documenting short staffing question

nimbex, RN · May 25, 2003

Some facilities have specified forms others do not. Having been forced to go this route a few times I could tell you what was included. I no longer have a copy of the pre-printed form, this is from memory and not meant to be all inclusive.

First call direct supervisor and list the acuity with staffing ratio. If unsatisfied with response and you feel unsafe alert your supervisor you are using the chain of command and calling the next person. Do so, then if response has not changed, you then alert this person that you

"are docmenting the conversation and will accept the assignment under protest. you refuse to be held accountable for any meds, treatments that you were forced to delay during prioritizing, and you will not be held accountable should a patient be harmed due to lack of staffing ie. waited to long for call bell to be answered, decided to walk to bathroom without assist and fell.

You then write a quick summary of patients, especially all the high accuity things going on, number of staff and their exp. anyone who is willing to sign, have them sign it now.(yes some may back down later after management pressure.

Do ask for a meeting ASAP with the head supervisor to discuss how to prevent in the future. Hand the form into this person after making a copy for yourself (no patient identification HIPPA ya know).

I hope this helps.... sorry to hear you need it, I'm sure others will have some good ideas too. :confused:

nimbex, RN · May 25, 2003

Sorry, forgot to add that you should spend the time as well as the other staff (no matter how exhausted you are), to fill out incident reports on any and all meds missed so management can get a TRUE picture of how this adversly affected patient care.

altomga, ADN, BSN, MSN, DNP, RN, APRN · May 25, 2003

I wish there was a easy answer to this...documentation of incident reports are anonymous at my facility..and yes I fill them out!!

Tonight I have to go to work knowing we have only 5 RN's staffed on a unit that requires a minimum of 6 (with charge taking pt's) Yes they will have to emergently pull someone or send an assist..but on my unit the **it hits the fan often and of course they will try to blame the nurse for any wrong doings....NOT THE SITUATION THE NURSES WERE PUT IN BEING SHORT STAFFED!!!

DOCUMENT..DOCUMENT...DOCUMENT..

VOICE YOUR CONCERNS OPENLY.....

FILL OUT INCIDENT REPORTS....

ABOVE ALL...remember you are only ONE person!!

askater11 · May 25, 2003

The legal department told us to write incident reports--with the short staffing--this occured and could've been prevented/or treated more promptly.

teeituptom, BSN, RN · May 25, 2003

Such are the vagaries of life

angelbear · May 26, 2003

Last night nothing happened that we could not handle. I am a very hands on nurse and so is my night shift nurseing partner. We dont mind alot of hands on with the residents. The problem is this. We have a facility policy that no pod(area) is to be left unattended at any time including breaks. We pretty much run all the time with one cna in each area on nights. We have several 2 assists so if the nurses are willing we will go help with all the 2 man lifts. The main problem aside from a crisis which requires the time and attention of both nurses is shower time. We have 1 inparticular who likes to run off on us. If the nurses are in rooms with 02 and doing aeresols (usually right at shower time) we cannot hear a thing outside the room we are in. Then immed after the aeresols we begin to give report so it is not possible anyway you slice it for the nurses to watch this runner while the cna is doing her 2 showers. It has happened previouslly that the runner escaped at this time but that did not occur last noc. So would I just doc the potential danger or does there need to be actual harm in order to doc the short staffing?

niteshiftnurse · May 26, 2003

we were always told that any incident reports go to the director of the floor. My question is.....what happens when the director doesn't turn in the incident report. We also work under terrible conditions....short staffing.......and the director really doesn't give a flip

Tweety, BSN, RN · May 26, 2003

We had a nurse on one floor after repeatly short-staffing call risk management directly as well as filling out a report. She got results.

-jt · May 26, 2003

You fill out an incident report AFTER something has already happened. When Ive filled them out, Ive brought them to the Risk Management office myself - just to be sure they actually got there. You fill out assignment despite objection forms BEFORE something happens and to notify the hospital that they have put you in an unsafe situation that may cause something to happen -- & you are putting them on notice before it does.

We just got a new updated documentation form for this from the United American Nurses national RN union (UAN) which my state assoc is part of. Document Document Document. It goes to the person doing the unsafe assigning, a copy goes to the VP of Nursing, one to the nurse delegate, one to our union office, and the RN keeps a copy for herself. JCAHO has been asking to see them during inspections so we keep them forever. Our state assoc, which is also our local union, keeps their copies for at least 7 years. The forms canbe used as evidence in court for a nurse's defense should something go wrong when she was forced to accept a potentially unsafe assignment. Below is a quick look at the form but you can also print it out from the UAN website:

http://www.uannurse.org/uan/img/ADO1PRN.doc

Assignment Despite Objection

Date & Time: _________________________________

Facility: _________________________________

Shift: _________________________________

Unit: _________________________________

In accordance with the American Nurses Association National Code of Ethics for Nurses and my obligations as a patient advocate, I am objecting to my work assignment as:

_ Charge Nurse _ Staff Nurse _ Float Nurse

_ Other: ____________ .

I have notified (Name)______________________________, (Management Position)____________________________ that in my professional nursing judgement I am unable to assure the delivery of safe or adequate nursing care because of the following condition(s):

* Personnel assigned lack sufficient orientation

_ Self _ Other Assigned Staff

* _ Inadequate staffing for existing patient acuity

* _ New patients transferred or admitted to unit without adequate staffing

* _ Assignment posed potential of harm to health and safety of patients (explain below)

* _ Assignment posed potential for harm to health and safety of myself or other nursing staff (explain below)

* _ Inappropriate mix of providers (RN, LPN, NA, UAP/Tech, Clerical, other)

* _ Inadequate or unsafe equipment (explain below)

* _ Forced to work beyond scheduled tour (involuntarily)

* _ Other situation:

__________________________________________________

_____________________________________

Explain/Describe Conditions:

__________________________________________________

__________________________________

CONDITIONS & WORKLOAD SUMMARY

Unit Staff Assigned: RN ___; LPN ___; NA ___;

UAP/Tech ___; Clerical ___

Charge RN taking patients? Y/N #? ___

Outside Staff Assigned: RN ___; LPN ___; NA ___;

UAP/Tech ___; Clerical ___;

(Utilized as:___________________ )

Source of outside staff: Float from another unit ___;

Intermittent or Float Pool ___;

Agency/Fee Basis ___

Describe Assignment:

__________________________________________________

____________

Supervising Others?: Y/N ___

Starting Census:____

Describe Acuity:

__________________________________________________

_______________________________________

Ending Census: ____

Describe Acuity:

__________________________________________________

_______________________________________

Admissions/Transfers In - Pending: ___

Discharges/Transfers Out - Pending ___

Admissions/Transfers In - Actual: ___

Discharges/Transfers Out - Actual: ___

Other workload indicators: __________________________________________________

__________________________________________________

__________________________________________

I indicate my acceptance of the assignment despite objection; I will, despite objection, attempt to carry out the assignment to the best of my professional ability. It is not my intention to refuse to accept the assignment and thus raise questions of meeting my obligations to the patient or of my refusal to obey an order, if such were given.

However, I hereby give notice to my employer of the above facts and indicate that for the reasons listed, full responsibility for the consequences of this assignment must rest with the employer.

Copies of this form may be provided to appropriate state and federal agencies.

(Nurse's Signature) _________________________

(Nurse's Printed Name) _______________________

Supervisor's Acknowledgment Signature: _________________________________

Date & Time ___________________

SPECIFIC NEGATIVE PATIENT OUTCOMES

check all that apply:

_ Compromised Safety/Injury; _ Death; _Delayed/Postponed/Omitted Treatment; _ Delay of Medication;

_ Inadequate Observation/Monitoring; _ Delayed/Incomplete Documentation; _ Incident Report(s) Filed;

_ Delayed/Omitted Education/instruction; _ Delayed/Omitted Hygiene; _ Omitted Psych/Social Support;

_ Other (Spec(fy): __________________________________________________

________________________________________________

###

copies can be downloaded & printed at:

http://www.uannurse.org/uan/img/ADO1PRN.doc

SmilingBluEyes · May 27, 2003

Where I work, WE have two avenues: the occurence report and the charge nurse shift report. And I use BOTH to do this. You need to create and maintain a paper trail on issues like this. CYA my friend, CYA.

Zee_RN, BSN, RN · May 27, 2003

Oh, I copied that form! thank you. I will have to anonymously distribute it around the hospital. Just kinda leave it at various places.