Unsafe Assignment & Pt Abandonment

Nurseinprocess · Apr 4, 2011

I don't think there is any way to not accept a pt load once you are on the clock. When it happens on my unit we either suck it up, or one RN submits an SRM report to cover herself. I have been hit with 9 pts on a surgical unit and it was not something I would deal with on a regular basis. I don't understand how nurse mgrs will only staff for the amount of pts at the beginning of a shift and feel no responsibility to cover staff for the admits that arrive after that.

GM2RN · Apr 4, 2011

I don't think there is any way to not accept a pt load once you are on the clock. When it happens on my unit we either suck it up, or one RN submits an SRM report to cover herself. I have been hit with 9 pts on a surgical unit and it was not something I would deal with on a regular basis. I don't understand how nurse mgrs will only staff for the amount of pts at the beginning of a shift and feel no responsibility to cover staff for the admits that arrive after that.

I agree, it's become the norm and it's way out of control.

Others have posted on this board that they have refused a patient assignment after clocking in once they found what their assignment was but before taking report from the nurse handing off the patients. I'm just not sure that would work in the ED.

I have considered not punching in until I find out if we are staffed appropriately, but because the census continuously changes in the ED, I just don't know if I can do that.

rjflyn, ASN, RN · Apr 14, 2011

Seriously you most effective way to protest is with your feet. Go some place else. It's your choice if you continue to stay in an supposedly unsafe environment. If you dont want to leave then find out the cause of why there are not enough nurses and do something about it, be part of the solution and not part of the problem. For example if you facility needs nurses help recruit, I know mine is always looking for staff on the night shift, and even then thats not forever- I have nurses with 2 years in dept on afternoons and mid-days.

GM2RN · Apr 14, 2011

Seriously you most effective way to protest is with your feet. Go some place else. It's your choice if you continue to stay in an supposedly unsafe environment. If you dont want to leave then find out the cause of why there are not enough nurses and do something about it, be part of the solution and not part of the problem. For example if you facility needs nurses help recruit, I know mine is always looking for staff on the night shift, and even then thats not forever- I have nurses with 2 years in dept on afternoons and mid-days.

The problem with leaving is that the next place may not be any better. And that's assuming that I can find another job in my area.

We do need to fill one or two openings, but it isn't as if I can just go recruit and problem solved. Management already has several resumes in hand, or so I'm told. I can't force them to hire someone, and even when they do, it takes time to get them ready to assume the position on their own.

One of the problems that we have had is that all the nurses they have hired recently have been new grads with no experience in nursing, let alone in the ED. So when I"m charge, I have to be concerned with 3-4 out of 7 (when fully staffed) nurses per shift who don't always know what they are doing. Those of us who are experienced and see the danger in this have protested in all of the ways that are available to us, but we are told that the grievance process takes time.

Another issue that we are dealing with is nurses calling in sick. That is not something that I have any power to address, and management has not done it for some unknown reason.

You seem to suggest that by refusing an assignment I am part of the problem. I am certainaly not unaware of the possible ramifications of this action. But when all other avenues have seemingly failed, sometimes you are left with the choice of drawing a line in the sand and standing for your rights.

Advanced Practice Columnist / Guide · Apr 20, 2011

I would suppose your best bet is to ask the Michigan Nurses Association for advice. MNA is active in ensuring that nurses who are the forefront of bedside nursing care are protected from unsafe staffing. They actually broke off from the national association (ANA) years ago to pursue a more active political stance against unfair labor practices involving nurses. You have to be careful when you proceed with things like this, you are an at-will employee of the hospital, you could easily get targeted as a troublemaker if your employer finds out that you are questioning their practices. I am not saying this because I am a member of MNA as I'm actually not in Michigan anymore. I am now working in a state where there are mandated nurse-patient staffing ratios and hospital nurses are part of a collective bargaining unit.

GM2RN · Apr 20, 2011

I would suppose your best bet is to ask the Michigan Nurses Association for advice. MNA is active in ensuring that nurses who are the forefront of bedside nursing care are protected from unsafe staffing. They actually broke off from the national association (ANA) years ago to pursue a more active political stance against unfair labor practices involving nurses. You have to be careful when you proceed with things like this, you are an at-will employee of the hospital, you could easily get targeted as a troublemaker if your employer finds out that you are questioning their practices. I am not saying this because I am a member of MNA as I'm actually not in Michigan anymore. I am now working in a state where there are mandated nurse-patient staffing ratios and hospital nurses are part of a collective bargaining unit.

I work for a union hospital and I'm a member of MNA. They have been addressing the issue but the grievance process is so slow, and the hospital continues it's non-contractual practices in the meantime. I don't want to go into details here, but a patient came extremely close to being harmed a couple of days ago because of it, and it can be directly related to the staffing issue that we have been complaining about. If that incident doesn't cause them to make some changes, then nothing will.

morte, LPN, LVN · Apr 20, 2011

I work for a union hospital and I'm a member of MNA. They have been addressing the issue but the grievance process is so slow, and the hospital continues it's non-contractual practices in the meantime. I don't want to go into details here, but a patient came extremely close to being harmed a couple of days ago because of it, and it can be directly related to the staffing issue that we have been complaining about. If that incident doesn't cause them to make some changes, then nothing will.

Can you contact the law firm for the hospital? They would be the ones advising TPTB on what they could defend if something goes to court....

GM2RN · Apr 21, 2011

Can you contact the law firm for the hospital? They would be the ones advising TPTB on what they could defend if something goes to court....

I don't know if I can contact the law firm or not. I'll have to find out.

What's TPTB?

morte, LPN, LVN · Apr 21, 2011

The Powers That Be.....

GM2RN · Apr 21, 2011

The Powers That Be.....

LOL Thanks

lotusgirl1 · Apr 28, 2011

I'm not sure where you work. But it's not like that everywhere. I work on a very busy surgical unit. Days usually has 4 patients, but no more than 6. Midnights usually has 5 patients, but no more than 6. But, we are an acuity adaptable hospital. Which means, there are times that we have drips on our floor. We not only get some cardiac drips, but we also get all of the Insulin drips in the hospital. But in all honesty, in rarely happens. And even when we don't have the drips, we still only have 4 patient's on days. Which makes for a really really long 12 hours.