8 Dead at Florida Nursing Home without power after Hurricane Irma

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So what do you think happened here? They are located right across the street from a hospital but did not evacuate their residents to this hospital. WHY WHY WHY???

Specializes in Hospice, corrections, psychiatry, rehab, LTC.

I don't know the full circumstances here, but I have to wonder if this would hold true in a situation in which the nursing staff was not relieved for days, and was stuck on duty well beyond the human capacity to properly function.

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Specializes in Gerontology, Med surg, Home Health.
The courts and BONs have repeatedly found that short-staffing is not an excuse for substandard care. If you are in a situation in which you're short-staffed and overwhelmed and something goes wrong, the fact that you didn't have enough help is not a defense. Nurses who choose to continue working in those situations need to understand the risk they are taking on.

It is hardly a choice if you're the nurse who is there and no one shows up to relieve you. You have two choices: abandon the patients and almost surely lose your license or stay and do the best you can.

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The courts and BONs have repeatedly found that short-staffing is not an excuse for substandard care. If you are in a situation in which you're short-staffed and overwhelmed and something goes wrong, the fact that you didn't have enough help is not a defense. Nurses who choose to continue working in those situations need to understand the risk they are taking on.

I think that's the issue that really needs to be resolved- the only legally "good" choice for a nurse in an understaffed situation is to refuse the assignment (and probably get fired) - management faces no repercussions at all for creating the dangerous situation & they have a large financial incentive to understaff. Current laws allow management to just throw the nurse under the bus & walk off Scott free.

If you compare the actions of the board of nursing & the regulatory board for nursing homes in my state, it'll curl your toes. I was looking through old disciplinary actions & one that really caught my eye was a facility manager who had an expired license for like 3 years.. Outcome? $50 fine.. Lol, work as a nurse without a license for three years & I'd fully expect a referral for prosecution.

I really enjoyed working in ltc, but I value my license too highly to ever work there again.

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It is hardly a choice if you're the nurse who is there and no one shows up to relieve you. You have two choices: abandon the patients and almost surely lose your license or stay and do the best you can.

I'm not saying I think it's a good situation; just that it's important that nurses understand the risks involved. I have talked with lots of nurses over the years who believed that "but I didn't have enough help" or "I was exhausted but my employer told me I had to stay" would be a defense if they found themselves in trouble over an error they had made at work.

Also, those aren't necessarily the only two choices. I worked years ago in a setting in which we were consistently understaffed to a degree that all the nurses found alarming, potentially dangerous (this was in inpatient psych, in a v. tough setting. A "good" shift was when no one got hurt. Things could go v. wrong v. quickly). We went as far as contacting the BON for advice about our options for protecting our licenses (and communicated with them multiple times over time about the situation). The BON in our state advised us that, if we felt an assignment was unsafe because of inadequate staffing, we should notify our superiors that we couldn't continue working under those conditions and needed to leave. At that point, the BON would expect us to remain a reasonable amount of time to allow the organization to get someone in to relieve us, and the BON considered "a reasonable amount of time" to be two hours. After two hours, we were free to leave as far as the BON was concerned. Granted, we would be fired, but our licenses would not be in danger for abandonment. (Note -- I would not automatically assume that any other BON would take the same position.)

I've known too many nurses over the years who are just drifting through their careers assuming that they have no options in bad situations, or surely they couldn't actually be held accountable if something goes wrong. If one is going to be a licensed professional, I think it's important to understand the risks and responsibilities that come with that.

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I'm not saying I think it's a good situation; just that it's important that nurses understand the risks involved. I have talked with lots of nurses over the years who believed that "but I didn't have enough help" or "I was exhausted but my employer told me I had to stay" would be a defense if they found themselves in trouble over an error they had made at work.

Also, those aren't necessarily the only two choices. I worked years ago in a setting in which we were consistently understaffed to a degree that all the nurses found alarming, potentially dangerous (this was in inpatient psych, in a v. tough setting. A "good" shift was when no one got hurt. Things could go v. wrong v. quickly). We went as far as contacting the BON for advice about our options for protecting our licenses (and communicated with them multiple times over time about the situation). The BON in our state advised us that, if we felt an assignment was unsafe because of inadequate staffing, we should notify our superiors that we couldn't continue working under those conditions and needed to leave. At that point, the BON would expect us to remain a reasonable amount of time to allow the organization to get someone in to relieve us, and the BON considered "a reasonable amount of time" to be two hours. After two hours, we were free to leave as far as the BON was concerned. Granted, we would be fired, but our licenses would not be in danger for abandonment. (Note -- I would not automatically assume that any other BON would take the same position.)

I've known too many nurses over the years who are just drifting through their careers assuming that they have no options in bad situations, or surely they couldn't actually be held accountable if something goes wrong. If one is going to be a licensed professional, I think it's important to understand the risks and responsibilities that come with that.

The critical issue isn't nurses being held "accountable" - it's *acknowledging* that there's a discrepancy of power between management and nurses & a complete refusal by various BON's to acknowledge the discrepancy when disciplining nurses. It's really easy to go after a nurse's license & you can justify that action in a heartbeat - but doing so misses the "kingpins" as it were.

We don't know what went on with nursing staff at this facility (and we likely won't know until it goes to court), but we *do* know that the same government has loosened restrictions, regulations and accountability for nursing home owners & administration in Florida is now actively seeking criminal prosecution "for those responsible", and in the end, that's the nurses.

If you can't get any other sacrificial lamb, you can always have a press conference & announce to the public how "tough" you are as a prosecutor, because you "got" the nurse(s) involved.

In the end, under our current system, the *only* party that's "accountable" is the nurse.

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The critical issue isn't nurses being held "accountable" - it's *acknowledging* that there's a discrepancy of power between management and nurses & a complete refusal by various BON's to acknowledge the discrepancy when disciplining nurses. It's really easy to go after a nurse's license & you can justify that action in a heartbeat - but doing so misses the "kingpins" as it were.

We don't know what went on with nursing staff at this facility (and we likely won't know until it goes to court), but we *do* know that the same government has loosened restrictions, regulations and accountability for nursing home owners & administration in Florida is now actively seeking criminal prosecution "for those responsible", and in the end, that's the nurses.

If you can't get any other sacrificial lamb, you can always have a press conference & announce to the public how "tough" you are as a prosecutor, because you "got" the nurse(s) involved.

In the end, under our current system, the *only* party that's "accountable" is the nurse.

All of that is true -- so nurses in FL need to be aware that is the risk they are choosing to take if they choose to work in a SNF in FL.

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Specializes in Critical care, tele, Medical-Surgical.
The courts and BONs have repeatedly found that short-staffing is not an excuse for substandard care. If you are in a situation in which you're short-staffed and overwhelmed and something goes wrong, the fact that you didn't have enough help is not a defense. Nurses who choose to continue working in those situations need to understand the risk they are taking on.
Many times a judge in arbitration, court, or the licensing board rule in favor of a nurse who gave notice as soon as he or she became aware of the unsafe assignment.

Several unions have an "Assignment Despite Objection" "ADO" or "Disclaimer.

When I worked as a registry nurse I wrote to copies with that language, the name of the manager notifies, and why the assignment was unsafe. I didn't use a patient name, just the name of the unit and the number of patients. Often other nurses also signed it. Sometimes it resulted in additional staff.

It will state, "As a patient advocate, in accordance withthe Nurse Practice Act, this form confirms my notification to you that, in my professional judgment, today's assignment is unsafe and places my patients at risk.

As a result, I will under protest carry out the assignment to the best of my ability."

Here are samples:

http://crona.org/wp-content/uploads/2015/03/ASSIGNMENTDESPITEOBJECTION1.pdf

http://nurses.3cdn.net/a9f823a8e604abb607_fym6b9n3r.pdf

http://www.seiu1021.org/wp-content/blogs.dir/74/files/2017/02/ADO-form3-AHS.pdf

Scroll down to read the ADO: The ADO - HoneyBadgerRed

1199 SEIU UHWE Florida Region a Assignment ... - cloudfront.net | SLIDEBLAST.COM

https://higherlogicdownload.s3.amazonaws.com/OHNURSES/26931ef7-0793-494c-a6ee-4254906cc572/UploadedImages/ADO%20new.pdf

ADOs are used in Florida:

Nurses complain about staffing at two hospitals

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Specializes in Critical Care.

According to the coverage, the problem is that the nursing staff didn't have all the patient brought over to the hospital across the street, that wouldn't have been affected by lack of staff or working overtime. Personally if 8 people in your nursing home die simply because they lost air conditioning during pretty typical early September florida weather, then maybe it was well past their time to go.

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damned if you do, damned if you don't. You can't abandon an assignment once you're at work and given it. However, I worked per diem on a rehab unit that was understaffed and basically, a mess, and I never went back after my recent maternity leave. My husband didn't understand why I'd give up that "extra money" Nope - not worth the risk to my license and the potential criminal charges if anything happened due to the terrible conditions

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This is really too bad, but I'll be interested to see how it plays out. Not excusing these deaths, but how many patients were in this nursing home vs how many died? There was some reporting that there were inaccuracies in charting as in the chart said the patients temps were one thing, but at the hospital they were close to 108-but we all know how those inaccuracies could have happened with late charting etc.

Remember that we had nursing home deaths in the last bad hurricane- Katrina.Katrina Nursing Home Owners Acquitted - CBS News

At first pretty much everyone was saying that we should fry those nurses and owners, but they were told to shelter in place. So we better be careful how we look at this.

I can't imagine the hell it must have been either way for patient and nurse alike.

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Many times a judge in arbitration, court, or the licensing board rule in favor of a nurse who gave notice as soon as he or she became aware of the unsafe assignment.

Several unions have an "Assignment Despite Objection" "ADO" or "Disclaimer.

When I worked as a registry nurse I wrote to copies with that language, the name of the manager notifies, and why the assignment was unsafe. I didn't use a patient name, just the name of the unit and the number of patients. Often other nurses also signed it. Sometimes it resulted in additional staff.

It will state, "As a patient advocate, in accordance withthe Nurse Practice Act, this form confirms my notification to you that, in my professional judgment, today's assignment is unsafe and places my patients at risk.

As a result, I will under protest carry out the assignment to the best of my ability."

Here are samples:

http://crona.org/wp-content/uploads/2015/03/ASSIGNMENTDESPITEOBJECTION1.pdf

http://nurses.3cdn.net/a9f823a8e604abb607_fym6b9n3r.pdf

http://www.seiu1021.org/wp-content/blogs.dir/74/files/2017/02/ADO-form3-AHS.pdf

Scroll down to read the ADO: The ADO - HoneyBadgerRed

1199 SEIU UHWE Florida Region a Assignment ... - cloudfront.net | SLIDEBLAST.COM

https://higherlogicdownload.s3.amazonaws.com/OHNURSES/26931ef7-0793-494c-a6ee-4254906cc572/UploadedImages/ADO%20new.pdf

ADOs are used in Florida:

Nurses complain about staffing at two hospitals

THANK YOU FOR this Herring_RN.

I truly favor nurses who know their rights in the workplace. This story is sad and can be a lesson for us nurses to start knowing your employee rights.

Also, did the employers ever prepare the nurses with emergency action plan training?

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Update on the Hollywood SNF hurricane deaths -- they have been ruled homicides.

12 nursing home deaths in Hollywood ruled as homicides - Sun Sentinel

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