Is this an Unsafe assignment legally?

[c1henry2mr gmail]

I know the reason to refuse an assignment is generally left to nursing judgement.  However, are there situations that are more black & white?  I am an agency nurse and I've been working nights at this facility for a couple of years.  There are 3 units.  On day and evening shift the "rehab" unit has 2 nurses.  Its a 30 bed unit census around 26.  22 of the residents are LTC, only 2-4 are "rehab".   This facility doesn't take medically complex or patients needing physical therapy, focus is more on psych/dementia.   Many are homeless people who would have been discharged home from hospital if they had a place to go.  The other two units (1north and 1south) have 20-22 LTC residents, 5 or 6 residents on each unit have a wander guard and history of exit seeking.  1N always had one nurse and one CNA on the night shift.  1S had one nurse often without a CNA.   The CNA for 1N arrives at 1230-1am.   1S CNA is sleeping in an office and won't supervise 1N while the nurse gets report on 1S.    By cutting down to one nurse night shift leaving a unit unsupervised while the nurse is getting report or attending to residents on the other unit.  Is that allowed?  Doesn't someone need to be listening for call lights at all times.   Management knows the CNA arrives almost 2 hours after the shift starts and "will address it". That hasn't happened two weeks into the new schedule of 1 nurse for 2 units.  Don't I need to refuse the assignment?  I can't find specific documentation about the call lights but that can't be OK, can it?

[Been there,done that, ASN, RN]

I cannot follow this at all. Appears that the facility is a hot mess.. and getting worse. You have been working there for years. Do you feel like it's time to move on?

 

[JBMmom, MSN, NP]

Unfortunately many state laws specify only ratios and do not specify unit arrangements. Certainly your management has investigated so that they're within the letter of the law, but clearly that doesn't make it a safe or acceptable arrangement. So if you refuse an assignment, you MAY not be legally backed up if they meet requirements by law. Good luck with however your proceed, sounds like a difficult situation for staff and a sad situation for patients. 

[Tenebrae, BSN, RN]

Sounds like a complete mess. 

Run away as fast as you can

[egg122 NP, MSN, APRN]

Your management sounds pretty ethically questionable given that they are accepting and keeping patients that do not meet the criteria for skilled nursing care indicated by writing, "Many are homeless people who would have been discharged home from hospital if they had a place to go." They are filling beds for cash regardless of the need or qualifications of the facility. They are not likely to change or staff appropriately in the future. Keep that in mind. You protect you.