Dysfunctional Hospital - Terrible Ethical Situation

[abbaking]

This happened a few days ago on a short staffed Telemetry/Medical Unit. Night Shift - 20 Beds - 4 RN's - 1 CNA. Each of us had a patient that was confused, pulling at IV lines, Attempting (and succeeding) to get out of bed. Each RN also had other patients on Lopressor, Continous infusions, Post-ops, a few tahbso's, PCA, and I had the prime reward of a total care with C-Diff, SVT and stage 4 PU.

All of us were MAXED out. My confused LOL was getting OOB, pulling at her foley. We needed a sitter. No sitter was in the float pool. Asked MD to order ativan....No order given due to it being a chemical restraint only for last resort. The situation got worse. My other post op tahbso patient was desating 87% 5L Simple mask.

My confused LOL becomes combative. I am running room to room caring for a crasher and a my LOL not to mention my other 2 "good" patients.

Finally a sitter becomes available - BUT nurse manager calls and says its not within the unit budget for another employee on the floor due to patient census (needs 22 patients for 2 CNA).

At what point does this insanity jepordize the LIVES of the patients?

No sitter, No medications, No restraints, WHAT AM I TO DO? This was by far the worst situation in my entire career....We ended up having to move all the confused patients in an empty 4-bed room and having the Lone CNA sit with all of them.

Sorry about this vent but in my opinion Joint Commission, federal laws can kiss it - there are times when restraints are needed. No sitter and the budget issue is a waste. I will pay out of pocket for a CNA to help out....No more of this intentional short staffing and Passive MD's. Order the Ativan for pete's sake....If something happend We will fix it later!

[nicole109]

I'm sorry to hear about your horrible night, that sounded like every shift on the unit that I used to work on--only we were at a 6 to 1 ratio, every day, all the time...and a charge nurse that was virtually helpless because she ran charge for 3 units, one of which was an ICU...one of many reasons that I am no longer a nurse in a hospital--I agree that JCAHO can kiss it--I also think that JCAHO needs to be like secret shoppers but secret patients, because if they were they would see this stuff in live action, and not see the one week out of the year that the hospital calls and recruits every employee it has to come into work, and we are overstaffed like you've never seen before. It's sad the lies that administration tells, and to think that one day long long ago some of them were at the bedside as well...oh well, they will be our patient one day too--

[everthesame, LPN, LVN]

The shift you described is why I left med surg in a hospital and went to corrections nursing. It just got to the point where I felt like my license was on the line every time I walked in the door. And management was no help. They were more interested in criticizing how long it took to silence a bed alarm. Well, what am I supposed to do when five of my six patients are confused and four of them are trying to climb out of bed at the same time...while my fifth confused patient is trying to code and my sixth, non-confused, patient desperately needs the bed pan because the orthopedic surgeon who repaired fractures to both of her lower extremities did not feel she needed a foley. And in the middle of all of that, the charge nurse tells me I am getting an admit from ER...A 94yo female with a UTI.

My worst day in corrections isn't half as stressful as an average day on med surg.

Management loved to preach patient safety but wanted the staff to make it happen without costing them an extra dime.

[NurseCard, ADN]

Threads like this make me :redbeathe:redpinkhe:yeah::heartbeat my job!!!! Thanks!

Night shift on a child psychiatric unit... worst part of the shift is between 6:30-7:30 am, when the kiddos wake up and we are trying to keep them from beating each other up!

[dcampbell]

I am not very familiar with "Safe Harbor".

How could our OP have initiated it to help her on that shift?

Would it have helped her and her pts. enough, and in a timely manner?

How could she initiate it without putting her job at risk?

Has anyone here ever used "Safe Harbor" and what was the outcome?

[Mulan]

Doesn't "Safe Harbor" only exist in Texas?

[leslie :-D]

from a very quick google, it seems texas is the state that has invoked "safe harbor", although i'm pretty certain there must be other states?

anyways, here's a blog piece from a nurse attorney, with a caveat towards safe harbor.

she strongly suggests joining your state associations in producing change.

http://nurseattorney.blogspot.com/2007/06/your-job-or-your-conscience.html

leslie

[diane227, LPN, RN]

I just wonder.... what state do you work in and what kind of hospital do you work for? Is it a for profit hospital or a not for profit hospital? Also, you should write a detailed letter about the events of this night and your concerns about patient safety. Forward a copy of this letter to your manager and to her boss and be clean that you would like to know how they plan to assure that these types of unsafe condiions do not occur in the future. MAKE SURE you keep a copy of this letter for yourself. If you continue to have this problem, you might be left with no other choice but to make a complaint with the Board of Nursing and the State Department of Health.