Is this even Legal?

Nurses General Nursing

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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 Surgical Specialty Clinic - Ambulatory Care.
5 hours ago, CapeCodMermaid said:

NO SNF I know has a 1:5 ratio and I’ve worked in 20 different ones. ANA can recommend anything it wants but it’s NOT a regulatory body and a 1:5 ratio in a SNF is never going to happen.

Agreed. The ANA also recommends 1:4 ratio on medsurg....that is laughable to me as well. I have never experienced less than 1:8 on medsurg. But my point is that the ANA ratio recommendations are based on evidence that demonstrate the increased risk in death of the patient with higher ratios. So while I understand that these ratios are as rare as unicorn farts, they are based on research as to what is best for patient care. Just because everyone is telling us there isn’t enough money to hire enough nurses to make these ratios a reality; doesn’t mean they aren’t saying something more like “our profit margins would be to small if we made things this safe”. Even non profit hospitals are profiting machines and no one in healthcare is truly there for the patient’s best interests.

Specializes in Gerontology, Med surg, Home Health.

SNFs are UNDERFUNDED at least $38/day for every Medicaid resident in Massachusetts. Where will the $$ come from to hire more nurses?

Specializes in Surgical, Home Infusions, HVU, PCU, Neuro.
12 hours ago, not.done.yet said:

Safe Harbor is good advice, but you cannot invoke it prior to taking report. You have to have had report to call Safe Harbor and even once you have called it, you still must work your shift. Safe Harbor doesn't excuse you from providing care. It provides legal protection for providing care in less than ideal circumstances and requires a response from your facility on how they are dealing with the situation.

Safe Harbor (SHPR), which may be initiated by a LVN, RN or APRN prior to accepting an assignment or engaging in requested conduct that the nurse believes would place patients at risk of harm, thus potentially causing the nurse to violate his/her duty to the patient(s). Invoking safe harbor in accordance with Rule 217.20 protects the nurse from licensure action by the BON as well as from retaliatory action by the employer.

https://www.bon.texas.gov/practice_peer_review.asp

Definition of Safe Harbor - [NPR §303.005(b) and (e); Rule 217.19(a)(15), Rule 217.20(a)(15)]

Safe Harbor is a nursing peer review process that a nurse may initiate when asked to engage in an assignment or conduct that the nurse believes in good faith would potentially result in a violation of Board Statutes or Rules. When properly invoked, safe harbor protects a nurse from employer retaliation and from licensure sanction by the BON. Safe Harbor must be invoked prior to engaging in the conduct or assignment for which peer review is requested, and may be invoked at any time during the work period when the initial assignment changes.

Examples of Safe Harbor situations include clinical assignments related to staffing and/or acuity of patients where the nurse believes patient harm may result [217.11(1)(B) and (T)], and can involve a request to engage in unprofessional or illegal conduct, such as falsifying medical record documents. The latter is an example of a situation where a prudent nurse would refuse to engage in the conduct requested.[NPA §301.352(a-1), Rule 217.20(g)(1)(B)]

At the time the nurse is requested to engage in the activity, notify the supervisor making the assignment in writing that the nurse is invoking Safe Harbor. The nurse may use the BON’s Quick Request Form (or any document that contains the minimum information required by rule), or may use any other means of recording the initial request for safe harbor in writing with at least the minimum information required under §217.20(d)(3)(i)-(v):

(A) The nurses(s) name(s) making the safe harbor request and his/her signature(s);
(B) The date and time of the request;
(C) The location of where the conduct or assignment is to be completed;
(D) The name of the person requesting the conduct or making the assignment; and
(E) A brief explanation of why safe harbor is being requested.

This written Quick Request for safe harbor may be brief, but before leaving at the end of the work period, the nurse must submit a written Comprehensive Request (detailed account) of his/her request for safe harbor. Additional supporting documents may still be supplied at a later date. Quick Request and Comprehensive Request for Safe Harbor forms are available on the BON web site. There is also a separate form for requesting a determination regarding the Medical Reasonableness of a Physician’s Order. All of these BON forms are optional and do not have to be utilized by the nurse making a written request for Safe Harbor.

This is what I was referring too, maybe I misread or misunderstood how invoking Safe Harbor works

3 Votes
Specializes in Psych, Corrections, Med-Surg, Ambulatory.
8 minutes ago, Kallie3006 said:

This is what I was referring too, maybe I misread or misunderstood how invoking Safe Harbor works

Even though you invoke it after accepting an unsafe assignment, I would still give management a heads up that I intend to invoke it if I arrive at work to find a severely understaffed situation. Give them time to head things off at the pass.

2 Votes
Specializes in Surgical, Home Infusions, HVU, PCU, Neuro.
16 minutes ago, TriciaJ said:

Even though you invoke it after accepting an unsafe assignment, I would still give management a heads up that I intend to invoke it if I arrive at work to find a severely understaffed situation. Give them time to head things off at the pass.

Absolutely, I would not invoke without giving the chance to have the situation rectified

2 Votes
Specializes in Critical Care; Cardiac; Professional Development.

Definitely agree. I think my material point is that it doesn't excuse you from having to work your shift. If you don't accept the assignment there is no Safe Harbor. You just didn't show up for work (or left without working - ie: no patient abandonment). Accepting report and invoking Safe Harbor offers legal protections against your license and theoretically retaliatory actions by your employer.

It does not protect you if you walk off the job before or after taking report. There is a lot of misconception out there that somehow Safe Harbor excuses you from patient abandonment. It doesn't. It also doesn't excuse you from losing your job if you do not work your assigned shift. It simply protects you from the legal ramifications of working in less than ideal conditions and proves that you alerted your employer that you feel unsafe in an assignment, whether that be due to patient condition (ie: a stepdown nurse being forced to care for a pregnant patient in DKA - happened to me) or the heaviness/acuity of the assignment load.

3 Votes
Specializes in Surgical Specialty Clinic - Ambulatory Care.
18 hours ago, CapeCodMermaid said:

SNFs are UNDERFUNDED at least $38/day for every Medicaid resident in Massachusetts. Where will the $$ come from to hire more nurses?

I understand it is underfunded....that is not an excuse for poor care and unsafe working conditions. Which recent research has demonstrated it is. The money will come when we refuse to allow this to continue.

1 Votes
Specializes in Gerontology, Med surg, Home Health.

Sorry to be so blunt but you’re delusional if you think what we say will generate more reimbursement for SNFs. We’ve been saying for years that we don’t have enough $$ to properly take care of people. The government had the chance to pass a funding bill today and they didn’t

2 Votes
Specializes in Surgical Specialty Clinic - Ambulatory Care.
5 hours ago, CapeCodMermaid said:

Sorry to be so blunt but you’re delusional if you think what we say will generate more reimbursement for SNFs. We’ve been saying for years that we don’t have enough $$ to properly take care of people. The government had the chance to pass a funding bill today and they didn’t

It will generate more funding if we stand together and refuse to continue to work in conditions like this. The problem with medical people is that we care and companies know they can manipulate us into taking these crap assignments because we took an oath to do our best for those in need. But the people running these facilities didn’t make those oaths,they are business. Until we make the people feel the poor conditions our own government is putting both us and them in, then we have no hope of change. If that is how bleak my career is then I need to get out now.

2 Votes
Specializes in Gerontology, Med surg, Home Health.

It is bleak. If I weren’t so close to retirement I’d switch specialties

2 Votes
21 hours ago, KalipsoRed21 said:

It will generate more funding if we stand together and refuse to continue to work in conditions like this. The problem with medical people is that we care and companies know they can manipulate us into taking these crap assignments because we took an oath to do our best for those in need. But the people running these facilities didn’t make those oaths,they are business. Until we make the people feel the poor conditions our own government is putting both us and them in, then we have no hope of change. If that is how bleak my career is then I need to get out now.

I never took any oath. What oath are you referencing?

1 Votes
Specializes in Surgical, Home Infusions, HVU, PCU, Neuro.
3 hours ago, Horseshoe said:

I never took any oath. What oath are you referencing?

Our school had us take the Nightingale Pledge prior to our pinning.

1 Votes
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