herring_RN Guide 93,984 Views
Joined: Mar 14, '04;
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If ordered to go to lunch I would ask, "Who will take over my patient(s) while I'm at lunch?"
If there is no one I would say, "I would if I could, but I cannot abandon my patient.'
If ordered to i would ask with other staff to witness, "Are you ordering me to leave my patients without an assigned nurse?"
Sometimes they then understand that they are ordering you to violate the Nursing Practice Act and the law.
Here is an examples of a hospital fined after a patient was harmed due to ratio violations:
Palomar Medical Center (PDF)
555 E. Valley Parkway, Escondino, CA 820211, San Diego County - The hospital failed to ensure the health and safety of a patient when it did not follow its patient care policies and procedures. This is the first administrative penalty issued to this hospital. The penalty is assessed at $50,000.
The statement of Deficiency is in the column on the left. The right side has the required Plan of Correction.
Generally unless a patient is harmed there is no fine. The hospital must provide an acceptable Plan of Correction.
I'm sorry this is happening to you.
At the start of each shift that is not safe document in writing exactly what the situation is and give a copy to your manager or shift supervisor. If your union provides an "Assignment Despite Objection" (ADO) or "Disclaimer" use that and keep a copy. If you don't have a form use paper. Write, "In our professional judgment this assignment is unsafe because the facility failed to provide sufficient staff. As a result the facility is responsible for any adverse effects on patient care.
Write details on the one given to management.
Here is an ADO from the Washington State Nurses Association. California does not have it on line:
It is not a HIPAA violation to provide information to hospital management or to a regulatory agency.
Write an exact quote of what you were told and the name of the manager or supervisor. The date, time, location, number of nurses, number of patients, and room numbers of patients should be written on the form or paper.
If something happens remember the name of the patient and the room number. Don't write it anywhere and don't look at the chart when you are not assigned to that patient.
That form can be used in court or a disciplinary hearing. It is best for all nurses on the shift to sign it, but do it alone if they won't.
It can save your license, your job, and protect you in the event of a malpractice lawsuit.
I'll type the text of a flyer on reporting to the state:
HOW TO COMPLAIN TO THE DEPARTMENT OF PUBLIC HEALTH
INTRODUCTION: The Department of Public Health (Licensing and Certification Division) is the agency that determines the compliance of health facilities with state and federal laws, rules, and regulations. To accomplish this goal, the Department conducts periodic inspections of health care facilities and is empowered to take remedial action. Such remedial action may involve suspension of licensure, curtailment of public funding, and other enforcement actions. More frequently, the Department will cite the facility for a violation and request an acceptable plan of correction. Reports on the result of each inspection of a hospital along with the plan of action and hospital comments are kept on file in the department. All inspection records, lists of deficiencies, and plans of correction are open to public inspection. THE COMPLAINT: 1. Anyone can file a complaint: RN, patient, family member, others. 2. Avoid anonymous complaints. The whistle blower protection laws in long term and acute facilities provide protection against retaliation. Speak to your labor rep first about the problem. Go through the PPC or other facility-based structure. These avenues are often effective in resolving patient safety problems. 3. File the written complaint with the local DPH field office & notify CNA. A. The DHS evaluator will be best able to investigate the complaint if provided the following:
Name and address of the facility. Date, time, and location (unit or room number). Name(s) or medical record # of patient(s) involved. Names of involved staff. Staffing assignment sheets if available. Description of incident with quote from Title 22 (include number of section). Desired remedy IE “Nurse staffing must meet or exceed established ratios at all times.” Ask for implementation not just improved documentation.
4. The Department will conduct a complaint investigation.
5. The person signing the complaint will be contacted prior to the investigation of the complaint and also will be informed of the Departments findings upon conclusion of the investigation.
Here is a Nurse Alert explaining a lot about how to advocate for your patients and the profession of nursing:
find out what law firm represents the hospital in liability issues, have the union start with them. Of course, it should have been reported the first time that it happened..... I know, easier said than done.
U.S. Has The Worst Rate Of Maternal Deaths In The Developed World
NPR and ProPublica teamed up for a six-month long investigation on maternal mortality in the U.S. Among our key findings:
About half of Americans support single-payer health care
By Emily Guskin April 12, 2018
A Washington Post-Kaiser Family Foundation poll finds a 51 percent majority of Americans support a national health plan, also known as a single-payer plan, while 43 percent oppose it....
... Nearly three-quarters of Democrats support a single-payer health plan (74 percent), while a slightly larger share of Republicans oppose it (80 percent). Independents break the tie, supporting a government-run health-care plan by 54 percent to 40 percent.
Almost three-quarters of Democrats support single-payer, along with over half of independents
Q: Do you support or oppose having a national health plan -- or a single-payer plan -- in which all Americans would get their insurance from a single government plan?...
About half of Americans support single-payer health care - The Washington Post
Public support for ‘single payer’ health coverage grows
JUNE 23, 2017
Currently, 60% say the federal government is responsible for ensuring health care coverage for all Americans, while 39% say this is not the government’s responsibility. These views are unchanged from January, but the share saying health coverage is a government responsibility remains at its highest level in nearly a decade.
Among those who see a government responsibility to provide health coverage for all, more now say it should be provided through a single health insurance system run by the government, rather than through a mix of private companies and government programs. Overall, 33% of the public now favors such a “single payer” approach to health insurance, up 5 percentage points since January and 12 points since 2014.
Democrats – especially liberal Democrats – are much more supportive of this approach than they were even at the start of this year...
Support for single-payer health insurance grows in U.S. | Pew Research Center
PEW RESEARCH CENTER SUMMER 2017 POLITICAL LANDSCAPE SURVEY http://assets.pewresearch.org/wp-con...re_topline.pdf
The MA chapter of ANA is opposing it! So is the Organizations of Nurse Leaders.
"Amanda Stefancyk Oberlies, CEO of the Organization of Nurse Leaders, stated, "Make no mistake: this proposal threatens the high quality of care we provide patients. It will force many hospitals to reduce critical services and will dramatically increase emergency room wait times. This measure will prevent nurses and doctors from being able to use their best judgment in times of crisis.""
It will INCREASE the quality of care. Five patients as a tele nurse was too much most of the time, especially with the high acuity many of them were. Heck, even 2 patients as an ICU nurse is too much if one is really critical.
This "leader" is just plain wrong. There have been MANY scientific studies demonstrating that safe staffing ratios save lives.
It is dishonest and harmful to patients who die due ti failure-to-rescue. The profession of nursing is considered the most honest of occupations.
Any nurse who denies the importance of sufficient nurse staffing is hinderingv the profession of nursing.
"Massachusetts has some of the best hospitals in the country. Make no mistake: this proposal threatens the high quality of care we provide patients," said Amanda Stefancyk Oberlies, CEO of the Organization of Nurse Leaders. "It will force many hospitals to reduce critical services and will dramatically increase emergency room wait times.
This measure will prevent nurses and doctors from being able to use their best judgment in times of crisis. Further, there are no scientific studies or reports that demonstrate the effectiveness of this one-size-fits-all staffing requirement improving quality of care."...
Coalition to Protect Patient Safety Launches 2 18 Ballot Question Opposition Effort - Coalition to Protect Patient Safety
In 2012 the ANA stated, "The nurse staffing resolution identifies short-staffing as a top concern for direct care nurses that negatively affects patient care and nurse job satisfaction. It notes that staffing decisions remain largely outside of nurses' control, and that staffing plans lack enforcement mechanisms.
The resolution requests ANA to "reaffirm its dedication" to advocating for a staffing process, directed by nurses, that is enforceable and that includes staffing principles, minimum nurse-to-patient ratios, data collection, and penalties for non-compliance in all health care settings where staffing is a challenge".
Of course you should know the policies and procedures of your unit.
If asked I would tell the truth. Maybe that is why I was often not scheduled when they were expected.
In my state the surveyors are experienced RNs. They often require a "Plan of Correction" (POC) for any violation. That is good to know as hospitals complying with the POC are safer and often better staffed.
The Patient Safety Act: What the Bill Does
It protects patients safety
The Patient Safety Act:*What a Bill Does
"How to get involved" for Massachusetts voters:
The Coalition to Protect Massachusetts Patients
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