Assigned to TWO units simultaneously, anyone else?

Editorial Team / Admin · Aug 29, 2015

So, how do codes work? Three people, one of them not even medical or nursing, doesn't sound like enough to pull that off. What about the legally permitted meal breaks? It's impossible to get an uninterrupted break with no relief, so I'd be making sure to put down no meal and that I need paid the extra half hour.

Either way, it doesn't sound safe at all to have so little staff available. You said you're in Texas. While I am not familiar with Texas's Safe Harbor act, would that be a resource to look into?

Sol6 · Aug 29, 2015

Thank God there hasn't been a code here yet that I know of, but they certainly wouldnt work well. I'd have to run it with the MD and have the guard call 911 for emergency transport to our sister facility.

Legally permitted meal breaks (or any break for that matter); that may be a good talking point for me to take this to upper administration. It definitely has the potential for safe harbor territory, just been blessed that every patient has been stable so far.

It's a shame to be put in position where I may have to move on down the road due to safety concerns. This is an otherwise great gig. Where else do you get the luxury to spend 30 minutes getting a history for and ER patient then still have enough time to make sure all their needs are attended to without feeling stressed?

emmy27 · Aug 31, 2015

This sounds crazy. I mean I'm sure it's typically fine, but it has the potential to go so bad, so fast.

How/why are they keeping an ER which typically sees 0-2 patients/day open? And how can they possibly think it's safe to staff an ER (even one as underutilized as that) with *no* dedicated staff?

Sol6 · Sep 1, 2015

I think that this ER exists to fulfill the requirements of CMS. I'm not certain if this is correct, but I believe that to participate in medicare and medicaid billing a facility has to comply with EMTALA. So they keep the ER for billing/legal reasons.

emmy27 · Sep 1, 2015

My understanding is that all hospitals are required under EMTALA to have the policies and capacity to *evaluate*, triage, and provide initial care for patients presenting with emergencies, but not to actually have an ED. Having an ED that isn't actually equipped for emergencies (which is what I would call an ED with only one nurse who sometimes also has another full assignment) seems substantially worse than not having an ED at all, as it gives the public a false sense of what care is available.

You'd be in deep water if something serious came in and you were by yourself, especially if your other patients were unstable... what *would* you do in a code? Even with a doc, just two people for compressions, bagging, getting access, drugs, intubating, watching the monitor, recording? How long could you each do compressions before you dropped from exhaustion? Is the doc going to bag and give meds at the same time? Heck, how do you even waste narcs when you're the only one there?

I mean, you do what you have to do, I guess, but it sounds... less than ideal. I'd get out of there, personally. It seems like a disaster waiting to happen.

LWitcher, BSN · Sep 2, 2015

OMG, promise I feel a majority of the time that nurses are treated so unfair, but yet we are needed, it makes it difficult because you want to prove you are capable of doing your job but at what cost? Truly not at the cost of some patients life, and neither at the cost of one's license! :no:

allnurses Guide · Sep 3, 2015

The Texas Administrative Code requires that a registered nurse on duty in the hospital must be available for emergency services at all times.

The hospital MUST have a written staffing plan posted in a conspicuous and accessible location for both patients and direct care staff.

http://www.ilga.gov/commission/jcar/admincode/077/077002500G07100R.html

Before we had our ratios smaller facilities such as your would provide that the nursing supervisor be immediately available to the ER. No nurse with an inpatient assignment could be available at all times.

Federal law, CMS regulations state:

Â§482.23(b) Standard: Staffing and Delivery of Care
The nursing service must have adequate numbers of licensed registered nurses, licensed practical (vocational) nurses, and other personnel to provide nursing care to all patients as needed.
There must be supervisory and staff personnel for each department or nursing unit to ensure, when needed, the immediate availability of a registered nurse for bedside care of any patient.
https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_a_hospitals.pdf

I suggest you put your concerns in writing before working another shift. This could prevent a tragedy.

Keep a written notice ready and available to fill in the specific unsafe assignment, date, time, and signature.

Here is information on the Texas Safe Harbor law:

https://www.bon.texas.gov/pdfs/safe_harbor_forms_pdfs/SHPR-CompRequest.pdf

Please read this. it has a form to use. Following this by notifying the hospital in writing BEFORE accepting an unsafe assignment can save your license, prevent your being a defendant in a law suit, and possibly save your your job.

What they are doing is not acceptable because you can only be in one place at a time.