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.