Forced to Take an Assignment You Can Not Handle - page 4

Hello! I am a nurse who has been practicing in MO for a little over a year. This is a new profession for me in a new state. I previously attended nursing school in Texas and learned about Safe Harbor there. Safe Harbor... Read More

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    Quote from jrwest
    Ahh- they sound like a good idea, but I guess we would not be allowed to use them as it is tied, and pt can not move as desired- ie: the " I can fall if I want to " thing.
    Ughhhhhh.
    As with all restraints, the pt has restricted movement. They have to be tied so that one pull releases it from the bed. Our wrist restraints are that way too.
    herring_RN likes this.

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    Quote from sapphire18
    As with all restraints, the pt has restricted movement. They have to be tied so that one pull releases it from the bed. Our wrist restraints are that way too.
    Decades ago belt restraints were common. One hospital where I went as a registry LVN required all patients over 65 to wear one or sign a refusal. Many alert patients wore them. They could turn side to side and use the urinal. They were tied under the bed to the nurse or nursing assistant could just grab an end and pull it untied.
    .
    sapphire18 likes this.
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    Quote from 1RN4Christ
    Hello! I am a nurse who has been practicing in MO for a little over a year. This is a new profession for me in a new state. I previously attended nursing school in Texas and learned about Safe Harbor there.

    Safe Harbor applies when a nurse believes an assignment may place patient's at risk of harm, thus violating the nurse's duty to the patient and also protecting the nurse's license. I searched the Missouri BON site and could not find anything regarding laws that govern duty to the patient such as this one. So, what options does the nurse have regarding this issue? Chain of command?


    The reason I ask is because of the assignments I am forced to take when the acuity of my present patients is high. We never go on diversion, even when short-staffed, and are often left without employees to sit on one-on-ones with confused patients although ordered. This makes the shift VERY stressful for everyone and quite unsafe. Then, when a blood transfusion and surgical patient has been added to that workload and you end up with 5 patients and you KNOW you can not tend to everyone following standards of practice, what do you do?

    I told my manager I did not have lunch (around 1430) and my patient who needed to be a one-on-one (that the doctor would not order) was getting out of bed every 5 minutes until a point was reached where someone forgot the patient's bed alarm and she almost fell when someone found her out of bed. The patient receiving the transfusion had to wait 3 hours before the 1st unit of PRBC's could begin and their Hgb. was 5.9. The surgical patient was seen once post-op by this nurse and one set of vital signs was recorded (they came to the floor around 1540, toward the end of the shift and had been in recovery for several hours and were supposed to go home that day but nausea and pain were not controlled). There was only one aid on the floor for 21 patients. I was constantly running to the confused patient's room until the time they were found out of bed...after I placed the patient back in bed and put the alarm on I went into the patient's bathroom and cried. The post-op patient had previously complained that no one was caring for her and was an employee of the hospital. I was embarrassed and could not blame her for the complaint as what was happening was unsafe practice.

    I did not want to receive the post-op patient because my workload was already heavy and I had started the day with 2 confused patients...thankfully one was eventually discharged. I felt neglectful of the other 4 patients because the very confused patient I was left with practically needed her own nurse.

    Sometimes I feel that nurses need advocates, too.


    I want to provide the best care possible and feel it is almost impossible on days such as previously described.


    Please help!
    Unfortunately, it's that way on Med/Surg floors. I used to work Med/Surg neurology & it was rough.One night, we were assigned 10 patients, & we held up report, didn't accept the patients. Management threatened us & we didn't care. They can't do anything to us if the patients were not handed off to us. After standoff, mgmt got more staff and we had a more mangeable assignment.
    anotherone, motownmama27, Sun0408, and 1 other like this.
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    How ridiculous that we get blamed for all falls yet can't do anything realistic to prevent them .

    oops , sorry, derailed.
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    I have found working Med/Surg that you have to have a tag-team partner for lack of a better description to survive!!!!
    anotherone likes this.
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    Thanks for all the comments :-)
    Last edit by 1RN4Christ on Feb 27, '13
    herring_RN likes this.
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    Everyone else has said it--that is the typical med-surg experience. When I started my first job, I was told I'd never take more than 5 patients. As soon as I was off orientation, 6 was the norm. At my current hospital, I think the med/surg nurses typically take 7. I couldn't do it! That is why I made the switch to ICU. It isn't that it is less stressful, but I'd rather my stress be due to my patient's condition rather than simply being overwhelmed with the sheer number of patients.
    anotherone likes this.
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    I hate to bust your bubble, but I work in an Inpatient Mental health facility with 52 pts on my floor. Our patients, are extremely unstable, violent, aggitated, and some should be restrained but it is against facility policy. It is not uncommon to be so short staffed that I am left with the entire floor with the help of 3 aides who can only wash and watch. Our budget doesnt allow for sitters, or extra staff. It is ridiculous, but healthcare is stretched to the max it seems. I would Love
  9. 2
    I have to echo the sentiment about ICU that Stratiotes made. I am still in nursing school, but I am doing my last rotation in the ICU and working my preceptor's schedule and I hope with everything I am that it helps me land an ICU job straight out of school. Is it stressful? Yes. Are there a ton of things I don't know? Yes. But the difference with ICU vs. the med-surg floors I've had clinical on is that you have time to look things up that you don't understand. I have been taking my preceptor's full load of patients. She has essentially been standing in the doorway just watching while I do at least 90% of the work, and I still have time to look meds up that I don't know, look up diagnoses and treatments that I don't understand, because the fact is that when you only have 2 patients, maybe just 1 if they're on CRRT or sepsis protocol, you have free time. Period. I couldn't do med-surg nursing... it is just too difficult. I would rather have two more complicated patients than seven or eight "easier" ones... easier being relative when they could be confused or simply demanding with their finger on the call button all night. There is no finger on the call button when a patient is on the vent with fentanyl and versed running.
    1RN4Christ and anotherone like this.


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