What do I do? Help!

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    I currently work in a SNF and am a nurse responsible for 40 patients on my unit. We have approx. 120 patients in total and 3 nurses to cover the shift. I just found out that they want 2 nurses to work per shift. I think this is very unsafe, since our acuity is getting greater and we always seem to be short on CNA's to help with the most basic needs.

    The facility knew this shortage was coming, yet they haven't done anything to prevent this..just assumed that the remaining nurses would pick up the slack. I've heard that they can get away with this lack of nurses because on paper they do have enough RN's - it's just that half of them are administrative and do not work on the floor.

    Tomorrow is the first day that I am expected to carry 60 patients by myself. Did I mention that I am a new grad and have had my license for only 2 months? I've told my DON that I did not feel safe with this scenario and she basically blew me off. I'm seeking new employment - but I'd like to know if I am right to refuse to accept the extra patients.

    The administrator and owner of the facility is awful and threatens to take action to revoke licenses for patient abandonment. But is it really abandonment if I refuse to take the assignment in the first place?

    Any advice would be great. I'm going to stand my ground tomorrow and refuse to accept the extra load. Perhaps to some, I sound like a whiner, but as a new grad, I don't want to risk my license for a facility that doesn't care about their nurses or residents. My opinion is that some of the RN's that are administration need to get their behinds in there and fill the shortages. Do I have any rights??
  2. 8 Comments so far...

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    This is a very sad but continuing problem in our healthcare community. There are times that is seems money wins out over patient care. I have worked in SNF also and know very well the problem. The place I worked at was a 200 bed facility and they had only one nurse on duty on the evening and night shifts. I was fortunate enough to have CNA,s and CMA's to help. However, being the Shift Nurse in Charge, did get hectic. Maybe your facility could start training CNA's to work there. Good Luck and remember, alot of us have been there, done that, and understand.

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    C.E.Worden,LPN
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    Sorry to hear about this horrible situation you're in! If it were me, I would give written notice (perhaps even no notice- if working there is that unsafe). It sounds like the management at your new job have created a hostile, unsafe, and inflexable working environment!That one manager who threatened "your license" sounds like an unprofessional bully. Who needs to work in those horrible conditions? You'll burn out so fast you won't know what hit you! As for refusing assignments (the question of patient abandonment)- you need to check your individual state's nursing practice act. The "safest" way to go would probably be to find a better place to work (a place that cares not only about "numbers on paper" but about patient safety and staff concerns).If you do decide to search for a new job, make sure and ask about nurse-patient ratios & staff rentention. Ask to talk to the staff, if possible. Any facility that has high turnover should raise red flags. Good luck!!!
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    I am so sorry that you have to go through this. I quit a simialar situation and thought that I would never find a job, about five years ago as a new grad and NO jobs. Keep a folder and document everything that you state and the administrator, DON state, etc, including statistics and your objections. ALSO I just read an article where an administrator was prosecuted for negligence and abuse because a family member taped resident care. Does anyone remeber where it can be found??? Good Luck and I'll keep watching for your postings.
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    I tried to send you a private e-mail copy of the BRN advisory on Patient Abandonment. It is at www.rn.ca.gov/policies/policies.htm
    Your license is safe. If you refuse you may lose a job you don't want anyway.
    This sort of thing must stop! Both the abuse of nurses and abuse of patients!

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    I also worked in SNF as a new grad (5 years ago). It had a population of (60 skilled, 60 intermediate). We had 2 RNs on daylights and evenings and 1 RN on nights. It was pretty much the standard staffing for SNFs in this area. It is certainly overwhelming for a new grad to handle. Family members have no idea what they are putting their loved ones into.

    I highly recommend getting some hospital experience. It will give you a lot more confidence simply due to increased experience with a vast array of patients. Unfortunately, hospital staffing is awful too and patient acuity is terrible. But if you really want to do LTC for your career (and people need to recognize this as a valid career choice), you could pick yourself a time limit and set some goals (e.g., I will do med-surg nursing for 2 years and then move to a SNF, or whatever). Sometimes, when you pick a timeframe for something, it's easier to get through it knowning there's an endpoint.
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    First of all realize this is happening in LTC all over the place, and it is quite normal to have your license threatened for patient abandonment, if you refuse to stay. The administrator may be a bully, but LTC is full of them. There is a form called assignment with objection I believe it is called, you can find it is the Million Nurse March discussion, or at www.florenceproject.org, fill it out and ask the DON or Administator to sign it, keep a copy for yourself and ask for a copy to be put in your personnel file. Expect to get alot of crap if you do this, however remember you are standing up for not only yourself but for the patients you are responsible. If something untoward was to occur it is your license on the line, no matter how many aides you may have in the building, ultimate responsiblity falls to you.And trust me when I tell you that if a bad situation happened it is you they will be looking at, not the admin. or the DON if someone did it would be in an ancillary manner. It is a difficult situation but first of all PROTECT YOURSELF. Last but not least think about becoming active in the Million nurse march, it is situations like this that we are trying to bring to the attention of the public and legislators. It is imperative that it is not the nurse that should take responsiblity for these types of problems. That should fall to management, nurse management or otherwise. Is the facility going to quit taking patients because of staffing issues? absolutely not. We must make the public and legislators understand these are real issues, with real consequences and the nurse should not be the one out there alone trying to figure out how to practice appropriately and take care of all the patients at the same time.
    Think about the form I told you about, it is bound to **** them off, but you need to protect yourself. And think about the march, it is worthwhile and it is nurses in situations like yours we are trying to protect, as well as the patients you know are not getting the care that they need.
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    Thank you to all those who've replied. I'm taking advice and have given my notice. I've accepted a job elsewhere for more money, benefits and most importantly better staffing.

    Why is it that nurses stay in positions like I am in - and do so willingly? How come they don't stand up for themselves and just say "NO" to unreasonable work loads? I just don't understand the logic behind it. Loyalty? Where is the company's loyalty to their employees? They keep heaping on the workload, obviously not caring for the well-being of residents or STAFF. Just doesn't make sense to me. Maybe someone can explain it.
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    Once you have left this facility, please contact your regional HCFA office or your state Department of Public Health & file a complaint related to unsafe staffing. You may find the number posted in the facility for reporting abuse & neglect (this kind of staffing is neglect)You can remain anonymous & will be helping the patients in this facility. It is against federal regulations to count administrative nurses in care giving staff. Please report this. It really is your responsibility as a nurse to report this kind of neglect. Good Luck.


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