Legal issues with only having one RN on the floor

  1. 1
    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.
    lindarn likes this.
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    I worked someplace that had a couple of small units, larger than yours but still, a small unit. They could be staffed with one RN and one LPN for a night shift, more during the day/evening. Never one single RN alone, but with an LPN, it was doable. Sometimes there was an aide, sometimes not. I don't think you'd win a legal angle on this, as you COULD have each nurse having four patients, with you (the RN) doing the pushes or whatever might be needed outside of the LPN's scope of practice (and that varies by State and facility).

    You should NEVER be the SOLE nurse for an eight-bed unit (with or without a CNA) because in the event of a problem that requires two nurses (absolutely possible on your kind of unit!) what are you supposed to do?
    lindarn likes this.
  5. 1
    That is my issue. I understand having an LPN or even an RN and CNA but I just cant fathom how they think it is appropriate to have a single RN on the floor. Even if there was only 1 or 2 patients you still need two people there.
    lindarn likes this.
  6. 1
    Is this unit set up so that it's in very close proximity to another floor/unit? If so, if you only had to yell for help and could easily be heard, maybe it is possible, but unless it's like the bottom 'elbow' of the letter "L", I can't see it.
    lindarn likes this.
  7. 1
    The way I've always understood the rule on my unit is, there are always at least two RNs even if there is only one patient. Let's say you have 2 patients on the floor and therefore decide to keep only one RN. One of them has an acute change that warrants emergent imaging. Who's there to take care of the 2nd one when he starts seizing when the sole RN is with patient #1 at CT?
    MJB2010 likes this.
  8. 5
    This is unsafe. Period. What if someone codes on you? You can't even call for help easily. What if there is a security issue? If you're the only staff member of any kind, you--and your patients--are plumb out of luck.

    This issue would be governed by state laws, so maybe your BON would be able to direct you to any pertinent legislation.

    Another place to ask questions is risk management for the facility. Sometimes they swallow their tongues when they hear some of the lame-brained ideas aministration wants to implement to save money.

    One bad outcome can trump all of the "savings" many times over.

    Hope you get some good answers.
    VivaLasViejas, chevyv, wooh, and 2 others like this.
  9. 3
    Quote from rn/writer
    This is unsafe. Period. What if someone codes on you? You can't even call for help easily. What if there is a security issue? If you're the only staff member of any kind, you--and your patients--are plumb out of luck.

    This issue would be governed by state laws, so maybe your BON would be able to direct you to any pertinent legislation.

    Another place to ask questions is risk management for the facility. Sometimes they swallow their tongues when they hear some of the lame-brained ideas aministration wants to implement to save money.

    One bad outcome can trump all of the "savings" many times over.

    Hope you get some good answers.
    This. As the only RN working working in a dialysis unit, I was left alone as the only license in the building regularly. Technically I was not allowed to leave the floor for any reason. I had to pee sometimes. I also like to have at least a small break during a 16 hour shift or else I would get dizzy. They tried to make me sign something saying I would never leave the floor, but I refused to sign it. They still left me alone with 10 patients and 1-2 techs. When a patient codes, and there is just 2 of you, that is one to call 911 or call the code and one to "code". My company decided it was worth the savings in $$$ on staff to let the few people die that did code. They pretty much said as much to me when I complained. They said if someone dies, they were probably going to die anyway. Well thanks a lot idiot manager, I spend a lot of time with these patients and care about them, so " oh well they were going to die anyway" just doesn't cut it. I quit.

    You and your fellow staff members need to stick together and be heard on this issue NOW. I would get risk management involved.
    interceptinglight, wooh, and rn/writer like this.
  10. 3
    You need to check your state to see if there are any safe staffing mandated. Then you need to check with your BON to see what their position is. They are taking a huge risk leaving one nurse. How do you call for help? Are you within hearing distance for emergencies? How do you reposition and move patients with just you? I would also check with the Joint Commission for a safety/quality violation. Your facility has to give the JC a staffing matrix and they are supposed to follow it within a certain percentage.
    Health Care Staffing Services - Patient Safety and Quality Care - Joint Commission Resources
    Hospitals - Patient Safety and Quality Care - Joint Commission Resources
    http://www.nursingworld.org/SafeStaffingFactsheet.aspx

    But unless your state has enacted laws......the facility can pretty much do as they wish. when you contact your BON, as them how to document unsafe staffing so that you can document your dilemma.
    missvic, wooh, and rn/writer like this.
  11. 0
    I worked as the sole nurse in an ICU for 4 years. I had to take 3 patients; I didn't get another nurse until the 4th patient was admitted. I was the RN, the secretary, and the aide. The beds were great, and made positioning patients pretty easy~ I never really needed help but on rare occassions. If I got an admission, the secretary from one of the floors would come and put my orders in and put the chart together, if I was busy. Also, the tele floor was right beside this ICU, so I could yell for help at any time. If I already had two vents with multiple drips, I could ask for another nurse and they would usually accomodate me. I never really had a problem with it, but I was an experienced nurse.
  12. 4
    I don't care if you are an experienced nurse...only having one person on a floor is asking for trouble. Even in our PICU we have 2 nurses and a secretary no matter what. I'd have to question this practice and if it is true, I'd have to go find another job. Just my opinion!
    missvic, KelRN215, LibraSunCNM, and 1 other like this.


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