Family wins lawsuit against hospital for unsafe staffing

HappyNurse2005, RN · Jan 23, 2006

Hello?? Why didn't the nurse refuse? There is no way in heck I would accept an assignment of 20 patients. No way.

Do we know if she was in teh ED or on the floor? Why weren't cardiac enzymes done (potentially catching the MI)? Chest xray?

This is mindboggling that staffing is that short.

SharonH, RN · Jan 23, 2006

the fault isn't this individual nurse (i'm sure though that she feels responsible). however, management that allow this should be held accountable.-from traumarus
traumarus....amen!unsafe staffing...you bet management should be accountable.when management leaves a nurse stranded in an unsafe staffing scenario it is simply a "unsafe delegation"....and they have failed to make patient safety their priority. everyone wants to point fingers at the rn.....what about the manager who sat on their a**...at home while all this occurred?i think that...is criminal neglect.

that reminds me of an incident that happened at piedmont hospital here in atlanta about 5 years ago. i wasn't working in that particular department so i may have some of the details wrong but basically this one unit was being deluged with admissions and they did not have the staff to handle it. so they refused all further admits and somebody called the ceo of the hospital at home. how they got this guy's number, i don't know. but this resulted in every nurse manager and nursing division head being called in to work that night to get the situation under control. i don't know what the overall outcome was in terms of somebody losing their job but you better believe it was a big deal.

DutchgirlRN, ASN, RN · Jan 23, 2006

I WOULD NOT HAVE ACCEPTED THAT ASSIGNMENT !!! I think the administration is woefully at fault and guilty of endangering patients.

If they knew they couldn't reasonably staff the floor they shoud have turned patients away. We do it. There are administrative personel who are nurses.Their butts should have been up working on that floor. I do not accept an assignment over 6 patients and depending on the acuity have refused to take more than 4 or 5 by refusing any new admits. It's called critical thinking and ethical decision making.The 2.7K won't bring back her health but thankfully will cover her health needs.

Keysnurse2008 · Jan 23, 2006

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hello?? why didn't the nurse refuse? there is no way in heck i would accept an assignment of 20 patients. no way.

do we know if she was in teh ed or on the floor? why weren't cardiac enzymes done (potentially catching the mi)? chest xray?

this is mindboggling that staffing is that short.

__________________

happynurse2005

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this ...is much bigger than an individual nurse. where was the doc that admitted all these patients?i bet he /she was at home too.

the management of this hcf.....is guilty.they are guilty of not fulfilling their job duties to safely "delegate" by ensuring there was adequate staff to care for these patients.if they had any ethical core values in their shriveled lil hearts they'd have gotten out of bed and came in to assist that nurse. this brings up another issue too.....who was the one who gave her the 20th report?hello?

it is so easy to become desensitized as the years roll by.you are taught to be "empathetic" not sympathetic. but these people lying there in those beds folks are someone's mother, brother, father, sister, child, friend.....they are someone to somebody. everyone owes them safe care ...the md....the nurse(offgoing and oncoming)...and heck yeah that nm too!these are people ...with lives, thoughts, memories, personalities......and when you take that away from a family.....it is so wrong in so many ways. so when that nurse manager saw that she had unsafely staffed a unit like that...and she / he didnt come in.......that is neglect of duty owed to that patient.i hope she/he got their full 8 hours of sleep...id like to know...was it worth it?to take that much away from a family?

DusktilDawn · Jan 23, 2006

i think hospitals and health care facilities should be held accountable for their staffing practices. it's easy enough to say that the nurse should not accept the assignment, laws and sbon regulations reflect this, it is this fact that has also enabled hospitals and health care facilities to dump all responsibility and accountability for their own actions onto individual nurses and the nursing profession in general.

is there anyone of us that has not been in a position where they were forced to work understaffed? plenty of times personally, start a shift adequately staffed only to have 6 admissions arrive on the floor with no notification, faxed report sitting at the desk (nurses taking care of patients will not notice a faxed report at the desk). i've even called supervisors to have the floor closed to admissions d/t staffing and have been told "no." i have even asked for help from these same people only to be told they are "too busy." heck, i've even called admitting, explained the staffing situation and still nothing, why should they care, it's my problem, of course i'm speaking to people who are not nurses and have never spent time on a nursing unit and therefore have no grasp of the situation.

how many of us have "accepted" an unsafe assignment against our will? this has also happened numerous times personally, no notification of admissions, patients arrive on unit, no opportunity to refuse or delay admission. no opportunity to advocate that perhaps the patient should be sent to icu instead of a gpu.

how many of us despite calling for assistance from our supervisors have been patted on the head and told "you'll just have to do the best you can." too many times to count. added bonus, the charge nurse is also responsible for a full patient load along with all the other bs related charge nurse responsiblities.

how many places staff by patient numbers only and do not factor in patient acuity? mine does. try arguing with a questionably educated person in staffing who has absolutely no nursing experience about needing extra staff because there are numerous patients of high acuity on the floor, only to receive the robotic response that your grid says for x amount of patients you get y amount of rns and z amount of nas. next try getting a supervisor to approve extra staffing only to be told "there is no one."

it's easy to sit back and say we would have refused this assignment in this particular case. let's say the nurse refused the assignment, someone would have been mandated to stay ot, no doubt from the previous shift (which no doubt was also short staffed) with little choice because no one would accept the assignment. now you are still short staffed with the added bonus of an already exhausted staff forced to work ot. stay or be fired, great options, being fired always looks wonderful on a resume (not). leave an already exhaused overworked staff member who has already done a full shift or take the assignment. leave one rn for 40 patients. pretty piss poor options placed on nursing staff imho.

what are the options for the patient? none actually.

i think it is high time some laws and regulations are changed in order to make hospitals and health care facilities accountable for their staffing practices. for too long they have gotten away with denying knowledge concerning their own working conditions for nurses. for too long the blame has been placed on nurses for "accepting" too many patients, usually under coercive conditions.

talaxandra · Jan 23, 2006

I think it's interesting how many people perceive this as being, at least partly, the responsibility of the nurse, rather than a system problem.

allnurses Guide · Jan 23, 2006

Agree with the above posters about not starting out with 20 patients, they just seem to proliferate as the shift goes on! When 6 ambulances hit the back door, what am I supposed to do? Tell them to circle the block a few times? The nearest equivalent ED is 60+ miles away. In an ED, ballooning up far beyond the ratio you started with is a nightly possibility AND probability. And when I get admit orders, if there is a several hour delay in getting to the floor (see the above postings, those folks most likely started out with a full load too), do I just ignore all the ones left in the waiting room until I can move her out? All of us pick up the slack. Sometimes I just really need the floor to go ahead and take another, because I've got 3 more to take his/her place.

I didn't see anywhere in the article that the nurse was culpable, just the hospital. Not her fault.

Cute_CNA, CNA · Jan 23, 2006

Haven't really read the other posts, but...

I was at a meeting recently, and a couple of possibilities for the nursing shortage were mentioned that I hadn't thought of before.

One, and I think this is a big one, is b/c women now have more vocational options than they did 50 years ago, whereas you could be a teacher or a nurse (or something else). In other words, there weren't many options.

The second one supposedly has to do with the economy. If the economy is going well, and there is already one breadwinner in the family, nurses (often women) stay home with their kids. If the economy isn't doing well, then nurses go back to work for an increased overall income.

I just thought that was interesting, those 2 possibilities.

Keysnurse2008 · Jan 23, 2006

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Haven't really read the other posts, but...

I was at a meeting recently, and a couple of possibilities for the nursing shortage were mentioned that I hadn't thought of before.

One, and I think this is a big one, is b/c women now have more vocational options than they did 50 years ago, whereas you could be a teacher or a nurse (or something else).

Alot of things come into play....the aging babyboomer population-we are living longer.

Secondly is yes...more females are choosing another option for employment.Alot are choosing to become physicians vs becoming a nurse.

That doesnt change the fact...that when a HCF opens their door...and admits that patient....they owe them a duty to receive safe medical care while there. This whole article just makes me so sad.It's like no one looks at these patients as human anymore.They are just a MR#...or procedure X in bed 2.....I mean....these are people.I hate that HCF's have lost sight of that.What happens/doesnt happen to patients greatly depends on how much staff you have on duty...and how experienced they are.So...when HCF's try to skimp on the nsg budget and understaff units or actively attempt to only recruit new grads...it is basically like saying they could care less that this one patient can no longer talk...or that she suffered an anoxic brain injury and now has a lifelong battle against CHF d/t the extensive myocardial damage.That...is......just sad and wrong that it has come to that.

caroladybelle, BSN, RN · Jan 23, 2006

WOW, 20 patients in an acute setting:eek: I still think that the nurse share SOME responsibility. If the family was there saying she needs HELP NOW, why did she wait to go check her? I understand being overwhelmed and busy, but come on!

When I graduated from Nursing School in 1993, the initial floor that I worked on, routinely used 2 or rarely 3 RNs for a 41 bed unit on Nights. The unit held Orthopedic surgical and the other half held infected ortho, or ID patients.

One of my first shifts as a grad nurse, a worked with an RN that was covering 20 patients...and we discharged 2 and admitted one.

And when you cover that many patients...and that is the routine on a floor, you will have several families at once all saying that they need to be seen at once. And there is no way to clone yourself on the floor.

Please don't blame the victim...unless you have worked in her shoes. It is the hospital's responsibility to maintain staffing....or divert patients when not able to maintain staffing. It was the facility's greed that led to this, as I doubt that the nurse volunteered to take that heavy an assignment.

flashpoint · Jan 23, 2006

I agree with this to some extent. Management needed to make sure there was sufficient staff. A human life is worth more than them saving a few bucks by understaffing.
However, the nurse should have enough sense to know that assignment was unacceptable. With accepting the assignment comes liability; which holds her as liable as the hospital administration.
I worked too hard for my license to lose it by accepting an assignment like that. Sure, she could have gotten fired, but she would have still had her license and could have went elsewhere.

But...what can you do about it? The hospital I used to work at had one nurse manager and one nursing CEO. The nurse manager could pitch in when we were in a major crunch, but hadn't worked the floor in so long she couldn't actually take an assignment or anything...she could answer lights, help with meds, etc, but that was about it. She was awesome in ER and could run circles around the best of us, but work the floor? Almost better off without her. The nursing CEO hadn't worked the floor in such a long time, she didn't even own scrubs or decent shoes and most of the other "non-clinical" nurses in the building were in the same boat.

So...what do you do when the nurse manager just came off her regualr shift plus another 8 hours in the ER that was slammed with traumas? She can't come work the floor safely when she has been there for over 16 hours already. Sometimes there is just NO ONE to come in...I wouldn't even answer the phone on my days off when I knew it was the hospital calling. The closest hospital is over 60 miles away and most of the time when we were full, they were full too, so there was no one to divert to (the closest after that one is 175 miles away). There are a few 5-10 bed facilities in the area, but they don't have capabilities to care for anything critical, no telemetry, no ICU, no OB, etc.

Sure you can FYI the doctors and pray they have the sense not to do a bunch of soft admits. You can call and beg people to come, even for a couple of hours and you can give only the care necessary to sustain life and skip the back rubs and showers and oral care. But there are a lot of places, like here, where there is really no choice but to add more patients to your list and pray that nothing goes belly up. Someone has to care for the patients that are admitted and if there is no other staff and no where else for them to go, what can you do???

GooeyRN, ADN, BSN, CNA, LPN, RN · Jan 23, 2006

I do not blame the nurse. Maybe there wasn't another hospital locally to work at so quitting/getting fired wasn't an option. Thats how it is were I work. The next closest hospital is in THE NEXT STATE. I had to take a 15 pt assignment already. I work med/surg. 2 RN's to 30 patients. One CNA. We since went to CAH status so we have less beds. We are now suppossed to take 10 patients each, regardless of shifts. No guarantee on a CNA either. It is a small hospital. If there aren't any patients in OB or ICU, the staff doesn't have to come in. They are then on call. Therefore, there is only one RN in med/surg, and one in the ER. One LPN in the nursing home connected. What happens if there is a code? :angryfire Yes, it happens. Patients sit in the ER with no nurse. They have to wait. The med/surg nurse has to LEAVE THE FLOOR and go to the ER if thats where the code is. This is in an effort to save $. Very sad. But remember, the patients sleep at night so we don't have to worry about them complaining they don't feel well or having a problem. :angryfire Guess who gets in trouble when the patient says the nurse did not address their needs fast enough?