Dear Nurse Beth, I have worked as an acute hemodialysis nurse for more than 4 years. My question has to do with the long hours we are sometimes required to work. Often, after being at work 12-15 hours an emergent pt will show up in the ED requiring one of us to stay another 3-4 hours (or even longer). If we refuse, it could be called abandonment, but if we stay we may be so fatigued that it could be unsafe. How is this type of situation viewed by the BON and is it even legal for a nurse to work this many hours?

Dear Required to Work Overtime, You are so right, working when you are fatigued is not safe for you or your patient. If a mistake is made because you are exhausted, it is still a mistake, and you are no less responsible. Here's the problem: Providing adequate staffing is the responsibility of the facility, the employer; not the individual staff nurse. The employer needs to have a contingency plan to deal with emergencies instead of relying on whoever is on duty to stay an additional 4+ hours. It sounds like the facility is offering a twenty-four hour service (hemodialysis) that it is not prepared to cover. It is not abandonment until you have accepted care of the patient. If you are at the end of a run on one patient and preparing to go home, and are called to the ED- you do not have to go. I'm sorry, I am not able to work overtime today. Acceptance of Patient Assignment Remember the key is acceptance of patient assignment. Acceptance of a patient assignment occurs when a nurse has heard the patient report/status directly and agrees to the assignment. This includes receiving complete patient information and having the opportunity to ask relevant clarifying questions. A nurse can not be cited for abandonment unless they have accepted an assignment. Likewise, a request to take an additional patient in the middle of the shift is an additional assignment which also requires acceptance by the nurse. Bear in mind that once an assignment is accepted, the nurse is responsible for its completion unless responsibility can be transferred to another qualified person. You cannot leave until you have handed off care to another nurse. The American Nurses Association (ANA) opposes the use of mandatory overtime, and supports the Safe Nursing and Patient Care Act which would limit the number of overtime hours a nurse may be required to work. Hope this helps

Hemodialysis Nurse : Forced to work overtime or face abandonment?

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Ramireex

3 Posts

I think Nurse Beth may be wrong. Duty is not based on whether or not report has been completed. If you are given an assignment that is unsafe, you have many options and of course, the most extreme would be to invoke a safe harbor it the equivalent. If you are the only nurse present and you leave without handing off care, you are abandoning your patient. I would certainly run this through your attorney or ask your board of nursing.

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Natkat, BSN, MSN, RN

872 Posts

Specializes in Corrections, neurology, dialysis.

Ramireex said:

I think Nurse Beth may be wrong. Duty is not based on whether or not report has been completed. If you are given an assignment that is unsafe, you have many options and of course, the most extreme would be to invoke a safe harbor it the equivalent. If you are the only nurse present and you leave without handing off care, you are abandoning your patient. I would certainly run this through your attorney or ask your board of nursing.

Not in acute dialysis though. You don't assume care of the patient until you are ready to dialyze them. If you never assume care and never do dialysis then you're not abandoning them. It doesn't matter if you are the only dialysis nurse present. The patient is still under the care of the primary nurse.

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traveler782

30 Posts

My old hospital use to require mandatory overtime. I am not sure how it was enforceable. Although if you refused you found yourself working a terrible schedule like 1 on 1 off, 1 on an such (coincidence?). That hospital was in Georgia and there is no nursing union and the BON is super weak politically in that state. If you don't like the working conditions your only option is to quit. I asked my manager once if there was such a thing as "mandatory overtime" and how is it legal...I was given frown and told that is the way things are. 4-5 nights a week gets old fast.

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Samsaunt

1 Post

And that's why nurses need to organize to stop mandatory overtime as we did in PA.

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Chisca, RN

745 Posts

Specializes in Dialysis.

... more than that is against the labor laws..

Right to work state means no labor laws. You would sooner win the lottery than win a labor dispute against an employer in Tennessee.

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Dafabb, LPN

123 Posts

Specializes in Med/Surg/.

BRAVO to you!!!!!

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Dafabb, LPN

123 Posts

Specializes in Med/Surg/.

LMtally43 said:

I agree with you Nurse Beth. I am a dialysis nurse and I was once employee for a contracted dialysis company. One time I was on call, had done 3 pts on 2 different hospitals on 1:1 and was asked to do an emergent dialysis on a pts that went to a ER. I was exhausted and fatigue. I refused to do the patient. The manager kept threatened me with disciplinary action if I didn't comply and I told her that I will seek legal advice and she stopped it. You have to stand on your rights. And you know what.... I was not fired or reprimanded by the chief of nursing at all, but I did resigned and sent in my resignation letter that situation among other unsafe practices they had. So you have to stand for your rights.

Bravo to you!

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