Hello! I am a nurse who has been practicing in MO for a little over a year. This is a new profession for me in a new state. I previously attended nursing school in Texas and learned about Safe Harbor there.
Safe Harbor applies when a nurse believes an assignment may place patient's at risk of harm, thus violating the nurse's duty to the patient and also protecting the nurse's license. I searched the Missouri BON site and could not find anything regarding laws that govern duty to the patient such as this one. So, what options does the nurse have regarding this issue? Chain of command?
The reason I ask is because of the assignments I am forced to take when the acuity of my present patients is high. We never go on diversion, even when short-staffed, and are often left without employees to sit on one-on-ones with confused patients although ordered. This makes the shift VERY stressful for everyone and quite unsafe. Then, when a blood transfusion and surgical patient has been added to that workload and you end up with 5 patients and you KNOW you can not tend to everyone following standards of practice, what do you do?
I told my manager I did not have lunch (around 1430) and my patient who needed to be a one-on-one (that the doctor would not order) was getting out of bed every 5 minutes until a point was reached where someone forgot the patient's bed alarm and she almost fell when someone found her out of bed. The patient receiving the transfusion had to wait 3 hours before the 1st unit of PRBC's could begin and their Hgb. was 5.9. The surgical patient was seen once post-op by this nurse and one set of vital signs was recorded (they came to the floor around 1540, toward the end of the shift and had been in recovery for several hours and were supposed to go home that day but nausea and pain were not controlled). There was only one aid on the floor for 21 patients. I was constantly running to the confused patient's room until the time they were found out of bed...after I placed the patient back in bed and put the alarm on I went into the patient's bathroom and cried. The post-op patient had previously complained that no one was caring for her and was an employee of the hospital. I was embarrassed and could not blame her for the complaint as what was happening was unsafe practice.
I did not want to receive the post-op patient because my workload was already heavy and I had started the day with 2 confused patients...thankfully one was eventually discharged. I felt neglectful of the other 4 patients because the very confused patient I was left with practically needed her own nurse.
Sometimes I feel that nurses need advocates, too.
I want to provide the best care possible and feel it is almost impossible on days such as previously described.
15615 Pomerado Road, Poway, 92064, San Diego County - The hospital failed to ensure the health and safety of a patient when it did not follow its policies and procedures for fall prevention. This is the third administrative penalty issued to the hospital. The penalty is $75,000.
^^^THIS needs to be blown up and posted EVERYWHERE...that'll definitely take the wind outta the sails of the "bottom line" people..why pay a fine when you can pay a nurse??? *rhetorical question*...
Knowledge is POWER...thanks Herring for providing this info. I am sure that most states have restrictions and will provide fines for not following policies and procedures...guess we ALL have investigating to do, for the sake of us providing optimum care and for our licenses!!!
The confused pt getting OOB needed a roll belt. Simple as that. Oh, and I loove it when the various specialties get you bc they can't understand what the pt is saying, lol....like you have magical mind-reading powers!
I'm appalled by the apathy that most or the responders are showing. I've been a nurse to nearly 40 years. When we can't do the work that our patients need it is frustrating. To tell a young nurse, that's the way it is, get used to it....which is what I read in many of these responses, I find disturbing to say the least. I think the more important message is to write to the person in charge with a copy to the person he/she reports to, doesn't change...keep going up the line until someone listens. When we are put in situations that are unsafe, we need to speak out, if possible with the support and help of co-workers. Aren't we there to care for people?
I agree with this completely. We have to speak up and say this is not right. Contact your health department, your congressman, your state nursing association. The important thing is we have to stop just accepting poor working conditions as just another part of the job. I applaud Texas. All states should have something like that. As a profession, we have to stand together and make ourselves heard. We have to stop telling each other to deal with it. All our voices together is the only thing that will really affect change.
The confused pt getting OOB needed a roll belt. Simple as that. Oh, and I loove it when the various specialties get you bc they can't understand what the pt is saying, lol....like you have magical mind-reading powers!
Made by Posey- goes around the pt's waist and ties to the bed. When applied correctly, the pt can still roll back and forth but not escape the bed. They can be used with geri chairs too.
Ahh- they sound like a good idea, but I guess we would not be allowed to use them as it is tied, and pt can not move as desired- ie: the " I can fall if I want to " thing.
Ahh- they sound like a good idea, but I guess we would not be allowed to use them as it is tied, and pt can not move as desired- ie: the " I can fall if I want to " thing.
Ughhhhhh.
As with all restraints, the pt has restricted movement. They have to be tied so that one pull releases it from the bed. Our wrist restraints are that way too.
Specializes in Critical care, tele, Medical-Surgical.
As with all restraints, the pt has restricted movement. They have to be tied so that one pull releases it from the bed. Our wrist restraints are that way too.
Decades ago belt restraints were common. One hospital where I went as a registry LVN required all patients over 65 to wear one or sign a refusal. Many alert patients wore them. They could turn side to side and use the urinal. They were tied under the bed to the nurse or nursing assistant could just grab an end and pull it untied.
Hello! I am a nurse who has been practicing in MO for a little over a year. This is a new profession for me in a new state. I previously attended nursing school in Texas and learned about Safe Harbor there.
Safe Harbor applies when a nurse believes an assignment may place patient's at risk of harm, thus violating the nurse's duty to the patient and also protecting the nurse's license. I searched the Missouri BON site and could not find anything regarding laws that govern duty to the patient such as this one. So, what options does the nurse have regarding this issue? Chain of command?
The reason I ask is because of the assignments I am forced to take when the acuity of my present patients is high. We never go on diversion, even when short-staffed, and are often left without employees to sit on one-on-ones with confused patients although ordered. This makes the shift VERY stressful for everyone and quite unsafe. Then, when a blood transfusion and surgical patient has been added to that workload and you end up with 5 patients and you KNOW you can not tend to everyone following standards of practice, what do you do?
I told my manager I did not have lunch (around 1430) and my patient who needed to be a one-on-one (that the doctor would not order) was getting out of bed every 5 minutes until a point was reached where someone forgot the patient's bed alarm and she almost fell when someone found her out of bed. The patient receiving the transfusion had to wait 3 hours before the 1st unit of PRBC's could begin and their Hgb. was 5.9. The surgical patient was seen once post-op by this nurse and one set of vital signs was recorded (they came to the floor around 1540, toward the end of the shift and had been in recovery for several hours and were supposed to go home that day but nausea and pain were not controlled). There was only one aid on the floor for 21 patients. I was constantly running to the confused patient's room until the time they were found out of bed...after I placed the patient back in bed and put the alarm on I went into the patient's bathroom and cried. The post-op patient had previously complained that no one was caring for her and was an employee of the hospital. I was embarrassed and could not blame her for the complaint as what was happening was unsafe practice.
I did not want to receive the post-op patient because my workload was already heavy and I had started the day with 2 confused patients...thankfully one was eventually discharged. I felt neglectful of the other 4 patients because the very confused patient I was left with practically needed her own nurse.
Sometimes I feel that nurses need advocates, too.
I want to provide the best care possible and feel it is almost impossible on days such as previously described.
Please help!
Unfortunately, it's that way on Med/Surg floors. I used to work Med/Surg neurology & it was rough.One night, we were assigned 10 patients, & we held up report, didn't accept the patients. Management threatened us & we didn't care. They can't do anything to us if the patients were not handed off to us. After standoff, mgmt got more staff and we had a more mangeable assignment.
LadyFree28, BSN, LPN, RN
8,429 Posts
^^^THIS needs to be blown up and posted EVERYWHERE...that'll definitely take the wind outta the sails of the "bottom line" people..why pay a fine when you can pay a nurse??? *rhetorical question*...
Knowledge is POWER...thanks Herring for providing this info. I am sure that most states have restrictions and will provide fines for not following policies and procedures...guess we ALL have investigating to do, for the sake of us providing optimum care and for our licenses!!!