Frustrated Nursing/Patient Ratio!!!

[bubba143]

;) I am so glad I found this site! I need to vent and looking for resources. I have worked at an acute rehab center for more then 10 years and I have enjoyed this job up until the last two years. We receive patients aged 18 and up. Car accidents, hip/knee

replacements, s/p amputations, decontioned patients, etc,. Two years ago we were told that because of the new medicaid/medicare we were going to be accepting traumatic brain injury patients.

We have 52 beds and I usually work 3p-11p. On this shift (if we are fully staffed) there are 5 nurses and 5 nurses aides on the floor. Dealing with the head injury patients at times can be difficult, especially when they first arrive, because they can be combative, loud and they wander all over the unit. We do not have a seperate unit for them. This patient will usually have an aide assigned to him, to watch and make sure he does hurt himself or others.

This weekend I lost what little patience I had left. We admitted a head injury patient who is the most difficult we have had so far. He is physically strong and very mobile. He spent the whole weekend trying to get out of the facility and walking up and down the hallways swearing loudly. He kept walking into other patients rooms, swearing at them and at times we felt we had no way to control him. He did have a person assigned 1:1 with him, but everyone on the unit had to become involved in trying to keep everyone safe because he all over the place.

When I expressed the nurses concerns to upper management, we received no backup support. We were told by the medical staff on call there was nothing he could do. He had already increased his PO medication and did not want to order anything IM because he was afraid one of us would get stuck with the needle. I totally agreed with this thinking, but I did not agree that the patient was appropriate for our facility. family members and patients were complaining to us and there was nothing we could do. This is the first time I have felt unsafe taking care of a patient. My fellow staff members and I are frustrated that upper management does not seem to care about our safety or the other patients safety.

I received a phone call today from the Director of Nursing. She was not available when I called back so I spoke to my Nurse Manager.

The Medical Director had spoken to her because he was not happy with some of the things I said this weekend. I told her what happened this weekend and how most of the other patients received very little attention because most of the staff members were spending time with him.

Here are my questions:

- Should I call OSHA and question how a facility becomes licensed

to accept head injury patients and what the staffing ratio should

be?

- Should they have a seperate unit where they can wander without

disturbing other patients?

- Do we as nurses have the right without being reprimanded to express

our concerns?

I believe I will leave this job shortly,which I hate to do because I really like the people I work with. We as nurses feel like we are being abused because so much more is expected of us with no backup being offered.

I am sure I will have more questions, but any help with these is greatly appreciated! Thank You!

[ktwlpn, LPN]

the local rehab where I did my clinical had a secure unit for this type of patient.They also had padded rooms with closed ciruit cameras and could isolate a patient that they felt was a dnager to self/others.

[RN1989]

I don't know of any regulatory agency that mandates nurse/patient ratios except for the laws that govern CA hospitals. Most agencies leave it to the individual facility to come up with what the appropriate ratio should be. Management's ideas of ratios is NEVER the same as what the bedside staff's idea of ratios should be.

It is not likely that you will find a regulatory agency willing to get into the middle of this particular situation unless there is injury to another pt because of the problems.

You need to check the labor laws in your state regarding retaliation and whistle blowing.

You have a few choices - continue to fight this issue and deal with all the repercussions or leave. If you choose to fight you must do it professionally with lots of documentation. You will need to document after each and every shift making notations of staff present, number of pts, pt acuity, specific incidents that occurred, how much time each staff had to spend dealing with the problem pt, how many other pts complained, etc. You will need to document witnesses to the incidents, who you talked to, conversations with the docs and admin and all that was said. It will be very time consuming. You will need to submit your issues in writing to the admin and follow the chain of command. It may or may not get you anywhere or they may fix things. or it could get you labeled as a troublemaker and start you on the downhill road of more misery and termination.

You will have to decide what to do. Since you have worked at this one place for so long I am guessing that this is starting to be a new thing for you to feel the effects of money on healthcare. What you have described is going on multiple times a day all over the place. Nurses must either fight and risk their job or just endure and risk their license. Good luck with whatever you decide. All of us are here to sypathize/empathize and vent with you.

[everthesame, LPN, LVN]

If other patients and their family members are complaining, I would be giving them the name and contact number for either the patient liason or the director of nursing. Perhaps after a few threats to move loved ones to a more secure facility TPTB may decide to do something.

[Dolce, RN]

At this point the patient does not sound like he is totally appropriate for rehab. I believe he needs to be in a locked unit until his behaviors make him appropriate for therapy in your type of setting. Patients in a rehab hospital have to be able to participate in therapy in order to improve. This patient sounds like he needs much more 1:1 attention than your facility is able to provide. I would clue his doctor in to that and have them try to relocate the patient if your facility cannot provide adequate staffing to care for him safely.

[Simplepleasures]

I know where you are coming from. I too worked on a brain injuy rehab unit, it was one of the hardest jobs Ive ever had in nursing. I think the advice given to investigate the whistleblower protection laws in your state is a wise thing to do at this point. You probably already have gotton on someones bad side and if you are fired in retaliation, you may be covered by this type of law, as I was.The name of the law that gave me protection and the opportunity to sue my former employer is called the Wisconsin Healthcare Whistleblower Retaliation Act. My lawyer is now working on another whistleblower case very similar to mine. I also have researched a state website that posts decisions of Fair Employment Law violation cases and there are several more that have recently been associated with this law. Nurses ARE beginning to feel they can report illegal/ unethical/ unsafe/ practices to a state agency , because now they have legal recourse. My state law states that a nurse is protected from retaliation even if she reports IN HOUSE or to an outside agency. I hope you have similar protections in your state. Good luck.

[interleukin]

My heart goes you to you guys who deal with head injury all the time. They are the very difficult.

Regarding how to complain...always be sure to tell the DON that family members and/or the public are witness to what has happened or is happening. Management doesn't care when we complain about something. But when we tell them the PUBLIC witnessed the problem, watch how fast you get their attention!

Most facilities rely on pr to create their image. We know what the realities are, though.

Anything that might smear their image to the public will get them acting to fix rthe problem.

More importantly, once management knows about an issue, THEY are then accountable for any bad outcome. And you can be certain when there is a bad outcome, they will invariably say, "Well, no one told me about it. i would have done something had I known."

LET 'EM KNOW, AND WATCH 'EM GO!

(Hey, I like that)

When the system is letting you down, have the courage to speak out.

Some feel one's integrity and esteem are more important than a job.

Some don't. Where do yo stand?

[bigredrn57]

If other patients and their family members are complaining, I would be giving them the name and contact number for either the patient liason or the director of nursing. Perhaps after a few threats to move loved ones to a more secure facility TPTB may decide to do something.

Another alternative is to give family members the phone number of the CEO and the state regulatory commision for JCAHO.:trout:Do this quietly. A patient said it best,"You can lie and keep your job. Or you can tell the truth and look for another. That's integrity." What is it worth?

[lenjoy03, RN]

NUrses doesn't deserve this kind of treatment!!! I agree on the above post, give the complainants the number of DON and CEO. Sometimes no matter we do, it can't be resolve unless the relatives and patient themselves do it...

[lindarn]

NUrses doesn't deserve this kind of treatment!!! I agree on the above post, give the complainants the number of DON and CEO. Sometimes no matter we do, it can't be resolve unless the relatives and patient themselves do it...

Another avenue that nurses can pursue is the Facilities and Licensing Division of your state, usually part of the Department of Health. This is the department that licenses heath care facilities. I would think that they would be interested if there are goings on in a facility that are not in the best interests of their patients, and patients have been harmed as a result.

Lindarn, RN, BSN, CCRN

Spokane, Washington

[Poochee]

So sorry your experiencing this, especially after 10 years. I've been there, and know how extremely time consuming it is to have a new post-head injury pt. to care for.

I can't say I blame you for wanting to leave.

But, maybe research alot, for what you can do/provide for these patients.

It may help.

If not, then, I so totally don't blame you, we all know how much can be too much.

Best of Wishes to You.