Responsible for 132 clients and Working during breaks

  1. I have a question. Is there a cap or legal standard in Mississippi on how many clients RNs are responsible for working in an intermediate care facility for the intellectually disabled (11p-7a)? And is it legal for me to clock out for break, and still be responsible for the floor at such a facility? Does the facility, my title, or shift matter?

    Asking bc there are 132 patients that I am responsible for, being that we are short a nurse on the 11-7 shift. There is another nurse (an LPN, we have the same duties) but when she's off I have to work by myself and when I'm off she has to work by herself. We were told that we still needed to clock out for break on the days that we work by ourselves but we would still be responsible for the floor if something happened. Is that ok? Has anyone dealt with this?
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    About Nroh

    Joined: Feb '18; Posts: 17; Likes: 12
    Specialty: 1 year(s) of experience

    38 Comments

  3. by   BrandonLPN
    To be honest, I'm not sure that sort of facility legally requires a licensed nurse be on duty at all overnight.

    As far as breaks/lunches go.... it's been my understanding that since breaks are paid, you are responsible to respond if needed. Lunches, especially lunches where you punch out, are your own time. You aren't getting paid. Of course, if something happens during your lunch, and one of the aides (or whoever) comes and gets you, it's reasonable to assume you would nd your lunch early and get compensated accordingly.

    Without the LPN are you literally the only staff present? Are there aides?

    I don't interpret "being responsible if something happens" as it's your fault if anything bad happens. I interpret it as you are responsible to react to events in the way a prudent, educated nurse would do in the same situation.
  4. by   Crush
    That does not sound safe to me. What type of a facility is this?
  5. by   JKL33
    Quote from Nroh
    We were told that we still needed to clock out for break on the days that we work by ourselves but we would still be responsible for the floor if something happened. Is that ok?
    I think you're trying to find out if it is legal and/or if it is the usual practice.

    The right question (which only you can answer for yourself) is whether or not you accept those terms.

    I would not.

    I don't accept terms where part of someone's business model is to require me to stay around (in the break area, on the premises, whatever) retaining full responsibility as an on-duty nurse, without being paid. Look at it this way - we all know that the thing that seems right and ethical and safe is for you to stay in proximity as a matter of safety for the patients. Your employer refuses to pay you for that. They have to be able to show that they are giving breaks according to the law, so what they have chosen to do is make it look like you're getting your break while scaring you into not taking your break.

    The other side to this which I can't answer is whether you actually can be held legally responsible as a licensed on-duty nurse while not on the clock. If they are required to have a licensed nurse on duty (which I assume they are or I can't imagine them ever staffing the place with licensed nurses) - do they meet that obligation by not having anyone actually clocked in during certain times? Could you ever be accused of abandonment (by say, a family) for having appeared to leave/go off duty with no one to replace you? Again, I don't know. But I wouldn't trust these employers to care.

    Hope you are able to figure out a solution ~
  6. by   caliotter3
    JKL 33 said it. Legal or not, do you want to continue doing this to yourself? Should most of the 132 become acutely ill in groups, what are you going to do? This type of scenario actually happened in a 165 bed facility where I once worked (before my time) and that was when all assigned nurses were on duty. Puking, diarrhea in the bed, fevers, etc., calling responsible doctors after assessments on groups at a time. What if one of these acutely ill patients passes when you are at the opposite end of the hall? What if there were a fast moving fire? Not out of the realm of possibility. I would find another job if it were me. I have been responsible for 80, but then there were a minimum of two other nurses in the building that I could call for help. I didn't think that was too great at the time either.
  7. by   Nroh
    Quote from BrandonLPN
    To be honest, I'm not sure that sort of facility legally requires a licensed nurse be on duty at all overnight.

    As far as breaks/lunches go.... it's been my understanding that since breaks are paid, you are responsible to respond if needed. Lunches, especially lunches where you punch out, are your own time. You aren't getting paid. Of course, if something happens during your lunch, and one of the aides (or whoever) comes and gets you, it's reasonable to assume you would nd your lunch early and get compensated accordingly.

    Without the LPN are you literally the only staff present? Are there aides?

    I don't interpret "being responsible if something happens" as it's your fault if anything bad happens. I interpret it as you are responsible to react to events in the way a prudent, educated nurse would do in the same situation.
    There are direct care staff (they aren't certified) and the one nurse if the other nurse is off. That's the thing. They want me to clock out for lunch. Technically I'm off of the clock. But I can't leave to get lunch, go to my car if I wanted to, etc. Kind of like I'm off the clock as far as the time keeping system goes so it won't look like they aren't giving me a break but I still have to be there working bc I'm the only nurse there bc there can't not (double negative) be a nurse on the floor. And of course if something was to happen, I would take care of my clients, even tho I'd be technically clocked out for lunch. I was just wondering if it was "legal".
  8. by   Nroh
    Quote from Crush
    That does not sound safe to me. What type of a facility is this?
    It's an intermediate care facility for the mentally retarded. Definitely not safe, but does that make it illegal? Would I have a case if I presented it to the board or a lawyer?
  9. by   QuietIsntAWord
    I work in a similar situation. I clock out for my break and I do leave the unit, but I can't leave the "campus". I do have CNAs on the floor and I carry a radio with me everywhere I go in case I'm needed. We also have a pager system so if a call bell goes off for longer than a set amount of time, I get a page. If I get called to an emergency while on my break, I respond and later I write up a form stating that I only took a 5 minute break or however long it actually was and I get paid for that time.

    Do you have anything like this in place? If not perhaps you could recommend it so you feel better about actually taking your break.
  10. by   Nroh
    Quote from JKL33
    I think you're trying to find out if it is legal and/or if it is the usual practice.

    The right question (which only you can answer for yourself) is whether or not you accept those terms.

    I would not.

    I don't accept terms where part of someone's business model is to require me to stay around (in the break area, on the premises, whatever) retaining full responsibility as an on-duty nurse, without being paid. Look at it this way - we all know that the thing that seems right and ethical and safe is for you to stay in proximity as a matter of safety for the patients. Your employer refuses to pay you for that. They have to be able to show that they are giving breaks according to the law, so what they have chosen to do is make it look like you're getting your break while scaring you into not taking your break.

    The other side to this which I can't answer is whether you actually can be held legally responsible as a licensed on-duty nurse while not on the clock. If they are required to have a licensed nurse on duty (which I assume they are or I can't imagine them ever staffing the place with licensed nurses) - do they meet that obligation by not having anyone actually clocked in during certain times? Could you ever be accused of abandonment (by say, a family) for having appeared to leave/go off duty with no one to replace you? Again, I don't know. But I wouldn't trust these employers to care.

    Hope you are able to figure out a solution ~

    Thanks for that information. I am looking for another job. It is a great job when the other nurse isn't off or when there are 3 nurses hired on night shift bc there would always be two of us there. And it's only 15 minutes from home. I don't want to jeopardize my license though.
  11. by   Nroh
    Quote from caliotter3
    JKL 33 said it. Legal or not, do you want to continue doing this to yourself? Should most of the 132 become acutely ill in groups, what are you going to do? This type of scenario actually happened in a 165 bed facility where I once worked (before my time) and that was when all assigned nurses were on duty. Puking, diarrhea in the bed, fevers, etc., calling responsible doctors after assessments on groups at a time. What if one of these acutely ill patients passes when you are at the opposite end of the hall? What if there were a fast moving fire? Not out of the realm of possibility. I would find another job if it were me. I have been responsible for 80, but then there were a minimum of two other nurses in the building that I could call for help. I didn't think that was too great at the time either.
    You are right and I have thought of those possibilities. I am currently looking for another job. I don't want to jeopardize my license.
  12. by   Nroh
    Quote from QuietIsntAWord
    I work in a similar situation. I clock out for my break and I do leave the unit, but I can't leave the "campus". I do have CNAs on the floor and I carry a radio with me everywhere I go in case I'm needed. We also have a pager system so if a call bell goes off for longer than a set amount of time, I get a page. If I get called to an emergency while on my break, I respond and later I write up a form stating that I only took a 5 minute break or however long it actually was and I get paid for that time.

    Do you have anything like this in place? If not perhaps you could recommend it so you feel better about actually taking your break.
    No we don't have anything like that in place. I'm dealing with the situation now until I find a new job but I still wouldn't feel "ok" with that bc like someone else said, could a family member sue bc I "abandoned" my clients bc I took a break without another nurse being on duty if something tragic happened? Would my facility have my back since they only want me to clock out for legal reasons on their part? Or what if something happens on opposite ends of the hall? I can't be two places at one time. I just wondered if that was something that would hold up in court or in front of the board if i presented it to them.
  13. by   QuietIsntAWord
    "The American Nurse's Association's definition of patient abandonment is "a unilateral severance of the established nurse-patient relationship without giving reasonable notice to the appropriate person so that arrangements can be made for continuation of nursing care by others..."

    That's a tough one, considering you said there is no other nursing staff available, but technically (in my position at least) I'm still available if needed, I'm just not right there. And I do communicate to my staff that I'm going on break. I'm really not sure... can you ask your DON these questions?

    With that being said, if you don't feel comfortable with it then get out. Trust your gut.
  14. by   SpankedInPittsburgh
    I don't know if its legal but it wouldn't be acceptable to me. You have a nursing license to protect and clearly the place you work could care less about that. Find a new place to be a nurse

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