I Quit!

[Super Nurse JoshuA]

I quit my job yesterday. They were going to try and staff my acute med/surg floor with me (1 rn), 1 lpn and 2 aids for 28. I told the floor no thank you, I quit, and I left the building. (I had not clocked in or took report). For several months 2 nurses (R/L or R/R) has been becoming the normal staffing pattern for my floor regardless of the number or acuity of the patients.( I believe the increase of code blues, rapid responses, and overall failure to rescue rate would speak to the complications the patients are experiencing from this).

I've worked at this hospital for 5 years, almost 2 as an RN. I'm kind of disappointed it ended this way, but at the same time I feel so much relief from not having to go back. I had been feeling burned out for the last several months and was dreading going in anyways (I had started thinking about calling in but than realized it was too late to call in and I would have received insuffecient notice from my hospital). I have been trying to transfer off this floor for a couple of months now and was told no one could leave my floor because we are so short staffed. I didn't even confirm the staffing for the floor that day until after I left the hospital and was calling Nursing Staffing office from my cell phone to inform them I was refusing to clock in or accept responsibility for that many patients. I have learned if things ever start to get this bad where ever I work in the future, I'm going to turn in a 2 week notice pronto so it doesn't come down to this.

Any support, advice, or critics?

[cardiacRN2006, ADN, RN]

You were really smart to not clock in. I always clock in at the start of shift, prior to receiving an assignment.

Well, if it's one thing I learned from this thread, it's not to clock in right when I enter the hosptial like I would normally do.

[RosesrReder, BSN, MSN, RN]

Well, if it's one thing I learned from this thread, it's not to clock in right when I enter the hosptial like I would normally do.

Amen to that!

[CseMgr1, ASN, RN]

Staffing has been cut on purpose to cut cost. They tell you it can't be helped but it is deliberate. I used to fall for the bull and work like a donkey because I wanted to be a team player. "Team player" is managment talk for "SUCKER".

The word "Team Player" has been used (and abused) to the point where it only has meaning for those who use it exclusively for the purpose of intimidating an individual into believing that they aren't fit to walk the earth if they refuse to accept an unsafe assignment.

[nerdtonurse?, BSN, RN]

We have a system....

Charge nurse gets there early, scopes out the census, scopes out who's on (did anyone call out, etc?). If it's bad, we get a text message not to clock in.

We've had to do it twice since I started; one night it was me, another LPN, and an RN to 36 tele beds, with NO aides; of the 36, a solid 20 were total care (read: q2 turn) with probably 10 on PEGs, and 2 expectant DNRs. We all refused to clock in, based on the charge's text message. Day shift, who hadn't given a rat's rump, even though they did the board and could see we were getting 12 pts a piece, finally clued in that we weren't accepting the pts and they wouldn't be able to leave (they had 4 patients per nurse and were complaining about how beat they were). Day charge starts yelling at Night charge, who tells us to get our purses, we're leaving. Day charge tells me that I'll be fired, never find a job again, and I told her I'd quit jobs I liked better than this one -- get another 2 nurses and an aide, or she's spending the night.

Guess what? They found another 2 nurses and an aide...

[CrunchRN, ADN, RN]

We have a system....

Charge nurse gets there early, scopes out the census, scopes out who's on (did anyone call out, etc?). If it's bad, we get a text message not to clock in.

We've had to do it twice since I started; one night it was me, another LPN, and an RN to 36 tele beds, with NO aides; of the 36, a solid 20 were total care (read: q2 turn) with probably 10 on PEGs, and 2 expectant DNRs. We all refused to clock in, based on the charge's text message. Day shift, who hadn't given a rat's rump, even though they did the board and could see we were getting 12 pts a piece, finally clued in that we weren't accepting the pts and they wouldn't be able to leave (they had 4 patients per nurse and were complaining about how beat they were). Day charge starts yelling at Night charge, who tells us to get our purses, we're leaving. Day charge tells me that I'll be fired, never find a job again, and I told her I'd quit jobs I liked better than this one -- get another 2 nurses and an aide, or she's spending the night.

Guess what? They found another 2 nurses and an aide...

That is totally awesome! If only more nurses would do this then problem solved.:yeah::yeah::yeah:

[RNsRWe, ASN, RN]

Tweety, are you aware of any cases where this has happened....where someone was charged with abandonment by the BON because he just showed up in the building? It's hard for me to picture that: the "intention" to take an assignment (meaning you came to work that day) doesn't seem to equate to TAKING an assignment and then changing your mind later. Where does this happen?

As for the clocking in thing that some have mentioned, I guess I'm also wondering about that, too: I clock in a few minutes before my shift starts, so I can see what my assignment is and find the nurse I'll be getting report from. Sometimes, the assignment is not made until ten minutes after the start of my 7:00 shift. However, I haven't accepted ANYTHING until I've started to get report on those patients. Just because someone wrote my name next to a patient run doesn't mean I'm going to take it, only that I'm EXPECTED to take it.

That said, the problems I've had have NOT been at the clock-in point, at the start of my shift. Nope. The problems are when I'm assigned say 6 patients on the evening part of my shift (7-11) and then find out at 11pm (or ten minutes before, or five minutes after) that I'm going to be short staffed the rest of the night and that if I don't take four or five more, no one will. I can't abandon the patients I have by walking out--NO ONE will accept my report. So I can't just leave! I guess I'm hoping that if it ever gets to the point Josh was just at, it IS at the shift's start! Otherwise, I don't see my "in my dreams" stomp-out-the-door scenario happening.

[neatnurse30]

Wow, 14 pts per 1 nurse! I wanted almost to not accept an assignment for 9 pts because that was so many. But I did, and 4 hrs later we got another nurse so I ended up with 6. I am so proud of you to quit! You are very, very brave and I, too, support your decision 100%!

Best luck to you!:heartbeat

[loricatus]

That said, the problems I've had have NOT been at the clock-in point, at the start of my shift. Nope. The problems are when I'm assigned say 6 patients on the evening part of my shift (7-11) and then find out at 11pm (or ten minutes before, or five minutes after) that I'm going to be short staffed the rest of the night and that if I don't take four or five more, no one will. I can't abandon the patients I have by walking out--NO ONE will accept my report. So I can't just leave! I guess I'm hoping that if it ever gets to the point Josh was just at, it IS at the shift's start! Otherwise, I don't see my "in my dreams" stomp-out-the-door scenario happening.

Hummm. Seems like the nurses that are leaving at 11PM are the ones that should be charged with patient abandoment since there is no one to take report on them-don't you? If you already have a full load, whoever is giving them permission to leave has technically taken report on them.

[DusktilDawn]

Hummm. Seems like the nurses that are leaving at 11PM are the ones that should be charged with patient abandoment since there is no one to take report on them-don't you? If you already have a full load, whoever is giving them permission to leave has technically taken report on them.

The nurses leaving at 11pm in this scenario have given report and therefore have passed the care of their patients onto someone willing to "accept" them. As long as someone "accepts" report and assumes responsiblity for those patients, than they cannot be charged with abandoment.

It's not usually the individual nurses "granting permission" for them to leave, it tends to be the supervisors who are not taking report on these patients, technically or otherwise. Basically I've seen plenty of supervisors that have allowed (grant permission, if you will) staff to leave even though it leaves the unit short-staffed. But then, if you've worked your shift, should you not be entitled to leave when that shift has ended? Do we want to enable states and facilities the ability to mandate OT for nurses and create a situation where mandatory OT becomes the solution for the short-staffing issues created by health care facilities? Some states have already enabled health care facilities to use mandatory OT for the staffing issues. Mandatory OT also has it's own issues that nurses can be held accountable for. If you've worked 12 hrs, tired and exhausted, are you really capable of taking care of patients past this 12 hr mark? What's your recourse if you've been mandated to stay OT, yet don't feel capable of providing adequate care?

With the scenario RNsRWe describes the only course of action she could take would be to refuse to accept those additional patients. Refusing to take additional patients would not be considered abandoment. Yes, according to SBONs that would be appropriate, however, that would not protect her against being fired by an employer. SBONs clearly distance themselves from what they consider "employer/employee issues." SBONs hold nurses responsible for "accepting" an assignment and fail to recognize the true lack of autonomy nurses have when it comes to "accepting" patient assignments and they also fail to recognize the coersion employers place nurses under. Employers claim ignorance of the situation and the nurse is held responsible. IMO this failure on the SBONs part ALLOWS employers to exploit nurses and endangers the very public they are supposed to protect. It doen't work if you place responsiblity without the necessary autonomy onto nurses.

This brings us to another problem faced by nurses in the scenario RNsRWe describes is that unless ALL THE NURSES are refusing an additional four or five more patients, than that nurse stands alone. The nurse that refuses is painted out to be "difficult" since no one else had a problem accepting more patients. Although SBONs would consider the nurse's actions appropriate, that doesn't protect that nurse from disciplinary action by her employer should they deem it inappropriate that the nurse didn't accept that patient.

The crux of the problem is that nurses are held responsible without the autonomy necessary for that responsiblity and health care facilities are not. Accreditation agencies (JHACO), state legislatures, SBONs, and nursing organizations REFUSE to recognize this, thus enabling health care facilities to claim ignorance regarding their staffing practices, practices that they have FULL AUTONOMY over. Until health care facilities are held accountable and responsible nurses will continue to face this issue and bear the burden of responsiblity and accountability.