Nursing safety

[Carissa_RN]

Hey, I wanted to get some feedback from my fellow colleagues. I work within a surgical hospital environment of which part of this system is a short stay surgical unit that operates Monday to Saturday, closing Saturday mornings. When the unit is to close, my clinical manager believes it is acceptable to have one registered nurse care for 1-6 post-operative patients either by themselves or with the presence of a PSW. My concern is that if there were a surgical or medical emergency, the RN would be alone without immediate resources however my clinical manager believes that a PSW is adequate support and will be able to respond appropriately in an emergency situation - I believe that this is an unsafe working condition for both patients and nursing staff. Any thoughts or comments?

C.

[nurseprnRN, BSN, RN]

you're right, it's unsafe, and before i ever was complicit in such an arrangement i would like to see it in writing where the patient care assistant (or whatever that abbreviation stands for) is allowed to practice to the standard of a registered nurse in an emergency. i would also like to see it written in the standards of practice for short-stay units, pacus, or conscious sedation units, all likely to have the kinds of patients you have with the types of complications you might see. you can find those standards online with ease.

nice try, though. if your manager keeps it up, go to your hospital risk manager. there is one. s/he will be verrrrrrry interested in this.

[roser13, ASN, RN]

I've seen a similar thread recently. If memory serves, the overwhelming majority of P&P's advocate a minimum of 2 licensed personnel on a unit at a time.

Ask to see your P&P that would allow such minimal staffing.

[Zookeeper3]

This is not an ICU type setting. So I can see the manager's thinking. More important though... what are your resources for help? Do you have rapid response? A code team? A supervisor that can pull another RN from another unit if you have one or two patients having complications? How good is your support person... can they run VS and chart on the other patients when things go bad and can you trust them to really know and tell you?

Often we say we have no back up when there are unseen options or a thorough back up plan in place. Just have to think out of the box. But if you're answering "NO" to several of my questions... then your patients and you ARE at risk and I'd voice concerns, write them, then use the chain of command... risk management is a good sneaky way around to just ask questions if there is no minimum staffing policy.

[Riseupandnurse]

This sounds very unsafe to me, especially if you are alone, even if it's with just one patient. What if something, anything, happened to YOU so you couldn't respond to the needs of the patients? How would anyone even find out in a timely fashion?