Quote from Tweety
Here in Florida unfortunately we have no mandated ratios.
The BON expects us to refuse assignments we feel are unsafe. Because if we accept the patient, and there's a bad outcome, we hang, not the institution, but the nurse. Time and time again a poor nurse has been before the stonefaced BON here citing unsafe ratios only to be slapped with the "why did you accept the assignment, and did you report it up the chain of command...blah blah blah...".
Ditto here in TX. We do have the Safe Harbour policy though for protection if we refuse a unsafe assignment. But I think it is very specific. I mydelf will willing take to vents is there is not alot else going on with them but that third I too would have refused.
Cut and pasted from the TX BNE website....
Staffing Ratios - Is there a law regarding how many patients( nurse : patient ratio) a nurse can be assigned to care for in Texas?
The BNE has no jurisdiction over workplace/employment issues, such as staffing ratios. The Nursing Practice Act (NPA) and Board rules are written broadly to apply to nursing practice in any setting. The main rule applied to nursing practice is 217.11 Standards of Nursing Practice. To view both the NPA and rules, click on "NPA" or on "Board Rules & Regulations" from the BNE home web page. In particular, you should familiarize yourself with Rule 217.11 "Standards of Practice" as mentioned above as these standards would be your area of concern in a floating, short-staffing, or other practice situation.
Standard 217.11(1)(B) requires the nurse to maintain a safe environment for the patient. This requirement supercedes any agency policy or physician order.
Standard 217.11(1)(T) holds the nurse accountable to accept only those assignments that are within the nurse's education/training/experience, as well as his/her physical and emotional ability. If a licensed nurse accepts an assignment, he/she is responsible for the care delivered.
A past RN Update article that might be of interest is entitled "RN and Nurse Manager Responsibilities Related to Staffing Issues"(the reference for the Safe Harbor rule has changed since publication of this article--Rule 217.20 mentioned above is the correct/ current rule) in the January 2002 RN Update. Past issues of the RN Update can be found on our web page under "Publications."
Though this article was geared toward RNs as it was published before the two nursing boards combined, the same answer would apply to LVNs as well as RNs. If you practice in an acute care environment, you may wish to contact the Department of State Health Services at www.dshs.state.tx.us
, or 512-458-7111 as they do have regulations related to involvement of an executive-level nurse in staffing plans. You may also wish to contact various nursing specialty organizations, such as the Texas Nurses Association at 512-452-0645 or www.texasnurses.org
. While the board cannot address employment issues, specialty nursing organizations exist to serve their members and may be able to provide you with additional guidance.
If you feel you are being asked to accept an assignment that would cause you to violate the NPA or rules (especially any of the standards of practice in Rule 217.11), you may wish to review Section 301.352 of the NPA re: refusing an assignment. If your facility routinely utilizes (in total) at least 5 RN's (if LVNs are also involved, Safe Harbor applies to LVNs as well), you may wish to consider invoking "Safe Harbor".(See Rule 217.20 on the web page and also the Safe Harbor form under the "Publications" heading. This does not protect your employment (as the BNE has no jurisdiction in this area) but does prevent potential action against your nursing license when the procedure is correctly followed.