HELP!! No charge nurse, no supervisor and OUTRAGEOUS ratios!!

yuzzamatuzz · Jun 28, 2013

That sounds like a disaster. Who do you escalate issues to if there is no house supervisor or charge nurse? I've never heard of swing beds...I don't understand how they can call a patient just "half of a patient". It'd be one thing for them to open up a "long term care" type floor and have different ratios. But to mix those patients with telemetry patients is just unsafe and takes aware from everyone. I usually have 4 patients on my telemetry floor...if I had 7 "swing" patients and one telemetry patient I wouldn't be able to adequately monitor the telemetry patient. Personally I'd quit, you deserve better than that.

ncrn4806 · Jun 28, 2013

Thank you for your input. I have a new job but I wanted to work out my notice. However, I go back to work on Monday and have seriously thought about refusing the assignment but I do not know my rights as far as that goes. I do not feel comfortable taking the assignment though.

We have no one but our unit director to take issues to but she is there from 8-5 on the weekdays.

I appreciate your feedback.

monkeybug · Jun 28, 2013

Thank you for your input. I have a new job but I wanted to work out my notice. However, I go back to work on Monday and have seriously thought about refusing the assignment but I do not know my rights as far as that goes. I do not feel comfortable taking the assignment though.
We have no one but our unit director to take issues to but she is there from 8-5 on the weekdays.
I appreciate your feedback.

I would suggest contacting your BON about unsafe working conditions and your rights and responsibilities.

HouTx, BSN, MSN, EdD · Jun 28, 2013

Oh my gosh - I didn't know anyone was still doing Swing Beds. I worked as a consultant 20 years ago with facilities that were trying to do this. It never worked. This is a faulty idea - dreamed up by administrators. Supposedly, you are supposed to only provide half the care to those patients even though they are in the same area (sometimes in the same room) as the other patients. Just how the heck are you supposed to justify that to the patients and their families - GRRRR! The only way this works is to have a separate designated area for those patients.

The lack of adequate supervision & administrative staff is a whole different issue. My spidey sense tells me that this place may be going down the tubes rapidly - Are they running short of supplies also? Rationing linens? That would be a sure indicator of impending financial disaster. Cash your payroll check as soon as you get it!

Agree with PP - look for another job ASAP. In the meantime, review your state Nurse Practice Act to find out if there is a "safe harbor" type of mechanism that protects you from liability incurred with excessive workload. If you're in a Joint Commission accredited hospital, review your facility's Plan for Providing Nursing Care. It should spell out exactly how things are supposed to be managed. If the facility is trying to make significant changes - such as you have described - they need to be approved through the normal administrative mechanisms. If there is a mis-match (actual staffing does not match the Plan), it is a serious breach and can cause problems with accreditation. There is a similar requirement for CMS (Medicare).

In the meantime. Adhere absolutely to all organizational policies. If the workload is so great that it is jeopardizing patient care, call your Chief Nursing Officer. S/he is ultimately responsible & since they have eliminated other leadership positions, s/he has to be available to respond.

ncrn4806 · Jun 28, 2013

HouTx thank you so much! You hit it right on the money! They are running out of supplies and rationing linens!!! I will look up the nurse practice act for our state and their Plan for Providing Nursing Care as well.

Like I said, I have another job but I am working out my 6-week notice but I might not be come Monday. I just cannot handle that many patients on our floor and give safe nursing care.

blondy2061h, MSN, RN · Jun 28, 2013

I find the healthiest patients often to be the neediest and most time consuming. Q30min call light use and such.

MunoRN, RN · Jun 28, 2013

You have the right to refuse any assignment, but your employer also has the right to fire you for refusing any assignment. Refusing an assignment can help protect your license, but offers no protection for keeping your job.

OCNRN63, RN · Jun 28, 2013

HouTx thank you so much! You hit it right on the money! They are running out of supplies and rationing linens!!! I will look up the nurse practice act for our state and their Plan for Providing Nursing Care as well.
Like I said, I have another job but I am working out my 6-week notice but I might not be come Monday. I just cannot handle that many patients on our floor and give safe nursing care.

"I'm sorry, buy since mgmt has decided you only count as half a patient, I can only give you half your meds a d take half your vitals. Dietary will be giving you half your meal tray."

s0ad · Jun 28, 2013

Occ. I will have 7-8 patients on days if we are short, but that is usually not the case, and I always feel unsafe when it happens. Our charge nurse usually doesn't do a ton, but I can see where you are coming from. Of course you can refuse an assignment if you feel it is unsafe, but that does not mean they have to keep you, they can fire you. If I was routinely given 7 to 8 patients on days though I would give my two weeks notice ASAP.

Isabel-ANP-BC · Jun 28, 2013

Yup, in most states as long as you don't clock in and don't take report, it's not patient abandonment. The facility can fire you, but the BON doesn't get involved. I live in NYS. I worked a hospital where I walked in one night and found out I had 13 patients (normal load was 7 - 9) and that the other nurse had 14. We had one nurse call in and the hospital refused to float a nurse from another unit (turns out the other big med-surg unit had 5 nurses and 5 patients each). The other RN on my floor and I were there for 17 hours. I refused to come back in for my next shift (which was 7 hours from the time I left). I got written up. A few weeks later, when in and refused an assignment because it was the same 13/14 patient deal. They sent us another nurse. A few months later I quit. Wasn't worth it.

Maybe more nurses need to start saying, "No, not doing it." As a group we might lose jobs initially, but if enough of us say it, someone will have to start listening.

DLS_PMHNP, MSN, RN, NP · Jun 28, 2013

"Since you only count as 1/2 of a living, breathing pt, I can only devote xx minutes/hours to you during my shift. Your call light use will also be restricted as such..."