Is this even Legal?

Published

We normally have 3 nurses working per shift but i have a coming up shift where Im the only one on the schedule to work this particular day. I was told that they have tired to get other nurses to come help that day but are not having any luck. its a 16 bed unit. If im the only one who shows up that day not only will i be charge, admit, discharge nurse but ill also have 16 pts to assess and chart on. Is this even Legal? What do I do in a situation such as this?

Specializes in Dialysis.
20 hours ago, Kyrshamarks said:

Simple. Call in sick that day. Let them worry about the staffing.

This would be my answer

2
Up Vote Up Vote ×
Specializes in retired LTC.

TriciaJ has presented the closest explanation of how 'Safe Harbor' is supposed to work.

In short, you accept the assignment, but UNDER PROTEST. There's documentation and management notification as the assignment then begins.

You do the best you can and keep in touch with mgt as you see nec.

The next step of 'Safe Harbor' is that a meeting of nurses is supposed to take place very shortly after the shift. The situation is reviewed and recommendations are made.

There is a very good article here on AN written by another poster, The Commuter. Check it out.

Remember that legally you act the best you can as any other good nurse would act under the circumstances. That's how your actions would be viewed.

1
Up Vote Up Vote ×
9 hours ago, amoLucia said:

TriciaJ has presented the closest explanation of how 'Safe Harbor' is supposed to work.

In short, you accept the assignment, but UNDER PROTEST. There's documentation and management notification as the assignment then begins.

You do the best you can and keep in touch with mgt as you see nec.

The next step of 'Safe Harbor' is that a meeting of nurses is supposed to take place very shortly after the shift. The situation is reviewed and recommendations are made.

There is a very good article here on AN written by another poster, The Commuter. Check it out.

Remember that legally you act the best you can as any other good nurse would act under the circumstances. That's how your actions would be viewed.

Sorry, but this is so wrong.

The OP would be a complete idiot to go to work that day. Tell them now that you will not be there because you will be committing professional suicide to accept 16 patients or accept any more than you normally have.

You, OP, have failed to state what type of ward you work on. It is an old folks' home where 16 might not be unusual? Is it ICU or Step down? or what?????

How can we answer you if you don't answer us?

CALL OFF THAT DAY.

And I wouldn't trust them even if they tell you they got another nurse or 2 to agree to come in.

It doesn't matter if other nurses routinely accept this kind of baloney. YOU learn to stand up for yourself. I don't know if it's legal or not, but it is completely wrong to expect you to work alone if that is not the norm.

Does Medicare know about this? Do the doctors know about it? What the devil is the Administrator doing about it? And your Manager? And I don't want to hear "Oh, but the poor patients and what about ethics". Ethics and reality aren't always compatible. Hard, cold reality enters in.

Also, if you do it this once, what's to prevent it from happening again?

7
Up Vote Up Vote ×
Specializes in Surgical, Home Infusions, HVU, PCU, Neuro.

https://nurseguidance.com/when-an-assignment-is-unsafe/

This has some good information in it that could be of benefit to all of us.

3
Up Vote Up Vote ×

This is a terrible situation to be put in. I am not a call out person, but there is no way you can take this assignment. Is it a hospital? What type of facility? Go up the chain of command and put it all in writing ahead of time. They need to fix it before this situation happens.

1
Up Vote Up Vote ×
Specializes in NICU/Mother-Baby/Peds/Mgmt.
On 4/13/2019 at 2:03 AM, TriciaJ said:

One option is to preemptively write up a notice that you are accepting an unsafe assignment under protest. You state on the form that you have already let your management know that your upcoming assignment is unsafe and you urged them to supply additional staff. You state that you will do your best under the circumstances, but in any untoward event YOU WILL NOT BE HELD RESPONSIBLE. Show them the document before the shift in question, just to let them know you are serious.

Make several copies of this document. If you arrive at work and still find you've 16 patients, present that document to your management. If they're not even there, phone someone at home to remind them about the document.

Then you prioritize the best you can. You phone management every hour and let them know you still need staff. Do not get embroiled in a lengthy conversation, you don't have time. State your case and hang up.

Send copies of your document to all the regulatory agencies you can think of: BON, JCAHO, the state licensing board; whomever has an interest in the running of your facility.

If you give them adequate heads up that you mean business, I suspect they'll beat some bushes and magically come up with some staff in the eleventh hour.

Absolutely not. You're telling her to take more than a double normal assignment. The lawyer for the patient you hurt or kill will use that against you ie; "you knew it was an unsafe assignment and you STILL took it?" and "your normal assignment is only 5-6 patients, correct?" Your hospital will throw you to the wolves. If something happens to a patient that wouldn't have happened if there had been adequate staffing you'll have to live with that. And who's going to help you run a code? And you won't have time to call anyone every hour, you'll be lucky to go to the bathroom once. Do ANYTHING but take report on 16 patients.

9
Up Vote Up Vote ×
Specializes in Psych, Corrections, Med-Surg, Ambulatory.
9 hours ago, Elaine M said:

Absolutely not. You're telling her to take more than a double normal assignment. The lawyer for the patient you hurt or kill will use that against you ie; "you knew it was an unsafe assignment and you STILL took it?" and "your normal assignment is only 5-6 patients, correct?" Your hospital will throw you to the wolves. If something happens to a patient that wouldn't have happened if there had been adequate staffing you'll have to live with that. And who's going to help you run a code? And you won't have time to call anyone every hour, you'll be lucky to go to the bathroom once. Do ANYTHING but take report on 16 patients.

No, that is where Safe Harbour comes in. That is why you develop a document stating that you gave management a heads up and are accepting the assignment under protest and will not be held responsible for ill effects. That's your CYA.

But first, OP needs to research the applicable law for that in her state, to see if that measure is even feasible. I have used this type of document - in a union shop preprinted documents are available. It's a really good idea to do this any time you're short staffed enough to be concerned for safety. Management hates this because it goes outside the system; they can't just bury it like an incident report. It gets their attention and often improves staffing, at least for a time.

By the way, these are psych patients (based on another thread). Still not a safe situation. Some people really shy away from not showing up for work. This is one alternative that provides some legal CYA if the OP doesn't want to outright refuse to go in or refuse to accept the whole assignment when there.

This is a good measure for every nurse to research in your own state and see if this option is available and worthwhile for you.

Up Vote Up Vote ×
1 hour ago, TriciaJ said:

No, that is where Safe Harbour comes in. That is why you develop a document stating that you gave management a heads up and are accepting the assignment under protest and will not be held responsible for ill effects. That's your CYA.

But first, OP needs to research the applicable law for that in her state, to see if that measure is even feasible. I have used this type of document - in a union shop preprinted documents are available. It's a really good idea to do this any time you're short staffed enough to be concerned for safety. Management hates this because it goes outside the system; they can't just bury it like an incident report. It gets their attention and often improves staffing, at least for a time.

By the way, these are psych patients (based on another thread). Still not a safe situation. Some people really shy away from not showing up for work. This is one alternative that provides some legal CYA if the OP doesn't want to outright refuse to go in or refuse to accept the whole assignment when there.

This is a good measure for every nurse to research in your own state and see if this option is available and worthwhile for you.

My understanding is that Safe Harbor can protect your license, but certainly not your job. Also, I doubt it would protect you in the event of a civil lawsuit, though I am not totally sure about that.

ETA: I just found the info on Safe Harbor in Texas, and it does state that the facility cannot retaliate against the nurse for invoking Safe Harbor.

It also states the following regarding protections from civil suits:

Safe harbor protections do not apply to any civil action for patient injury that may result from the nurse's practice.

https://texreg.sos.state.tx.us/public/readtac$ext.TacPage?sl=T&app=9&p_dir=F&p_rloc=190612&p_tloc=14839&p_ploc=1&pg=3&p_tac=&ti=22&pt=11&ch=217&rl=21

2
Up Vote Up Vote ×
Specializes in Psych, Corrections, Med-Surg, Ambulatory.
16 minutes ago, Horseshoe said:

My understanding is that Safe Harbor can protect your license, but certainly not your job. Also, I doubt it would protect you in the event of a civil lawsuit, though I am not totally sure about that.

ETA: I just found the info on Safe Harbor in Texas, and it does state that the facility cannot retaliate against the nurse for invoking Safe Harbor.

It also states the following regarding protections from civil suits:

https://texreg.sos.state.tx.us/public/readtac$ext.TacPage?sl=T&app=9&p_dir=F&p_rloc=190612&p_tloc=14839&p_ploc=1&pg=3&p_tac=&ti=22&pt=11&ch=217&rl=21

Good to know. I don't know how many days till OP is facing the shift in question, but it's worth checking out if it's even an option in one's state. It may be covered under the Nurse Practice Act. I just think it would be worth letting management know ahead of time that this will be invoked if need be. Hopefully OP shows up for work (if she still decides to) and voila! appropriate staffing levels.

Up Vote Up Vote ×

It is ridiculous for the administration to think you can care for that many patients safely. I would take it up to the highest level of management and even the CEO. Report them to JCAHO as previously suggested.

This is why nurses need to unionize, not only to protect ourselves but the safety of the patients!

4
Up Vote Up Vote ×
Specializes in Psych, Addictions, SOL (Student of Life).
4 hours ago, TriciaJ said:

No, that is where Safe Harbour comes in. That is why you develop a document stating that you gave management a heads up and are accepting the assignment under protest and will not be held responsible for ill effects. That's your CYA.

But first, OP needs to research the applicable law for that in her state, to see if that measure is even feasible. I have used this type of document - in a union shop preprinted documents are available. It's a really good idea to do this any time you're short staffed enough to be concerned for safety. Management hates this because it goes outside the system; they can't just bury it like an incident report. It gets their attention and often improves staffing, at least for a time.

By the way, these are psych patients (based on another thread). Still not a safe situation. Some people really shy away from not showing up for work. This is one alternative that provides some legal CYA if the OP doesn't want to outright refuse to go in or refuse to accept the whole assignment when there.

This is a good measure for every nurse to research in your own state and see if this option is available and worthwhile for you.

At the facility where I work (free standing psych) 16 patients is an average assignment for a charge RN. There is usually a Charge RN and LVN/LPT and two behavioral health associates except on noc shift when the BHS goes down to one of the acuity is low.

1
Up Vote Up Vote ×
Specializes in Nurse-of-all-trades, but mostly Peds/GP/PDN.
On 4/12/2019 at 10:03 AM, Horseshoe said:

NO WAY I would accept this. It will only keep happening if you do.

Truth!!

2
Up Vote Up Vote ×
+ Join the Discussion