Charge nurse doing staffing, supervisor overriding orders?

[Simply Complicated]

My department just layed off a manager and the office coordinator, with no plan to hire anyone to replace them. They "downsized" The new "policy" is that if we are short staffed, or have a call in it is now the charge nurses responsibility to call staff to look for the extra help. But only calling part time or Per diem. If we can't get help there, we have to get approval to call full time staff. Anyone else work somewhere that you have to do this? Not sure how long this will last, as hopefully the union is getting involved.

Also, how would you handle this? Dr. writes an order for a patient to only have male staff on his 1:1. Supervisor decides it's not necessary and isn't staffing this way. Actually staffing with no males on the unit. Pt can be very aggressive and assaultive. I don't see how this is even legal for the supervisor who is not on the floor, and does not know the patient to make this decision, and over ride the order?

[Simply Complicated]

Wow I had no idea that so many places have the charge nurse do the staffing. Crazy.

As far as the male staffing, this is something that has been frequently done on multiple units. We have had it frequently happen in the past few months, due to some of the patients we have had. We have quite a few male staff, so there is always a male somewhere between our multiple units. The not honoring the order is recent. Because it is psych, we have patients who get room restriction, with someone sitting in their doorway. Patients can become psychotic. We get patients who do respond better to males, which is why it's specified male only. Or you get a patient who will swing at anyone, with no warning. So the doc wants a male there. This particular patient attempted to punch the male sitting with him when he redirected him back to his room. You have a 200 pound, 6 foot male...they occasionally prefer not to have a female sitting with him.

Patients on psych are unpredictable. They can't have security sit with every psychotic patient who has a history of being assaultive. So we do the next best thing.

[Esme12, ASN, BSN, RN]

I must fell like being unpopular today......I am going to post something again that people might not like.

Although I do feel, especially in the present climate, that Unions or collective bargaining, is going to be the only protection for nurses.....but this is one of those examples that in dealing with a union facility, is annoying.

Most places I have worked the charge nurse is who calls for staff when there are call outs. I have personally found it more successful as it's easy to tell staffing no but your co-worker.....That's another story. I have found at collective bargaining facilities there is a huge us versus them bickering that goes on. The staff thinks administration is out to get them (ok maybe that part is true:D) and the administration think the staff are just lazy loud mouths (well.....:othere are times..).

I also hear a lot of....that's not my job at union facilities. While there are plenty of pluses there are negatives in the rules that accompany a union and a non union worker can't do a union persons job and only certain union people can do non union jobs, etc......while the rules are necessary at times to protect the job they also hinder the performance of the job. Like the calling in of staff. Most hospitals have the staff from the floor call (I know there are places that don't either) and yes.....the supervisor need to be the one to approve OT as her and the manager (I know they are gone) that are held fiscally responsible. I have seen staff that help out another staff member by calling that staff member only for extra shift thus incurring a ton of OT when there were others who would have come in....So there are reasons why rules are made.

Another misconception I hear is that the doctor ordered it. The reason for the order is to charge a higher rate of acuity to that patient and/or have the legal ability to physically restrain the patient when necessary and in some cases to watch to prevent harming themselves when SI is an issue. But to say that the MD ordered a male and it can't be legally done by a female when the supervisor changes it, while maybe morally corrupt, is not legally binding. Just because the "doctor ordered it" doesn't make it a legally binding order, in some cases, morally binding maybe, liable if something happens maybe...but illegal??? not necessarily.

As a psych facility I would think there would be policies in place that are somewhat better than a non-psych facility would have and you would have a level of experts that would help you deal with kind of patient. I have on occasion felt a female sitter would be inappropriate (due to the sexua/violent) behavior and have switched several employees to accommodate this...for the safety of the staff. I, personally, am hesitant to remove 1:1's or staff them differently as I always believe the safety of the staff/patient is of the utmost importance.

So while it stinks it's not illegal......OP I hope everything works out......:)

[xtxrn, ASN, RN]

What in the dung do the supervisors do if they don't help get shifts covered? The VAST (all but one) majority of places I worked (all non-union, right to work) staffing was either the staffing coordinator's ("business hours") or the supervisors' responsibilities.... the charge nurses were there for the patient care-not nursing vacancies. Nuts to have the charge nurses have to take time away from actual patient issues. IMHO.

[Esme12, ASN, BSN, RN]

It's not that they are busy doing something else someplaces feel that having the floor call gets; better results because it's harder to say not to you fiends thatn your supervisor.....:)