NEVER say we are short staffed.

[TipitiwichitRN]

I guess I am starting to wonder why we can't tell the patient that.

I thought I knew- that it was rude- that it equated to saying "I don't have time for you"- "you aren't important" etc.

However, in my garbled mind, I am starting to wonder who, exactly, this omission really protects.

As a nurse, slammed and hurried, rushed and prodded by the latest budget meetings, job stability feeling shaky in her mind... along with the disease processes, the calculations, the mental to do lists, the hourly rounding to be signed on the doors, constant charting- in multiple locations, phone calls, the sounding alarms, the delegation, the collaborative efforts, new orders, lab interpretation, the basic ABC's...

that's a lot going on... and that doesn't even take into consideration the patient...and it's true! We DO have harder times getting into patient's rooms, we do spend less time "actively listening"... hard to do with that work load on your back...

If a patient is attentive, they know that the nurse is overloaded... aside from avoiding a lawsuit, what is the point.

There are ways to say things that do not covey that the patient is not important..

Now- I am not going to say it, and I understand why it's not appropriate, but I just wonder....

[Ayvah, RN]

Apparently, you missed the entire point in my post, as you quoted it. I said that you should NEVER tell a pt. or family member that the unit is short staffed, because if there were a serious event that happened, YOU would be liable for accepting an unsafe assignment. Your State BORN has strict policies about this, it is called the STATEe NURSE PRACTICE ACT. Get familiar with this, it overides anything your facility would like you to believe. And to another poster, you have the right to refuse an assignment at any time until report is over, and than can refuse new admissions, transfers etc., based on your professional judgement. All you have to do is document it, with copies sent appropriately to manager, DON, and hell, I'd probably send one to the Board of Directors if you do not belong to a nurses union. let 'em try to fire you; I bet they will back off after your first interview with the media (which is the third place I would go to after being fired for such an act, the first being an employment attorney; the second being the National Nurses United, who can help you understand your rights and options.

Wouldn't telling the patient the floor is short staffed make them more likely to sue the hospital instead of the nurse? Were I to lie and say that things were fine, I'd figure that the patient would get pretty mad at ME(not the hospital) if their request for pain medication is late or if they are having trouble breathing, hit their call light, and its 10 minutes before a person comes in, or if I don't notice their subtle deterioration because I have 5 other patients that I'm frantically trying to attend to. I'd think informing the patients about what's really going on would cause them to write more letters to management and possibly effect change on the floor.

While I agree that safe harbor is important to be aware of, management is quite adept at figuring out ways to fire a person not necessarily for the reason they want them gone (look at how many cases there are of firing older staff, for example, that's a rampant practice which is clearly illegal). While I admire your gusto, I am not optimistic that it would work in practice. Though, I'd be very interested to hear if I am wrong. (this is the reason we need staffing ratios in place!)

I came upon this thread ( Safe Harbor - Nursing for Nurses )about safe harbor, and I may be reading it wrong, but it seems to say that you are still supposed to work your shift and still could be liable for civil damages, but your license will be protected. So then why would it be bad to tell the patient you are short staffed then? Take a look at the posts by loricatus who talks about how nurses have been fired for safe harbor.

This explains a little more about safe harbor, at least in Texas FAQ - Peer Review

Safe Harbor enables a nurse in most circumstances to accept the assignment, thus allowing the nurse to protect his/her nursing license from board sanctions while at the same time delivering the best care possible to a patient(s).

Patients are better off with the nurse than without the nurse in the vast majority of cases; however, rule 217.20(g) clarifies that a nurse may engage in an assignment or requested conduct pending peer review determination unless the requested assignment or conduct is one that:

1. constitutes a criminal act

2. constitutes unprofessional conduct, or

3. the nurse lacks the basic knowledge, skills, and abilities necessary to deliver nursing care that is safe and that meets the minimum standards of care to such an extent that accepting the assignment would expose one or more patients to an unjustifiable risk of harm.

A request to falsify a patient record is an example of conduct that a nurse should refuse to engage in while awaiting a peer review committee determination, since there is no legal or factual basis that would support a nurse falsifying a patient record. A request to accept an assignment when a nurse believes the nurse staffing levels are unsafe would be conduct a nurse normally would engage in pending peer review’s determination since the supervisor normally would have some reasonable legal or factual basis to support her/his belief that the requested assignment does not violate a nurse’s duty to a patient, even if peer review ultimately determines otherwise.

Oh and one last thing - I LOVE the NNU/CNA/NNOC! I think their mission is right on target. They are THE group which has gotten things done to enact change and I'd encourage everyone to look into what NNU/CNA/NNOC is all about Ratios Home Page

[steelydanfan]

Wouldn't telling the patient the floor is short staffed make them more likely to sue the hospital instead of the nurse? Were I to lie and say that things were fine, I'd figure that the patient would get pretty mad at ME(not the hospital) if their request for pain medication is late or if they are having trouble breathing, hit their call light, and its 10 minutes before a person comes in, or if I don't notice their subtle deterioration because I have 5 other patients that I'm frantically trying to attend to. I'd think informing the patients about what's really going on would cause them to write more letters to management and possibly effect change on the floor.

While I agree that safe harbor is important to be aware of, management is quite adept at figuring out ways to fire a person not necessarily for the reason they want them gone (look at how many cases there are of firing older staff, for example, that's a rampant practice which is clearly illegal). While I admire your gusto, I am not optimistic that it would work in practice. Though, I'd be very interested to hear if I am wrong. (this is the reason we need staffing ratios in place!)

I came upon this thread ( Safe Harbor - Nursing for Nurses )about safe harbor, and I may be reading it wrong, but it seems to say that you are still supposed to work your shift and still could be liable for civil damages, but your license will be protected. So then why would it be bad to tell the patient you are short staffed then? Take a look at the posts by loricatus who talks about how nurses have been fired for safe harbor.

This explains a little more about safe harbor, at least in Texas FAQ - Peer Review

Safe Harbor enables a nurse in most circumstances to accept the assignment, thus allowing the nurse to protect his/her nursing license from board sanctions while at the same time delivering the best care possible to a patient(s).

Patients are better off with the nurse than without the nurse in the vast majority of cases; however, rule 217.20(g) clarifies that a nurse may engage in an assignment or requested conduct pending peer review determination unless the requested assignment or conduct is one that:

1. constitutes a criminal act

2. constitutes unprofessional conduct, or

3. the nurse lacks the basic knowledge, skills, and abilities necessary to deliver nursing care that is safe and that meets the minimum standards of care to such an extent that accepting the assignment would expose one or more patients to an unjustifiable risk of harm.

A request to falsify a patient record is an example of conduct that a nurse should refuse to engage in while awaiting a peer review committee determination, since there is no legal or factual basis that would support a nurse falsifying a patient record. A request to accept an assignment when a nurse believes the nurse staffing levels are unsafe would be conduct a nurse normally would engage in pending peer review's determination since the supervisor normally would have some reasonable legal or factual basis to support her/his belief that the requested assignment does not violate a nurse's duty to a patient, even if peer review ultimately determines otherwise.

Oh and one last thing - I LOVE the NNU/CNA/NNOC! I think their mission is right on target. They are THE group which has gotten things done to enact change and I'd encourage everyone to look into what NNU/CNA/NNOC is all about Ratios Home Page

So, what I take from this summary of Safe Harbor is that yes, it's better to have a nurse than no nurse at all, tha the only real problem they are concerned about is that you not allow yourself to be bullied into falsifying records; and that you SHOULD accept the unsafe staffing assignment pending peer review since the supervisor would would have some factual basis to support the making of such? HUH?

Your supervisor is short on staff, gives you an assignment that is clearly unsafe, yet you should accept it because she has some basis (other than expedience and filling the holes in her staffing matrix) for deeming it safe, and you should run around like an madman all day, and hope that some review team will later MAYBE find you in the right?

This is not "Safe Harbor", this is ludicrous. If the assignment is found "not to be unsafe", and someone had a bad outcome, than guess what, YOU are liable. It seems the hospital holds all the cards.

Oh, please, I beg of you all, get NNU into your hospitals ASAP and stop all this nonsense. Nurses should be about demanding and perfoming great patient care, not being so fearful that upholding thier mandate could get them fired.

[steelydanfan]

Question: "Wouldn't telling the patient the floor is short staffed make them more liable to sue the hospital instead of the nurse"?

No, and I'll say it again, NO.

Malpractice attorneys are very adept at all the regulations that apply to professional actions, and they probably know your BRN regs better than you do.

You have a state Nurse Practice Act, learn it, and use it when in a situation violates it.

Nurses are being sued more than ever, and if a pt. files a suit over an untoward outcome, you can bet the RN's will be named or at least subpoened during the process.

[dnnc52]

A nurse is a lot easier to sue than the hospital. Most likely the insurance at the desire of the hospital will settle to have less news coverage. So thats why ALWAYS carry your own mal-practice because the hospital attorney is exactly that to protect the hospital and if it takes throwing a nurse under the bus they will in a flash.

[carolmaccas66, BSN, RN]

I haven't read all the posts here, but this goes back to my pet moan - management being too stingy to actually outlay our hard-earned tax dollars to get an agency nurse in to help out, after all that is what nursing agencies are there for.

Complain to management next time, not that it will get you anywhere.

I have actually told patients and families if we are short staffed, and that they must go see the senior nurse and complain - no good telling little old me, I've tried to tell management and they won't listen. I've also told patients and their families to write to the CEOs as this makes the complaint more concrete.

Remember you can only do so much in one shift; you are not superwoman (though management expect it of us I suspect).

[Bumashes, MSN, APRN, NP]

We're told not to say that, too. But, I WILL NOT LIE to a pt about it. If they ask why it took so long, I will tell them the tasks that I was fulfilling before being able to get to them. If they ask how many other pts I have, I will tell them. If they ask if that's unusual, I will tell them what our hospital advertises as it's nurse : pt ratio. After that, they will be able to do simple math to determine that it's more of a load than is expected. As I said, I will not directly lie to them.

[RNforLongTime]

Found a few ways around it. If patient is alert/orientated I use objective data. Such as "I am so sorry your dinner is 10 minutes late, there are 35 of you, and two of us here working to take care of all of your needs" I personally do not feel that this is unprofessional. It lets patients understand the dynamics of the floor, and the staffing issue.

This is what I do. I can have up to six pt's in my unit and usually only two nurses...maybe an aide if we're lucky. One night I had to tell my more A&O pt that I was sorry I wouldn't be able to devote much time to her because there are 6 of you and only two of us...right now I have a VERY sick patient that is taking up most of my time, I have a few minutes right now so what can I do for you right now? She seemed ok with that response and I was telling the TRUTH! It's a very small enclosed unit and the more alert ones can usually see what's going on.

[iluvivt, BSN, RN]

This is simple ......Its not the patient's problem it is yours. When you are ill...in pain..felling scared and out of control do you really need or want to hear this..NO WAY. The nurse needs to instill confidence in their ability to provide care....... provide the best care you can and take up the issue in the appropriate professional setting.

[SunshineRN79]

This is simple ......Its not the patient's problem it is yours. When you are ill...in pain..felling scared and out of control do you really need or want to hear this..NO WAY. The nurse needs to instill confidence in their ability to provide care....... provide the best care you can and take up the issue in the appropriate professional setting.

I am sorry but it looks as if you do home health care!? Have you ever worked in a nursing home or hospital? If so what state are you in? Do you realize that SOME of us have to do a med pass of 60 in nursing homes and are in charge of 60 pts as we'll when given responsibility of charge nurse. When SOME of us have no choice because of the economy to move to an area of nursing where we have the best situation for ourselves and our patients its very difficult to ALWAYS put on a happy face! To me those of you who have said "act professional" are just as bad as all the management who have sold out to their bosses and their bosses (who must drive the newest Mercedes rather than give their patients the BEST care)

Nursing is not supposed to be the same as working for a corporation! I have cried with patients, held their hand and tried to comfort them when they tell me they are afraid, laughed hysterically with patients when something silly happens! Is this how someone in a corporation acts towards their customers? NO because they are not working with those humans who need compassionate care and understanding in a dire time of NEED!

If I have a patient load more than I can handle how can I truly be a nurse and not some fake "professional". My patients need someone to NURSE them back to health, and not the latter. Leave me short staffed, telll me to grin and bare it, underpay me, and ask me to create and illusion for the people who pay for your mansion! Ha!!! My patients have a right to understand why I cannot get to their soiled linen change because I have a fallen patient in another room, and another with a bun of 100 that I must call the dr about, and a family member screaming at me that their mother didn't get their pain medication when she wanted it, and a patient crying because she is depressed no one comes to visit her, and a patient who has dementia and keeps trying to get out of bed, and not enough cna's to help, and cnas who hate their job and do not promptly do what's best for the patient.

So don't you dare tell me that I can't explain why, in the most comforting way possible, I cannot get to the dirty linens right away. I am again a nurse and NOT an administrative assistant.

[Ayvah, RN]

This is simple ......Its not the patient's problem it is yours. When you are ill...in pain..felling scared and out of control do you really need or want to hear this..NO WAY. The nurse needs to instill confidence in their ability to provide care....... provide the best care you can and take up the issue in the appropriate professional setting.

No one is suggesting that you should walk into the room of a patient with their call light on, sigh, and say "I have sooooo many patients much sicker than you, what do you want???". What we are saying is that management is telling us to LIE to our patients and THAT is what is unprofessional. There is a right and a wrong way to deliver most any news, and of course you can say the truth while also instilling confidence in a patient; it will also give them an understanding that their non urgent needs may wait. Telling the truth does not make it the patient's problem nor are we suggesting telling the patients to take care of themselves.

For example:

-If a patient asks how many patients you have, there is no need to lie.

-If a patient asks if you are understaffed, you can say that "while we are a nurse short today I am keeping a close eye on all my patients, and you can always reach me immediately on the phone so you need not worry. Your CNA will also be in here frequently to help with anything you need." You can tailor this line to how sick your patient is. If they are very sick, you can emphasize that they will get a lot of your time.

-When (not if but when ) management tells you to script the line to every patient "I have the time", don't do it, because you know as well as I do that its a lie! This does not mean to tell the patient that you have no time, it only means to omit that line, or to give them a heads up that their request for their vitamins of the day may take an extra hour while you deal with a crisis situation.

[singingtothewheat]

i guess i am starting to wonder why we can't tell the patient that.

i thought i knew- that it was rude- that it equated to saying "i don't have time for you"- "you aren't important" etc.

however, in my garbled mind, i am starting to wonder who, exactly, this omission really protects. easy answer to that and you already know the answer. it benefits the people who make millions off our backs. fewer staff = fewer pay checks in the eyes of the machine.

as a nurse, slammed and hurried, rushed and prodded by the latest budget meetings, job stability feeling shaky in her mind... along with the disease processes, the calculations, the mental to do lists, the hourly rounding to be signed on the doors, constant charting- in multiple locations, phone calls, the sounding alarms, the delegation, the collaborative efforts, new orders, lab interpretation, the basic abc's...

that's a lot going on... and that doesn't even take into consideration the patient...and it's true! we do have harder times getting into patient's rooms, we do spend less time "actively listening"... hard to do with that work load on your back...

if a patient is attentive, they know that the nurse is overloaded... aside from avoiding a lawsuit, what is the point.

there are ways to say things that do not covey that the patient is not important..

now- i am not going to say it, and i understand why it's not appropriate, but i just wonder....

until nurses stand up and say, no more, the health care machine will just continue to chew us up and spit us out. worse than that though is that we put our patients at risk. when we get deluded by the constant slam of "the budget, the grid, blah blah blah, we are at their mercy and so are our patients. my way of dealing with this is to be part of a group of nurses attempting to get union representation. for my patients benefit and my sanity lol.