omg. last night at work was the worst night i've had there since i started.
from twelve midnight until five am, i was the only nurse in the place.
not even a med tech.
omg, i got so mad.
i called a nursing agency, but of course who's going to come out at midnight?
they overstaff the dayshift and leave nothing at night. this was the first time i have ever been there without another nurse and it's going to be the last.
it isn't safe.
there are at least sixty residents.
i told them this morning that, if they didn't get or find somebody (another nurse, be it lpn or rn) to work third shift w/me, that i would not be in.
then at 2:30 pm, this smarmy lpn called here and said i needed to make up my mind "because a no-call, no-show" wouldn't look good on my license!
how dare she threaten me like that!
in the first damned place, that has nothing to do with your nursing license.
i could walk off jobs from here to eternity and it wouldn't affect my license.
but the very idea.
instead of waiting to work with me tonight, when she already knew we would be short, she works today, then calls me and runs out of the bldg. before i could return her call!
as soon as i got it (on callwave), i called work and the b.itch had already left, so i called her house and left a message for her.
then i called work again and told them what she had done, and they said "well, we still haven't found anybody."
they had 3 nurses on days and at least 3 med techs; then expect me to do the whole house by myself after midnight ~ i don't think so!
so i said, "okay, then if and or until you all find somebody to work with me tonight, i am deathly ill and will not be in."
they don't even need to think they are going to pull that stuff on me ~ not for one second.
they just recently dropped all the insurance ~ i was planning to get that, except now you can't even get insurance there!
sometimes i wonder if i wouldn't be better off not working! hahahaha!
my fiance is supposed to work this week, though, and i get my check friday.
i am going to start looking around elsewhere if they are going to try to make me work alone; i won't do it. it isn't safe ~ not to mention fair.
i mean, putting "fairness" aside; it isn't safe for the residents.
they need at least an rn and an lpn there, around the clock, and hopefully a med tech.
they don't even need to start that stuff with me; i've been a nurse too long to take it. i won't.
Specializes in Trauma,ER,CCU/OHU/Nsg Ed/Nsg Research.
Originally posted by sueb
I'm pretty certain NO CALL, NO SHOW is NOT grounds for losing your license. It may get you fired from your job, but it is not the same as abandonment!
It's grounds for possibly losing your license in Ky now. Any other Kentuckians notice that in your latest issue of the Communique? I'm assuming other states are adopting this policy as well.
another thing that made it bad for me *nurses, are you listening?* was that, before the facility was bought out by new owners, on night shift there was one lpn.
she worked it ~ alone ~ for 3 years.
this was thrown up to me. (i wonder if it's "safe", why they have so many nurses and med techs on day shift, but oh well.)
apparently this nurse would do anything; she said she didn't even get any orientation and she had meds and treatments on all 3 halls....60+ residents. she told me she never got to sit down, etc. you can guess the rest.
she's still there and swearing she won't do it again. i wonder. but she set a bad precedent for me, unwittingly, when she allowed herself to be abused.
wouldn't it be interesting to the Dept. of Health for your state, the BON and others if the newspaper headlines read "Nurse Fired for Refusing to Risk Patient's Life"
There are regulations regarding what is safe staffing. If this is a LTC facility, and the administration isn't staffing with at least the mimimum standard, then they are setting themselves up for major investigation. I'm surprised you didn't call and inform your State governing agency yourself. Care of 60 residents IS unsafe practice!! However, be careful of anytime you consider "abandonment of shift." Check out what your State Board of Nursing has to say on that matter. I would have been as upset as you were in the same situation. Many places of employment require you to sign an agreement that you can quit with or without notice as well as be fired at will of your employer. It's a different story though, when you willfully abandon patients in your care.:)
How in the world do you get the impression that I abandoned patients in my care?
I told them TWELVE HOURS ahead of time to get me some help. If nothing else the DON could have come in and worked the floor with me. She's a registered nurse, so is the administrator and several office personnel. I didn't walk out on my patients.
It's not like I was asking for the impossible. They regularly use agency nurses. I don't know why they wouldn't get one unless they are trying to go back to dumping the whole patient load on one nurse.
Whoa!!! In the first place, I'm on your side...and wasn't accusing you of abandoning your patients..You said you could walk off jobs from here to eternity and it wouldn't affect your license. That's not necessarily so, and that's all I meant. Nothing more.
Previous position statement--found at NCSBON website below:
9. Kentucky:
The Kentucky Board of Nursing is authorized by Chapter 314, also known as the Kentucky Nursing Laws, to regulate nurses and nursing education and practice, in order to assure that safe and effective nursing care is provided by nurses to the citizens of the Commonwealth. The Board accomplishes this charge in part by licensing individuals to practice nursing, and taking appropriate disciplinary action for violation of the Kentucky Nursing Laws.
BACKGROUND
Multiple inquiries have been received pertaining to the responsibility and accountability of nurses for providing safe, effective patient care, including what constitutes abandonment of patients by a nurse.
These inquiries usually arise from a situation(s) where a nurse is given an assignment which:
The nurse cannot adequately fulfill due to "too many patients," high acuity level of patients, intense demand for nursing care, and/or a lack of qualified staff to meet the needs of patients.
The nurse is expected to provide patient care in an unfamiliar, specialized, or "high tech" patient care area for which the nurse is not educationally or experientially prepared.
The nurse is required to remain on duty for an additional period of time, to work an extra shift(s), double shifts or other overtime when the nurse, due to fatigue, questions his/her ability to practice safely, or when the nurse is unable to do so for any other reason.
Though these issues may be construed to be employee-employer matters, the underlying concern is the nurse's individual legal responsibility and accountability for safe, effective nursing practice within the context of the nurse's licensure and employment position, and whether:
The nurse would face disciplinary action by the Kentucky Board of Nursing for accepting or refusing an assignment which the nurse deemed potentially unsafe to a patient(s), and
A nurse's refusal to accept an assignment to work unscheduled or mandatory overtime would constitute a violation of the Kentucky Nursing Laws resulting in charges of patient abandonment and subsequent disciplinary action.
ADVISORY OPINION
After review of the statutes governing nursing practice and disciplinary action, and study of the issues and concerns posed in the inquiries, it is the conclusion of the Kentucky Board of Nursing that:
KRS 314.021(2) holds nurses individually responsible and accountable for rendering safe, effective nursing care to patients and for judgments exercised and actions taken in the course of providing care.
This conclusion is supported by American Nurses' Association Code for Nurses Statement 6 (1985, page 1), which states: "The nurse exercises informed judgment and uses individual competence and qualifications as criteria in seeking consultation, accepting responsibilities, and delegating nursing activities to others."
KRS 314.021(2) imposes individual responsibility upon nurses to undertake the performance of acts (e.g., perform procedures, assume assignments) for which they are prepared by virtue of their education and experience in nursing. Acts which are within the permissible scope of practice for a given licensure level may be performed only by those nurses who personally possess the education and experience to perform those acts safely and competently.
It is the opinion of the Board that:
Safe, effective nursing care is contingent upon the availability of an adequate number of nurses with sufficient resources who are able and qualified to carry out clinical judgment activity (and apply the nursing process) at a level consistent with meeting patients' nursing care needs in a safe manner.
In AOS #88-19 the Board advises licensees concerning accepting or rejecting patient care assignments.
As concerns the question of abandonment, the Board has received numerous inquiries concerning mandatory overtime. Callers reported being told that refusal to work mandatory overtime constitutes abandonment. In June 1990, the Board advised licensees that as a general principle a nurse who is on duty and is mandated by an employer to remain on duty for an additional shift/period of time would not be in violation of the Kentucky Nursing Laws if the nurse, after exercising prudent judgment, notifies the supervisor that he/she is unable to remain on duty and subsequently leaves the facility. The nurse in this situation may not be protected from disciplinary action by an employer.
In exercising prudent judgment, licensees should act in a manner to uphold the standards of nursing care as set by nurses with similar education and experience under similar circumstances. In other words, what would be reasonable under the circumstances of a given situation. This would include consideration of the patient's condition and informing the supervisor/manager of the decision to leave in a timely manner.
When an alleged violation of the Kentucky Nursing Laws is reported to the Board, specific steps (as set forth in 201 KAR 20:161) are taken to evaluate the report. Information is obtained from all possible sources in order to discover relevant facts and circumstances and the specific facts of each situation are considered. In all cases, an individual licensee is afforded due process (201 KAR 20:162) regarding any alleged violation.
ADDITIONAL INFORMATION
Various terms and additional related information applicable to this statement are provided for consideration by licensees and are summarized as follows:
Abandonment The term "abandonment" is not used in the Kentucky Nursing Laws. Courts have defined abandonment as an unjustifiable cessation of a legal relationship.
Civil or Criminal Liability Specific obligations incurred as the result of charges heard in a judicial court. Advice concerning such liability is not within the jurisdiction of the Board. Legal counsel should be sought for advice.
Employment at Will Doctrine The courts recognize an "employment at will" doctrine wherein an employer, in the absence of an employment contract, is generally free to terminate an employee at will. The courts further recognize that there is a "public policy" exception to this doctrine recognizing that an employer may be liable for the wrongful discharge of an employee if the discharge was contrary to a fundamental and well defined public policy as evidenced by existing law. [Firestone Textile Co. Div. v. Meadows , Ky., 666 S.W.2d 730 (1984).] Nurses may wish to seek legal counsel for additional information pertaining to employment practices, including termination or employer disciplinary action which may occur as the consequence of a nurse's refusal to remain on duty at the conclusion of his/her regular shift. Nurses should review and understand the employing agency's policies and procedures governing conditions of employment, work assignments, and employee/employer relationships.
Employee/Employer Issues The Board has no jurisdiction over employment related matters, e.g., salary, work conditions, and hiring and termination policies. A nurse who is an employee has a legal employment relationship governed by the facility's established employment policies.
Licensure The process by which the Kentucky Board of Nursing grants legal privilege to an individual to engage in nursing practice upon finding that the individual has attained the essential degree of education and competence necessary to ensure that the public health, safety, and welfare will be protected. The Board is the only agency authorized to take action on the status of a nurse's license.
Mandatory Overtime A requirement that an employee work beyond the regularly scheduled number of hours. The decision to require any employee to work overtime, and the decision to accept such an assignment is primarily an employee/employer related matter. No Kentucky law specifies the number of hours a nurse may work in a given time period.
Patient/Nurse Ratio The Kentucky Board of Nursing does not establish a ratio for the given number of patients for which a nurse may be assigned. Pursuant to the KRS Chapter 216B, the Cabinet for Human Resources promulgated administrative regulations requiring that health care facilities employ a sufficient number of qualified personnel to meet the needs of the patients [902 KAR 20:016; 026; 048; 051]. A patient/nurse ratio should be minimally based upon the qualifications of each nursing staff member, nursing care needs of the patient, and the patient's prescribed medical and nursing care requirements set forth in a plan of care.
When patients do not receive necessary care because of understaffing, then the specific facts of the given situations should be documented and reported to the nurse's chain of command as well as to the Cabinet for Human Resources, Division of Licensing and Regulation, and to the Joint Commission on Accreditation of Healthcare Organizations.
DETERMINING SCOPE OF PRACTICE
KRS 314.021(2) holds all nurses individually responsible and accountable for the individual's acts based upon the nurse's education and experience. Each nurse must exercise professional and prudent judgment in determining whether the performance of a given act is within the scope of practice for which the nurse is both licensed and clinically competent to perform. In addition to this advisory opinion statement, the Kentucky Board of Nursing has published "Scope of Practice Determination Guidelines" which contain a decision tree chart providing guidance to nurses in determining whether a selected act is within an individual nurse's scope of practice now or in the future. A copy of the guidelines may be obtained from the Board office.
SUMMARY
Within the context of their licensure status and employment positions, all nurses share in the responsibility for exercising judgment and taking action(s) which assure that nursing care is provided in a safe and effective manner. The nurse administrator(s) who determines staffing patterns and assignments shares in the responsibility for assuring that staff are able and available to provide safe and effective nursing care, and that staff are appropriately oriented, distributed, utilized, and have available resources necessary to provide care. Further, the nurse(s) who accepts an assignment is responsible for exercising prudent judgment in assuring safe, effective patient care.
The Board holds no jurisdiction over employment issues; therefore, this opinion does not address these issues.
The Kentucky Board of Nursing issues advisory opinion statements as to what constitutes safe nursing practice. As such, an opinion statement is not a regulation of the Board and does not have the force and effect of law. It is issued as a guidepost to licensees who wish to engage in safe nursing practice.
APPLICABLE STATUTES FROM THE KENTUCKY NURSING LAWS[1]
KRS 314.021(2) states that:
All individuals licensed under provisions of this chapter shall be responsible and accountable for making decisions that are based upon the individuals' educational preparation and experience in nursing.
The performance of acts requiring substantial specialized knowledge, judgment, and nursing skill based upon the principles of psychological, biological, physical, and social sciences in the application of the nursing process in:
The care, counsel, and health teaching of the ill, injured or infirm.
The maintenance of health or prevention of illness of others.
The administration of medication and treatment as prescribed by physician, physician assistant, dentist, or advanced registered nurse practitioner and as further authorized or limited by the board, and which are consistent either with American Nurses' Association Standards of Practice or with Standards of Practice established by nationally accepted organizations of registered nurses. Components of medication administration include, but are not limited to:
Preparing and giving medication in the prescribed dosage, route, and frequency;
Observing, recording, and reporting desired effects, untoward reactions, and side effects of drug therapy;
Intervening when emergency care is required as a result of drug therapy;
Recognizing accepted prescribing limits and reporting deviations to the prescribing individual;
Recognizing drug incompatibilities and reporting interactions or potential interactions to the prescribing individual; and
Instructing an individual regarding medications.
The supervision, teaching of, and delegation to other personnel in the performance of activities relating to nursing care.
The performance of other nursing acts which are authorized or limited by the board, and which are consistent either with American Nurses' Association Standards of Practice or with Standards of Practice established by nationally accepted organizations of registered nurses.
The performance of acts requiring knowledge and skill such as are taught or acquired in approved schools for practical nursing in:
The observing and caring for the ill, injured, or infirm under the direction of a registered nurse, a licensed physician, or dentist.
The giving of counsel and applying procedures to safeguard life and health, as defined and authorized by the board.
The administration of medication or treatment as authorized by a physician, physician assistant, dentist, or advanced registered nurse practitioner and as further authorized or limited by the board which is consistent with the National Federation of Licensed Practical Nurses or with Standards of Practice established by nationally accepted organizations of licensed practical nurses.
Teaching, supervising, and delegating except as limited by the board.
The performance of other nursing acts which are authorized or limited by the board and which are consistent with the National Federation of Licensed Practical Nurses' Standards of Practice or with Standards of Practice established by nationally accepted organizations of licensed practical nurses.
The board shall have power to deny, limit, revoke, probate or suspend any license to practice nursing issued by the board or applied for in accordance with this chapter, or to otherwise discipline a licensee, or to deny admission to the licensure examination, or to require evidence of evaluation and therapy upon proof that the person: Has negligently or willfully acted in a manner inconsistent with the practice of nursing; Is unfit or incompetent to practice nursing by reason of negligence or other causes including but not limited to being unable to practice nursing with reasonable skill or safety.
I hope you take the time to make sure that MANY people who can make a difference, will know about what is going on at that facility. I know you put up with ALOT, but think about those poor residents. One day we may all be in a facility like that, in pain or have fallen and no one is there to help you!! :eek:
I applaud your guts and standing up no matter the cost for you, however, please remember those left behind. You can make a difference for all of them.
Good luck to you and finding a position you will be happy in and BE APPRECIATED in!!! :kiss :kiss
last night at work was the worst night i've had there since i started.
:eek: 
skybirdrising
71 Posts
With the acute nursing shortage I am not sure you will be able to find a job! PLEASE! Don't sweat it!