CNE Expects Code Nurses To Leave Patients Under Direct Care

Nurses Safety

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CNE Expects Code Nurses To Leave Patients Under Direct Care

Wondering if anyone else has run into this and what you have done.

I work in ICU and am frequently assigned as a Charge Nurse. In addition to unit resource, Charge nurses are a member of the RRT/Code team. But they are also responsible to break other nurses when there is not a break nurse. Previously, when there has not break nurse, we have called the house supervisor and let them know that we will have a patient assignment and will not be able to attend the Code or RRT until the other nurse has returned.

This past week, both the DON and CNE have stated that it is their expectation that Charge nurses leave and attend the code regardless of breaking another nurse. They stated that Title 22 (California) allows for this in emergencies.

There is a section in Title 22 that reads: 

"The hospital shall plan for routine fluctuations in patient census. If a healthcare emergency causes a change in the number of patients on a unit, the hospital must demonstrate that prompt efforts were made to maintain required staffing levels. A healthcare emergency is defined for this purpose as an unpredictable or unavoidable occurrence at unscheduled or unpredictable intervals relating to healthcare delivery requiring immediate medical interventions and care."

The BRN however, does not have any such allowance. If one has accepted that assignment, then severed that assignment without first giving "reasonable notice to the appropriate person (eg. supervisor) so that arrangements can be made for continuation of nursing care by others" that is patient abandonment.

Neither ICU staff or our manager is comfortable with his new expectation, but our manager feels their hands are tied, and we must follow the directive. I disagree. I believe the argument can be made that RRT & Codes are not unpredictable or unavoidable in a hospital setting. We are not willing to put our license in jeopardy; I know I will flat out refuse to leave patients under my care, but know others won't. 

Has anyone run into this problem before? How did you handle it?

Thanks in advance.

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Specializes in Geriatrics.

I have not run into this exact problem, I do however completely agree with your decision to not leave the unit and attend to an emergency. Your supervisors should ensure there is coverage for the ICU patients you are responsible for, that means if they have to attend the code in your place then so be it. If something were to happen to the patients you are responsible for then it will be the Board of Nursing that has you justifying the situation. Stick to your guns and know you are doing the right thing. 

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Specializes in Tele, ICU, Staff Development.

They are misconstruing the intent of Title 22 to their own advantage.

"Just to clarify-are you telling me to leave the unit and abandon my patient (s)?"

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Specializes in Travel, Home Health, Med-Surg.
On 12/26/2022 at 5:48 PM, Tami707 said:

The BRN however, does not have any such allowance. If one has accepted that assignment, then severed that assignment without first giving "reasonable notice to the appropriate person (eg. supervisor) so that arrangements can be made for continuation of nursing care by others" that is patient abandonment

I would not leave the pts you are covering to go attend a code either. The hospital is definitely trying to get away with something. I would point out the BRN quote above and simply ask who will come and cover your pts before you leave the unit. I wouldn’t leave until s/he arrives to the unit and you give report/handoff (and of course it will probably be too late for you to go to said code so they will have to figure out something else). Having worked in California hospitals myself it has been my experience that they always try to skirt around (if not actually break) the mandated ratios to save a buck. You are absolutely correct to protect yourself!

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I am glad you have identified the issue. Leaving the floor is not inherently abandoning an assignment,  just as taking a break isn't. The issue is hand-off.  Coverage should be planned in advance. Couldn't the nurse going on break report off to both to the charge and another nurse as a back-up?  When I worked in ICU I was frequently charge and covered codes. It was honestly never a problem. It sounds like there needs to be a specific procedure drawn up to make sure patient safety standards are maintained. Keep pushing till this gets resolved! Good luck 

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Specializes in Critical Care.

Whether through ignorance or malfeasance, they are misinterpreting that section of Title 22.

The pertinent sentence in that section begins with:

"If a healthcare emergency causes a change in the number of patients on a unit..."

It does NOT state:

"If a healthcare emergency causes a change in the number of nurses on a unit..."

If you leave the unit for any reason, unless your patients have been reassigned to another qualified nurse and that nurse has accepted the assignment, you are abandoning your patients.

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Specializes in NICU; Mother-Baby.

I have never thought of this situation as a possible liability issue. I work in NICU and we frequently have to leave to attend deliveries, sometimes it is an unexpected code type situation where we are running out of the unit, and we don't give handoff to another nurse. Maybe we need to rethink that.

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Specializes in Critical Care.

I don't think reassigning patients temporarily to a qualified colleague during an emergency (RRT/Code) requires a full change-of-shift type Report.  At the first hospital I worked at two SICU nurses were assigned to RRT/Code Duty each shift (not necessarily the Charge Nurse).  When we were assigned to the RRT/Code Team we generally made sure one or two of our colleagues were familiar with the status of our patient(s) before the need for a temporary reassignment happened.  Then, if an RRT or Code was called and a patient hand-off happened, it was done very quickly. 

From a legal standpoint, it is the acceptance of the patient by another qualified caregiver that must happen before one leaves the unit to respond to a code.

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Specializes in Tele, ICU, Staff Development.
JMTrumpet1 said:

I don't think reassigning patients temporarily to a qualified colleague during an emergency (RRT/Code) requires a full change-of-shift type Report.  At the first hospital I worked at two SICU nurses were assigned to RRT/Code Duty each shift (not necessarily the Charge Nurse).  When we were assigned to the RRT/Code Team we generally made sure one or two of our colleagues were familiar with the status of our patient(s) before the need for a temporary reassignment happened.  Then, if an RRT or Code was called and a patient hand-off happened, it was done very quickly. 

From a legal standpoint, it is the acceptance of the patient by another qualified caregiver that must happen before one leaves the unit to respond to a code.

I know that being from California, I'm in the minority here, but our 1:2 ICU ratios prohibit that from happening. Otherwise an ICU nurse could easily end up with 4 patients, which may not be safe.

 

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Thank you everyone for your replies. 

We, all the Charge Nurses, have requested a meeting with our Manager, the DON, and CNE to discuss this. The consensus among us, is that this is an unsafe, as well as a license jeopardizing practice.  

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