpractice cases.

Make alot of noise. Go public with the paper and TV stations. Make them look really bad. Cover you @$$, if you know what I mean. Try to get things in order with your employment before you make you stink. It will be harder for the hospital to make you look like the bad guy it you have all of your evaluations, etc, to prove them wrong.

Good luck. Keep us posted with updates. JMHO and my NY $0.02.

Lindarn, RN, BSN, CCRN

Spokane, Washington

Another avenue to try is the Facilities and Licensing Division of you Department of Health. This is the facility who licenses acute care hospitals.

I would notify and involve the cardiac surgeons and cardiologists ASAP. They have more pull and influence than nurses!

Excellent responses, all of them.

I would like to add, that in a court of law, (unfortunately) if something happens to that patient under your care, an incident report is not going to prevent your license from having action taken against it.

One must always do what a prudent nurse would do, and a prudent nurse would not accept an unsafe assignment.

It seems rather harsh, especially since the nurse is only trying to do the best that can be done under the circumstances.

The incident report does not a license save.

Excellent responses, all of them.

I would like to add, that in a court of law, (unfortunately) if something happens to that patient under your care, an incident report is not going to prevent your license from having action taken against it.

One must always do what a prudent nurse would do, and a prudent nurse would not accept an unsafe assignment.

It seems rather harsh, especially since the nurse is only trying to do the best that can be done under the circumstances.

The incident report does not a license save.

I would also like to add, that make sure that you keep any and all any paper communications from management/administration that discusses the staffing changes being made. These will carry alot of weight in court, as the hospital is admitting that they are deliberately changing the previous staffing patters, and deliberately understaffing.

It might also be a good idea to contact an Employment Attorney, discuss with him/her what is going on, and get some professional advice to protect your license. Also, do you have malpractice insurance? This would be a good time to get it, if you don't already have it, before the you know what hits the fan with the hospital and you get fired. Or before some sentinal event occurs that you are involved in and makes you a high risk client for malpractice insurance.

This will also give you access to your own defense attorney in case there is litigation involving a patient event. If you have to rely on the hospital's insurance to represent you, and you have made waves about the unsafe staffing, they will throw you under the bus to save themselves and blame you for bad outcomes. JMHO and my NY $0.02.

Lindarn, RN, BSN, CCRN

Spokane, Washington