Leadership and risk management?

UM Review RN, ASN, RN · Feb 7, 2005

1) in rural healthcare there is often NO immediate option. We could contract with a traveler but when census drops I sit at home using vacation time while the traveler works. Most of the time, we understand that we'll have to make some sacrifices (like working extra shifts) but the rest of the hospital makes sacrifices as well.

In the case where staffing is a problem, wouldn't it make sense for administration to cross-train nurses and therefore prepare them to work on different units?

There are plenty of nurses who'd jump at the chance for training to a different unit. What upsets us is feeling unqualified and inadequately trained for the job that needs to be done.

My current administration is wonderful on the whole. We're not only a Magnet facility but we have been on the 100 Best Hospitals list for a few years in a row. We have one of the finest Stroke units in the country. Why? Because our management listens to our suggestions. I do not have to worry about being floated to an area in which I have not previously been trained or shown competence.

The OP sounded like this assignment came out of the blue, and it was an inappropriate assignment any way you look at it, IMHO, since she was completely unprepared to work in that area, especially as Charge.

I hope she gets back to us and updates us as to whatever happened. Now I'm curious.

purplemania, BSN, RN · Feb 7, 2005

Texas has a Safe Harbour Law for such incidents. If the nurse accepts the assignment, as opposed to walking off the job, then the nurse can notify the House Supervisor that he/she is filing for Safe Harbour. There is a form to complete online. When the BON gets this form (same or next day) they contact the facility. They may even investigate staffing practices at the facility. Hospitals HATE to have the BON involved. If your state does not have such a law you ought to press for one. See BON site for template (http://www.bne.state.tx.us)

Ruby Vee, BSN · Feb 8, 2005

ok can anyone help me with this scenario: due to the increasing rate of retirement of the staff at your local hospital and the difficulty in attracting nurses to come and work in your town (remote) it has become comman practice to to ask all nurses in the hospital to work extra shifts in other specialty areas that they are not used to. you arrive at work and find out that you've been relocated to a specialty area you have never worked before and are also told that due to short #'s you will in charge of the unit for the shift. you are told that there is nobody else to that can come in to work that area, and the hospital is counting on you. what would you do?!

years ago, when i had two years of med/surg experience (including charge), i was asked to float to micu to do charge. "there are a couple of experienced lpns there and some good agency folks, but no one to do charge." i refused, because i had no icu experience, and didn't even know how to read a monitor. if you're in charge, you're responsible for what goes on during your shift.

the nursing supervisor told me i'd lose my job if i didn't float. i continued to refuse. "it'll be on my license," she told me, "since i'm making the assignment."

"no," i told her. "it would be on my license. and i'd rather lose my job than my license." and i started gathering up my things to go home. in the end, they found another nurse to do charge in the micu and i floated elsewhere -- not to do charge.

i still think i did the right thing.

UM Review RN, ASN, RN · Feb 8, 2005

I still think I did the right thing.

I agree. And I noticed how quickly they "found" someone else before you could leave the building.

MandyInMS · Feb 8, 2005

When in doubt...don't.

Simple personal rule of mine

Ruby Vee, BSN · Feb 9, 2005

i agree. and i noticed how quickly they "found" someone else before you could leave the building.

that was a little fishy, don't ya think?

UM Review RN, ASN, RN · Feb 12, 2005

Aha! I finally found the article I was looking for regarding this issue. Here it is:

http://www.nso.com/newsletters/advisor/1999_summer/nurse/nso_8_99.php

Here's an excerpt:

Finding fault

By law, the administrators of a healthcare facility must provide enough properly trained personnel to meet patients' needs. But what constitutes "enough" or "properly trained" may be ambiguous because no specific guidelines exist. Court rulings on alleged understaffing are decided on a case-by-case basis and typically fault the facility for nursing deficits. But you can also be held accountable for mistakes related to understaffing. For example, if you were to float to an unfamiliar unit and attempt to perform a task for which you lack the necessary training and skills and something went wrong, you could be held liable. Or if you were placed in charge, even temporarily, you could be responsible if you didn't make appropriate assignments or properly supervise the staff under you. You could be faulted even for failing to notify administration that the unit was understaffed.

letina · Feb 12, 2005

I thought I'd have a go at replying to your question as I've been doing NCLEX practice questions and this scenario comes up quite a lot in the study preps.

I would show willing to work in the unit but make it clear that there are certain tasks/skills that I haven't received training for. Isn't refusal deemed as abandoning the patients? A tricky one I know, you're damned if you do and damned if you don't! :uhoh3: