CNE Expects Code Nurses To Leave Patients Under Direct Care

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. 

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!

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 

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.

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.

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.

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.