Legal issues with only having one RN on the floor

[photocodo]

I already posted this but I wasnt sure what section to include it under so I reposted it here.

I am currently a new nurse working on a Telemetry unit in NC. We recently changed to an acuity based scheduling system. It is a small (8 bed) unit and the way the staffing is set up, there is a possiblity that we could have 5 to 6 patients with only one nurse and no CNA. I know this is not ethical for the nurses or the patients but my question is are there any legal issues with the staffing? I have searched the internet and was unable to find any actual laws in reguards to patient/RN ratios or if you can only have one RN on the floor. It just seems that it would be a very bad idea to only have one RN on the floor, even if they are stable patients things can go down hill very fast. Thanks for any advice for this situation.

[MJB2010]

Honestly, for my own sanity, I quit and left it behind. No one else was willing to speak up for themselves, and when I spoke up I was standing alone. It would certainly not be worth my time to chase after them for months and legal fees.

[Calabria, BSN, RN]

So, barring the obvious issues if there is a code or emergency, who double checks your high-risk meds if you're the only RN on the floor? Who witnesses narcotic waste?

Doesn't sound safe to me.

[NBMom1225]

Is there a Risk Management department you can contact? Informing the legal department of the potential liability could produce some results...at my facility we are able to contact Risk Management anonymously.

[Music in My Heart]

So, barring the obvious issues if there is a code or emergency, who double checks your high-risk meds if you're the only RN on the floor? Who witnesses narcotic waste?

Doesn't sound safe to me.

We waste narcs at shift-change. Witnessing high-risk meds is done by the doc or by dragging a nurse over from another department... and no, it's not really safe... but is sometimes the reality of working in a rural microhospital.

[Music in My Heart]

Is there a Risk Management department you can contact? Informing the legal department of the potential liability could produce some results...at my facility we are able to contact Risk Management anonymously.

The part that makes me chuckle is that hospitals so small as to only have a couple of patients probably don't have risk management departments or legal departments; ours certainly doesn't.

[sapphire18]

We waste narcs at shift-change. Witnessing high-risk meds is done by the doc or by dragging a nurse over from another department... and no, it's not really safe... but is sometimes the reality of working in a rural microhospital.

Interesting...just pointing

out though, that if they don't

witness you drawing it up it's not

a true waste.

[morte, LPN, LVN]

True, if anyone wanted to get you for diversion, they could. I wouldn't be signing that waste with you at shift change. You need to call a nurse over to witness EVERY waste that you have, every shift.

Interesting...just pointing

out though, that if they don't

witness you drawing it up it's not

a true waste.

[Music in My Heart]

Interesting...just pointing

out though, that if they don't

witness you drawing it up it's not

a true waste.

No argument from me. I've often pointed out that they've no clue whether it's the Dilaudid or just NS that we're wasting. Diverting from the waste stream would be trivially easy. Again, I think it's just the reality of working at a just-barely-surviving microhospital.

[Music in My Heart]

True, if anyone wanted to get you for diversion, they could. I wouldn't be signing that waste with you at shift change. You need to call a nurse over to witness EVERY waste that you have, every shift.

No, actually they couldn't. They'd simply have no evidence that I was diverting - though obviously I could if I chose.

If you wouldn't be signing, you wouldn't be working there. That is simply how they do it and have done it for years and years.

Just one of many compromises faced by people trying to work in terribly under-resourced rural facilities.

Folks at the bigger facilities don't know how good you have it, sometimes.

[morte, LPN, LVN]

Need to check institution policy, if they say you are get a break, and you aren't, then they need to pay.

Beware that any laws pertaining to staffing, breaks, etc are most likely to be codified under state statutes rather than federal ones so statements on AN must be screened through the state-by-state filter. What is permissible here in California may not be permissible in Washington, for example.

On occasion, we staff a single nurse up on med/surg, though usually (but not always) with an aid. On the rare occasions that it happens, there is a nurse and a tech in the ER who, depending on their patient load, can help out emergently.

Overall, however, it's not safe IMO to ever have a solo staff member working without someone within earshot; it certainly shouldn't happen as a matter of policy.

[morte, LPN, LVN]

If you can't account for it, you can certainly be accussed, and how would you prove otherwise? Watch you back.

No, actually they couldn't. They'd simply have no evidence that I was diverting - though obviously I could if I chose.

If you wouldn't be signing, you wouldn't be working there. That is simply how they do it and have done it for years and years.

Just one of many compromises faced by people trying to work in terribly under-resourced rural facilities.

Folks at the bigger facilities don't know how good you have it, sometimes.

[backtowork]

A nursing home not far from where I live in rural Texas was shut down for this very reason..that is shut completely down..chains on the door..a for sale sign up front. A nurse was in your situation being the only licensed person. She copied the policy on wastes and high risk drugs, she attached a copy of the schedule to it, and she mailed it to the address posted for residents who have complaints..6 months later..it was closed. If they are staffing this way..there may be all kinds of other foogy-moogy goin on that state inspectors live only for the investigation of..ya get my drift?