How many patients can I legally have?

sharann, BSN, RN · Apr 23, 2005

In California it is not legal in an ICU setting. I dont know about it in your state though. Sounds illegal though, or very dangerous.

Gompers, BSN, RN · Apr 23, 2005

While California has safe-staffing laws in place, most states in the US have not yet come that far. It's unfortunate, but true. I'm in one of those states. In our ICUs, it's common to have two vented patients, but three is not acceptable.

bellcollector · Apr 23, 2005

I was always under the impression that it is up to us to decide if we can safely handle the pt load. I realize that it could risk your job but if you accept an unsafe assignment aren't you held legally accountable? IF so how do you get out of it right then on the spot? Just curious. Great question and topic.

pricklypear · Apr 23, 2005

I was always under the impression that it is up to us to decide if we can safely handle the pt load. I realize that it could risk your job but if you accept an unsafe assignment aren't you held legally accountable? IF so how do you get out of it right then on the spot? Just curious. Great question and topic.

I have refused to take another patient if I feel it would be unsafe for my existing patients. My job was never threatened over it, and if it was, I would quit after my shift that day.

wjf00 · Apr 23, 2005

I have refused to take another patient if I feel it would be unsafe for my existing patients. My job was never threatened over it, and if it was, I would quit after my shift that day.

Agree 100%. If you feel the assignment is unsafe, refuse the assignment.

OC_An Khe · Apr 23, 2005

First, there is no law limiting the number of patients that can be assigned to you in CT.

If you feel assignment is unsafe refuse the assignment. If the employer insists that you take that assignment then you are in a quandry. Question, was the assignments of your fellow workers on that unit similar to yours? Were you the safest person to give the new patient to? Question the logic of why you were selected for the new admit.

If you feel you must refuse go ahead but understand the potential consequences to both yourself and new patient. There are however plenty of ICU's in CT and if this type of assignment is common in your unit I would begin to look elsewhere. Also there is whistle blower protection for RNs in CT

Rocknurse, MSN, APRN, NP · Apr 23, 2005

Phew....in the end the nurse in charge ended up taking the assignment, despite being in charge and having two other ventilated patients herself, and the fact that I was next in line for the admit. I ended up helping her out as it was so nuts, but when I went to check on her other patients, one of them had had no vitals signs recorded from 8pm to 2am, and no meds given at all, and the other had a leak in his ET tube and a mouthful of tube feed. How is this safe? How is this "more safe" than any other unsafe assignment? How long can we keep doing this as an accepted practise? Maybe because I come from another country where there are accepted standards and this is illegal that I am so shocked and appalled. I would happily refuse an assignment if I thought it was unsafe, and I'm sure I would lose my job over it, but who wants a job like that? If that had been me with the two neglected patients, who's to say the nurse in charge would have done me the same favor I did her? Would she have kept her mouth shut and sorted things out as I did, or would she have reported me for patient neglect? I'm not prepared to find out. The previous day shift nurse was mandated to stay until 3am...and then the next days RN was mandated to start her shift at 3am to take over. It's inhumane and dangerous. I am so going to quit! I talk with my feet. It's an outrage that there are no laws to protect both the nurse and the patient. In England if there is no staff then beds are closed and surgeries postponed. It makes so much sense.

monica6511 · Apr 23, 2005

It sounds very unsafe. I would discussed it with my charge nurse before taking the assignment, let her know that you are uncomfortable and is not fair for the patient not to get the care he or she deserves. I have this type of problems where I work and usually one nurse will step and take an extra patient and make you look incompetent

then she would look good for administration. , But I am not looking to be a "Hero".,

some nights we don't have any "Hero's" so then the supervisor has to look for extra help from nursing agencies, etc. We as nurses need to step up to what we believe is the best thing to do. I feel for you (nurse in texas)

Tweety, BSN, RN · Apr 23, 2005

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.

Good luck.

Tweety, BSN, RN · Apr 23, 2005

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...".

Good luck.

austin heart, BSN, RN · Apr 23, 2005

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...".
Good luck.

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 http://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 http://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.