Forced to Take an Assignment You Can Not Handle

tokmom, BSN, RN · Jan 13, 2013

Op, not every hospital is run like this. I have worked in many different hospitals and they all staff differently. My last facility, that I stayed for 16 yrs, every day was like what you described. It was insane and totally unsafe. What a craphole, but I stayed because it was close to home and I was able to cut down to part time.

After awhile I couldn't take it, so I quit. I found a nice facility where staffing is 90% of the time, adequate. There are those days that people call in and we can't get coverage, but those days are few. Even then, the nurses will have 6 pts, max.

Look around for a different floor or maybe a hospital all together, but don't assume this is what it's going to be like everywhere.

tewdles, RN · Jan 13, 2013

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? You should notify the MD, let them know EVERYTIME the ordered care is negatively impacted as this WILL negatively impact patients. There is published evidence to support this. The physicians can be our allies in applying pressure on administration to be proactive about the care and safety of the patients.
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. We have to advocate for ourselves and stand with the other health care professions.
I want to provide the best care possible and feel it is almost impossible on days such as previously described.
Please help!

What a wonder that you can even survive work like that!

I hope that you will pat yourself on the back for what you were able to accomplish for the patients in your care under impossible circumstances.

Holy Moly...and only a year of practice, new state, new job...you rock!

ps...I have cried too many times because I was heart broken, exhausted, overwhelmed, etc. I think we all do. We have tipping points. It is helpful when you have a venue where you can "leak" out some of the pressure/stress/anxiety and then collect yourself.

Once I told a family that I had to go outside and take an important call. I went to my car (winter) and had a good cry. I literally hit my head against the steering wheel in frustration and left a nice mark. That sort of brought me to my senses, I got some snow off my car and put it on my blotchy face and swelling forehead and had a big drink of cold water.

When I went back in I was able to complete my duties with professional decorum and continue with my day. I had to fib to the family about my head. LOL

Good luck!

dudette10, MSN, RN · Jan 14, 2013

What I found repeating in your post was "confused patient." All it takes is one of them to totally wreck your day. No family, no sitter, everyone stretched thin as it is. The only way to survive that is via coworkers who are willing to tag team while charting. I was frustrated for another nurse who literally had to beg coworkers to sit with her patient so she could pass meds to her other patients. I tag teamed with her as much as I could. Everyone needs to pitch in! Are you ready to chart for a half hour? Relieve your coworker from being strapped to a bedside dammit!

allnurses Guide · Jan 14, 2013

Call the Dept of State Health Services for the state in which you work.
I'm a Nurse Surveyor for the State of Texas. The State regulations for Texas hospitals (and this applies to acute care hospitals, psychiatric hospitals and critical-access hospitals) contain an entire section devoted to specifics on the "Nurse Staffing Committee". For Texas, this nurse staffing committee must meet at a minimum of annually. The committee must consist of AT LEAST 60% registered nurses who spend at least 50% of their time providing direct patient care. There is also to be a nurse present from PI or Infection Control. This assures input from more than just the paper-pusher nurses who look at a grid, compare it to the census and # of nurses staffed and say "Mmmm, yeah, looks okay to me". Specific topics are to be discussed in these meetings, and the recommendations are then to be presented to the Governing Board and the Performance Improvement committees.
Too many times I have investigated a complaint of "unsafe staffing" only to find that the hospital considers these meetings superfluous and doesn't even have them...has the meetings but the committee is made up of nurses in management positions...the findings and recommendations of the committee are never to be discussed again or any combination thereof. There must be formal meeting minutes taken along with a roster of the attendees. Many facilities are under the misguided notion that these meetings are optional because they have no intention of taking ANY recommendations to the GB or PI committees. A hospital can be met with a pretty stiff civil fine (at least here in Texas) for not following the regulations that pertain to the Nurse Staffing Committee.
Once presented with the findings and recommendations (which are, unfortunately, accompanied by an increase in medication errors, patient falls, hospital-acquired infections etc), the GB and PI committee take action.
I hope this information helps.
oldladyRN

This is what happened in my state. Click the name of the hospital

Pomerado Hospital

15615 Pomerado Road, Poway, 92064, San Diego County - The hospital failed to ensure the health and safety of a patient when it did not follow its policies and procedures for fall prevention. This is the third administrative penalty issued to the hospital. The penalty is $75,000.

1RN4Christ · Jan 14, 2013

I really appreciate all the input and support. I did not know if what I described was a common occurrence. Unfortunately, I see it is more common than we would hope to find. If patients only knew... As a nurse, I want to provide the BEST care possible and I get so fed up with hearing the word "sue"...there are so many patient advocates out there informing the public on how to protect themselves from healthcare professionals and I understand why, but not one shares 'why' in the context of how much is demanded of a nurse in one work day. These "advocates" make us sound intentionally unsafe and incompetent. Nurses are quite misunderstood as their roles are not clearly defined.

Herring_RN, I love your idea and will continue to write down everything as you recommended.

Tewdles, I appreciate your encouragement and feedback - it's unfortunate you can relate. You forehead story made me laugh

nu run, the family had stayed the previous evening and was exhausted and did not want to come in until the following evening so they could rest. Fortunately, at one point, my manager told the varying specialties to quit paging me to come to the room when they could not determine the patient's needs (her speech had been intelligible - nothing new). It was like passing the buck...so frustrating! He (my manager) helped watch over her room and monitor the tele desk as much as possible the last hour he was at work which was INCREDIBLY HELPFUL!!!

dudette10, I wish you were on my unit that day!

old lady RN, I will check out your story. I need to check into whistleblower protection...

1RN4Christ · Jan 14, 2013

Oh, and the attending for the confused patient FINALLY ordered a 1:1 2 hours prior to the end of my shift. I explained we had tried to call people in all day for help and he said that I could tell administration the hospital needs to go on diversion if we can not carry out orders. He said he realized this issue was not my fault and would tell them himself if need be. Needless to say, night shift had someone in the room for the 1:1, no problem! Someone in a previous post had mentioned that the physicians can pressure administration so I thought I would mention this. :-) I am thankful for physicians who back up the nurses and their patients.

allnurses Guide · Jan 14, 2013

Oh, and the attending for the confused patient FINALLY ordered a 1:1 2 hours prior to the end of my shift. I explained we had tried to call people in all day for help and he said that I could tell administration the hospital needs to go on diversion if we can not carry out orders. He said he realized this issue was not my fault and would tell them himself if need be. Needless to say, night shift had someone in the room for the 1:1, no problem! Someone in a previous post had mentioned that the physicians can pressure administration so I thought I would mention this. :-) I am thankful for physicians who back up the nurses and their patients.

Good for you and the physician!

I forgot to mention telling the patients doctors and/or medical director of your concerns. Acuity matters a lot.

cjcerrn · Jan 16, 2013

I find it a little strange that you would receive a Post-Op patient. I do occassional Nursing Supervison for my hospital and I know it takes nothing short of an act of Congress to be put on diversion. Once we are in that status, ALL non-emergent surgeries must be cancelled and rescheduled. After all, if you can't take care of what you have, why voluntarily bring in more. This is part of the reason it takes approval from the CEO to go on diversion...loss of revenue from elective procedures.

jrbl77, RN · Jan 16, 2013

Most of my days are fairly close to the day you describe. I did have a really great day the last time I worked. I went home feeling great. But back to the problem at hand. I Have found in my years of experience that staffing is usually done as a number , not a concern about the acuity of the pts. I often have the feeling that today may be the day I finally lose it and walk off the job. I understand that I would lose my license, but can only take so much. The answer to this question, I only wish I knew. Yes, you can look for another job, but usually things are pretty much the same wherever you go. Some suggest home care. I was in that situation and let me tell you, that call is not all that is cracked up to be.

cclash · Jan 17, 2013

I'm appalled by the apathy that most or the responders are showing. I've been a nurse to nearly 40 years. When we can't do the work that our patients need it is frustrating. To tell a young nurse, that's the way it is, get used to it....which is what I read in many of these responses, I find disturbing to say the least. I think the more important message is to write to the person in charge with a copy to the person he/she reports to, doesn't change...keep going up the line until someone listens. When we are put in situations that are unsafe, we need to speak out, if possible with the support and help of co-workers. Aren't we there to care for people?

medfed1 · Jan 20, 2013

I had a similar situation.one New Year's Eve. 100 yr old female pt fell on 3-11 shift. 3-11 Nurse did not report it or

pass on to me coming on the 11-7 shift. Took report and made rounds. Found Pt up and wandering in her room, confused and moaning in pain. Got her back to bed did an exam, discovered a broken left arm. Called the Doc. Got answering serv., said he would have the Doc call me right back, immoblized arm with makeshift sling. To make a long story short the Doc never called back. The shift was going to hell, the pt kept getting out of bed, lights flashing everywhere. I called the family member on the chart and told her I was calling an ambulance and sent pt to hosp. Dr. was ticked off. D.O.N. was ticked off. Family was grateful. Pts. got proper care. We could all fill a library with these stories. When it dosen't make sense anymore. Call a family member to come and watch the Pt. That gets all kinds of attention.

AFrenchRN · Jan 20, 2013

I think in the case of this confused patient you should have initiated a low bed with floor pads and possibly considered using a posey vest restraint. This, of course, would require an order from the MD as well as family consent, but doesn't sound unreasonable given the acuity of your other patients.