Comment Deadline 11/30/08: Patient Safety: Rights of RN's Considering Pt Assignment

lindarn · Nov 23, 2008

from ana
11/20/08
public comment deadline 11/30/08: patient safety: rights of registered nurses when considering a patient assignment
deadline 11/30/08
the ana congress on nursing practice and economics (cnpe) is seeking comments on the ana position statement, patient safety: rights of registered nurses when considering a patient assignment.
which states: "the american nurses association (ana) upholds that registered nurses - based on their professional and ethical responsibilities - have the professional right to accept, reject or object in writing to any patient assignment that puts patients or themselves at serious and immediate risk for harm. registered nurses have the professional obligation to raise concerns regarding any patient assignment that puts patients or themselves at risk for harm. the professional obligations of the registered nurse to safeguard patients are grounded in the code of ethics for nurses with interpretive statements (ana, 2001b), nursing: scope and standards of practice (ana, 2004), and state laws, and rules and regulations governing nursing practice."
download the position statment below and send comments to [email protected]
if you are interested in participating in this review, please provide your comments to the ana staff member listed above by 5:00pm est on november 30, 2008.
cnpe appreciates your assistance with reviewing this position statement
download position statement
public comment: patient safety: rights of registered nurses when considering a patient assignment

after reading the above statement from the ana, my reaction, is, that is nice but what, exactly is the ana going to do to assist nurses who are faced with the impossible staffing situations that are all too common place. as usual, nurses carry all of the responsibilty and accountability, but receive none of the power and control to fix the problems that we did not create.

their "suggestions, are more of the same- that and $00.50 will get you on the subway, as we say in ny. it was a nice touch that they acknowledge the barriers that nurses face on a daily basis to do our jobs safely, but again, as usual, they continue to choose to not support the only treal solution to the problem- staffing ratios. just more fluff from the ana. jmho and my ny $0.02.

lindarn, rn, bsn,ccrn

spokane, washington

Julia RN · Nov 23, 2008

I had posted about this previously in a different thread-

https://allnurses.com/forums/f8/safe-staffing-saves-lives-ana-has-started-campaign-us-288904-20.html#post3164301

The 1995 document that this proposed revision would replace is attached there. I think it would be important to compare the two documents when making comments on the revision.

The comparison is interesting, from a historical perspective as well as a nursing practice viewpoint.

The Massachusetts Nurses Association was cited in the 1995 version:

"In 1984, the American Nurses Association House of Delegates directed that ANA issue a position statement on mechanisms to support nurses' abilities to exercise their right to accept or reject an assignment. The position statement was to be based on a Massachusetts Nurses Association 1981 Resolution and later the Position Statement on Mechanisms to Support Nurses' Abilities to Accept or Reject an Assignment. This action was referred to the ANA Cabinet on Economic and General Welfare."

That bit of history is left out of this draft- perhaps it is deemed no longer relevant as Mass. has since left ANA.

The current version cites Texas as an example of having a process to address this issue- no mention of California's law- not surprising. ANA finds a way, even in this document, to decry staffing ratios- around line 81.

Another change in the current version is in the role of the state nurses association. In the 1995 version:

"SNAs are encouraged to develop an ADO form to document unexpected or inadequate staffing. SNAs also should develop appropriate follow-up measures for nurses to take after filing the ADO form in order to fully document the extent of the nurse's protest. An SNA that distributes an ADO form must be prepared to review and act on information from these forms. Data about quality issues and facts related to risk in patient care because of substitution of registered nurses by others or understaffing of registered nurses have been hard for the SNAs to compile. With the ADO forms the SNAs can gather the anecdotal information to report to the public as well as the proper authorities."

That's been replaced or rather watered down with:

"ANA’s Constituent Member Associations should establish a mechanism to assist nurses’ in expressing objections to unsafe patient assignments."

Don't see much help for staff nurses in this document.

smoke over fire · Nov 24, 2008

I tried to post this also...

In my union hospital we call these disclaimers. We file them as a way to keep track of violations and to provide a resource for a nurse if anyone should be injured (to staff or patient).

These are also used as a basis for filing grievances which are complaints that the management MUST answer to with a third party party mediator or it can be taken to further legal proceedings.

So I agree with Lindarn, this is a primarily union tool, it's nice to see the ANA trying to use it, but without a legally binding contract what can become of the information?

If it passes I wonder if unions will send them copies of the disclaimers they collect?

O Also wonder if this is in reaction to this::uhoh21:

https://allnurses.com/forums/f195/ana-loses-another-member-340867.html

lindarn · Nov 24, 2008

I tried to post this also...
In my union hospital we call these disclaimers. We file them as a way to keep track of violations and to provide a resource for a nurse if anyone should be injured (to staff or patient).
These are also used as a basis for filing grievances which are complaints that the management MUST answer to with a third party party mediator or it can be taken to further legal proceedings.
So I agree with Lindarn, this is a primarily union tool, it's nice to see the ANA trying to use it, but without a legally binding contract what can become of the information?
If it passes I wonder if unions will send them copies of the disclaimers they collect?
O Also wonder if this is in reaction to this::uhoh21:
https://allnurses.com/forums/f195/ana-loses-another-member-340867.html

"Without a legally binding contract, what will become of this inrformation?" Nothing, which is exactly what the hospitals want. Distract the nursing staff with paperwork that have no teeth to inforce it. Another "attaboy" added to the additional burden of taking care of too many patients. As long as they occupy our time with this worthless "tool" we won't have the time to complain and notice that we are overworked.

The ANA wants us to think that they are doing something useful for the bedside nurse. Nothing could be further from the truth! JMHO and my NY $0.02.

Lindarn, RN, BSN, CCRN

Spokane, Washington

allnurses Guide · Nov 24, 2008

Smart management at non union hospitals would pay attention to notification of an unsafe situation.

I was working at a non union hospital. The ICU was notified that several patients would be coming from the ER very soon.

All the staff wrote a letter of concern with all the facts. It was signed by everyone, RNs, CNA, and secretary/monitor observer. A copy was made so we could make additional copies for everyone.

An Incident report with the date and unit was started.

When the supervisor was handed the letter and told an incident report sent to the hospital attorney she somehow found three additional competent RNs. When the concerns were verbal no one was available.

lindarn · Nov 24, 2008

Smart management at non union hospitals would pay attention to notification of an unsafe situation.
I was working at a non union hospital. The ICU was notified that several patients would be coming from the ER very soon.
All the staff wrote a letter of concern with all the facts. It was signed by everyone, RNs, CNA, and secretary/monitor observer. A copy was made so we could make additional copies for everyone.
An Incident report with the date and unit was started.
When the supervisor was handed the letter and told an incident report sent to the hospital attorney she somehow found three additional competent RNs. When the concerns were verbal no one was available.

I have also said many times, that when things are really bad and unsafe, and the hospital is ignoring your concerns, go to the top, and contact the hospital's law firm and senior partner with the concerns of the nursing staff. They do not want to have to defend the hospital when they are being morons. As usual, make copies for yourselves, incident report included, and make alot of noise. JMHO and my NY $0.02.

Lindarn, RN, BSN,CCRN

Spokane, Washington

PsychNurseWannaBe, BSN, RN · Nov 26, 2008

Unfortunately I do not see how this new document will help the current situation. There really isn’t any objective writing involved. It simply stating that an RN should have the right, but how does this help us legally? It doesn’t. Put some numbers into this document so that RNs have something to fight with when faced with this legal and ethical dilemma. Furthermore, should I or another RN wish to decline a patient assignment, it mentions nothing about repercussions that may incur from nursing leadership at the facility level. Sure, I may decline, but the facility may wish to reprimand me.

Currently where I work, should we reach a nursing shortage for the day and I refuse to stay, the policy clearly states that I am abandoning the patients and subject to disciplinary action up to and including termination. Furthermore, the BON may be contacted to investigate.

What power does the ANA really have when there are 50 BONs? Will the BONs reflect the ANA statements in the NPAs? We need ratios… numbers that are concrete so that we as RNs can have a leg to stand on. Until this happens, RNs will have to continue to tip toe and be at the mercy of the facility.