Covid: Protections for unsafe staffing?

[ClaraRedheart, BSN, RN]

Hi, I'm just curious how this has played out in other states who have seen major surges. I do NOT work on a Covid floor, but the higher acuity floors in my hospital are now taken up with COVID patients and the high acuity patients/not ICU  now come to us instead. Our ratios have not decreased though the patient population is much MUCH sicker than we're used to. Back when the pandemic wasn't as widespread here, but the flatten the curve was and elective surgeries were shut down, they decreased our ratios. I think they would again, but staff is sick and out, our hospital is overcrowded and frankly, they don't have the staff to decrease ratios. They're calling me every other day on my day off with overtime plus critical and once, double critical pay. I can't mentally do it again because I feel that every day that I work this heavier patient load is a day that I am risking my license. I've missed things because of emergencies in other rooms that I haven't seen until  the end of the day because that was the first time that I sat down to chart. I would love to help, but it's mentally and emotionally taxing to take the load that we're taking, add on top of that that any mistake that is made despite the increased load could cost me my license. They're offering bonuses for people that commit to sign up for extra shifts over a time period but no one is taking it. How has this worked in the hard hit states? When you go into an  under equipped hospital as a travel nurse, was that a risk to your license? How could they make this fair?  I would feel much better calling safe harbor at the breaking point every shift until staffing is better, but I feel that might cause problems with management . 

[turtlesRcool]

A lot of nurses worry about losing their license.  This seems to be something clinical instructors drill into our heads as a major threat.  But go to a state's BOE website and look through to see what nurses lose their licenses for.  It's not because someone's med was late.  It's not because someone didn't call a doctor immediately to report a high blood pressure.  It's because someone failed a drug test or didn't comply with the terms of their monitoring agreement after being flagged for drug use.  It's because of  illegal or unethical behavior.  It's not because of making honest mistakes or being overworked.  If you are really worried about legal action, now could be a good time to purchase malpractice insurance if you don't already have it.

Nursing during a pandemic is HARD.  I was mentally and physically and emotionally exhausted when I worked on a COVID floor during our surge.  But working on a "clean" floor was also extremely challenging because the acuity was so much higher than usual.  Like you, we saw patients come to a regular floor who would go to critical care in ordinary times (like fresh STEMIs).  We are unionized, so we did sometimes file our "unsafe staffing" papers, which probably don't really mean much, but they do provide a layer of protection (maybe) if there is patient harm due to inappropriate ratios or acuity.  Other than that, we just did our best, and helped each other when possible.

It sounds like people at your hospital are in a spiral of being overwhelmed at work, and needing to take time off, but taking time off means those who are in the building are even more strained, leading them to be too stressed to pick up extra shifts...and on it goes.  

If you need those days off, take them. You're fulfilling the obligations of your control hours, and you have to practice self care. That said, if you want to pick up, don't let fear of license sanction be the thing that holds you back.

[ClaraRedheart, BSN, RN]

The malpractice insurance is a really great idea, and I think would help to decrease some stress. It's not as pricey as I thought it would be!