From Lippincott Manual of Nursing Practice 8th edition
"Unsafe Nurse-to-Patient Ratio
- A pattern of unsafe nurse-to-patient ratio can be caused by staffing problems, be they temporary or longer term.
A series of actions to best resolve the problem includes:
Tolerance by staff nurses employed under such circumstances will preclude appropriate resolution and will leave the nurse open to unsafe practice and unmet patient needs, potentially increasing the risk of liability.
- Address this unsafe situation verbally and in writing to the nurse unit charge nurse with copies to the nursing supervisor and director of nursing.
- This will likely prompt action by the hospital, such as creating an as-needed pool of nurses to call for such situations, hiring more staff or, in the interim, securing contracts with outside nursing agencies and utilizing agency nursing personnel.
- Although the employer is liable for the acts of the employee performed within the scope of employment, the nurse will not be exonerated should a patient's care be compromised in a setting of an unsafe nurse-to-patient ratio."
Stood out like a sore thumb while perusing chapter 2
My summary " If you tolerate poor ratios and don't say anything, YOU ARE PART OF THE PROBLEM
I noticed it stops far short of suggesting ratios.
there should be a policy in place that outlines the appropriate actions for a nurse to take when declining an unsafe assignment. the safest recourse is to refuse the assignment and then take these steps, carefully documenting each step of the way. the alternative, taking report and accepting the assignment, places the nurse's license in jeopardy. management and administration will not be considered at fault if an error occurs or if a patient is injured under these circumstances, because the nurse accepted the assignment.
if there is not a policy in place for nurses to decline an unsafe patient assignment, there should be an immediate discussion with administration to see that one is outlined as soon as possible. this policy should include a formal means for the nurse to document his or her concerns.
working toward a solution through policy implementation and documentation is not easy, and there is always a concern of possible repercussions from management. working with state legislators to obtain laws for safe staffing ratios is an alternate option, but one that could take a considerable length of time to come to pass, particularly considering that each state must act individually. if, however, we do nothing and continue to accept unsafe patient assignments, both the nursing profession and the community for whom we provide care will be the ultimate casualties.
Last edit by David13 on Jun 22, '09