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!

[mom4josh]

So sorry for your bad night. I can certainly relate. I think you should file an incident report with lots of details. That way everyone who can do something about this situation will read it. That's what risk management is for... preventing another shift like this one. And, if they refuse to do anything about it, there's always Safe Harbor.

:hug:

[TangoLima]

Sounds like our unit!

I agree that the Ativan should have been ordered, and good nursing judgement should decide when it is appropriate to use.

On our unit, sitters, even our own CNA's, aren't counted in the staffing in relation to the census. At that point, they are viewed as sitters, not CNA's. If your institution doesn't want to use their own CNA's, then what about using agency sitters?

Sorry for the crazy night. Hope it gets better.

[TheCommuter, BSN, RN]

This is another example of how saving money is more important to management than overall patient safety. Sometimes I actually think they are unconcerned if patients get injured, just as long as they are staying "within the budget."

[makes needs known]

Someone is getting rich off of bad night. Management will pick apart your incident report and let you know, in detail, what you should have done differently.

[NurseGloria]

Makes needs known said, "Someone is getting rich off of bad night. Management will pick apart your incident report and let you know, in detail, what you should have done differently."

Not only that, on her next review she will probably see, "lacks communication and organizational skills." She may lose her job and license if she persists in trying to advocate for patients without a contract and a nursing organization to back her up.

[iluvivt, BSN, RN]

Nurses always seem to face the brunt of it b/c we are there 24/7 initiating all the orders...setting up the plan and care and organizing the care and assessing everything. When we call an MD for help..they better darn well help. That poor LOL needed that ativan...she was agitated and probably not sleeping or resting... how can that promote health???? This is also another example about how everyone has their hands in the health care industry..everyone is terrified to even order restraints now and if they do there are so many hoops to jump through..... its a nightmare for everyone..at least here in Ca. Yes I know why their need to be safeguards in place but I think we have gone overboard..just like we did with HIIPA. I feel like sometimes they say OK all you nurses take care off all these confused ill, elderly pts...BUT first lets tie your hands with all the stupid rules and laws and budgets.

[Tait, MSN, RN]

Makes needs known said, "Someone is getting rich off of bad night. Management will pick apart your incident report and let you know, in detail, what you should have done differently."

Not only that, on her next review she will probably see, "lacks communication and organizational skills." She may lose her job and license if she persists in trying to advocate for patients without a contract and a nursing organization to back her up.

I do not believe it is necessary to assume she will get in trouble for voicing her concerns. When done through appropriate channels, and with respect there should be no reason for retribution.

To the OP: Do you have a compliance hotline? I know we currently have an anonymous line, however that may solely be because we are under the thumb of OIG currently.

Sorry you had a really bad night.

Tait

[Liddle Noodnik]

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).

Then time to go over manager's head, DON or Medical Director, to either get one of THEM to sit w/ the patient, or for the doc to transfer someone out of the unit. NOT SAFE. I am so sorry

if they refuse to do anything about it, there's always Safe Harbor.

:hug:

What is Safe Harbor?

[Nurse SMS, MSN, RN]

I was also going to second for Safe Harbor. What an awful, scary situation to be in.

[shiccy]

Our definition of patients that are candidates for restraints are pulling at lines or at harm to themselves and others.

Also our policy states (don't know if it's a state thing or not) to be able to place the restraint and get an order within a 12-hour period, so you can place the restraint and catch the doc in the AM, OR place the restraint and call them in the morning.

I used to be really really scared of restraints, but after working on my unit for a few years, I got over that quickly.

[PherbRN]

I totally agree with your comment. Although to others this may seem a little paranoid, it is soooooo true.

As Professionals there must be something that we can do to protect our patients and ourselves as well.

If there is any information out there I would really appreciate hearing from you.