Management threatens nurses

JohnHood, BSN · Mar 6

I worked as an agency nurse at a similar hospital It 20 beds and the ER. It was me a tech and the ER doctor. There were four telemetry beds with only one working monitor. I pulled one shift and never went back. Your situation sounds very unsafe. I do not think I would sign in under those conditions.

heron, ASN, RN · Mar 6

Are those managers available to cover shifts? Even non-nurses can be useful as gofers, secretarial help, or answering call lights.

Meanwhile, who owns the hospital? Bet you a dollar they're trying to sell it.

Under current conditions, your chances of saving the facility seem slim, TBH. If Medicare and Medicaid funding goes away, a significant, perhaps fatal, hit on healthcare profits wil ensue.

Thus easing the way for continuing privatization of rural healthcare - likely supported by taxpayers. Also likely to be more costly than Medicare, et. al., are now

It all depends on the commercial ethics of the facility's owners.

Godspeed and keep us posted, if you have time.

Following ...

delrionurse · Mar 7

You may have to 1) deny an admission due to patient safety regardless of what the DON says 2) call before you're shift and tell them you need help on the floor (or call in) if they don't accommodate 3) call before your shift to ensure there is safe staffing (because they aren't) or 4) look for something else. They don't seem to be looking out for you.

Djadia, BSN · Mar 7

Can I legally refuse an admission d/t patient safety without receiving a corrective action? Last evening we had exactly that situation. We called the DON when ER called with an admission- a 21 yo. with severe hypocalcemia/ tetany. This was not an appropriate admission given the risks of cardiac arrest, seizures etc. We already had 12 patients - including 3 tube feedings w/ q4h flushes, 4 patients that required 2 person transfers/repos. 1 covid pt & 2 fresh surgicals.

The DON asked if we felt safe taking the admission. We obviously said no. He said he'd call us back. When he did his response "I told ER to send the patient to the floor" - no questions asked!

I don't want to jeopardize my license - but it's not safe. Can I refuse to take an admission without retaliation from management or getting fired?.

delrionurse · Mar 7

Djadia said:

Can I legally refuse an admission d/t patient safety without receiving a corrective action? Last evening we had exactly that situation. We called the DON when ER called with an admission- a 21 yo. with severe hypocalcemia/ tetany. This was not an appropriate admission given the risks of cardiac arrest, seizures etc. We already had 12 patients - including 3 tube feedings w/ q4h flushes, 4 patients that required 2 person transfers/repos. 1 covid pt & 2 fresh surgicals.

The DON asked if we felt safe taking the admission. We obviously said no. He said he'd call us back. When he did his response "I told ER to send the patient to the floor" - no questions asked!

I don't want to jeopardize my license - but it's not safe. Can I refuse to take an admission without retaliation from management or getting fired?.

You would have accept the consequences including corrective action, write up or whatever they do if you already accepted the shift. I am no legal expert, but you are protecting yourself if you say you can't accept a patient. Just because there are beds available, doesn't mean you can take an admission. That is the inference from your original post that I got and that is what the DON is indirectly saying, that if there are beds on your unit, no matter what the cost, you have to take the admission. It doesn't make sense for your manager to call and ask and then ignore your concerns. It sounds like a conflict of interest. Do you have safe harbor or a similar process in your state? It protects a nurse from discipline in instances like this. I am sorry that you are in this situation.

JKL33 · Mar 7

Quote

without following this escalation process.

What is the escalation process they're referring to?

This is a bad situation. You're saying there's a single RN for these 12+ inpatients?

I really sincerely hope you are working on plan B. I would do that, in earnest. Don't know what your personal situation is but if it were me I would put my foot down. I would tell them no, I would consider calling the admitting provider and saying "not sure what they led you to believe but this patient's needs cannot be safely cared for here,” I would report them to CMS and whatever other regulatory agencies might apply to their business situation, I would use their incident reporting system (IF they even bother to have one), and I would inform them that I will not be clocking in if I arrive to find another similar staffing dumpster fire for my next shift. They can do what they want with alll of that.

heron, ASN, RN · Mar 7

Djadia said:

I don't want to jeopardize my license - but it's not safe. Can I refuse to take an admission without retaliation from management or getting fired?.

Well, never say never, but it's pretty unlikely that you can challenge your employer's practices with no repercussions. Management is clearly not concerned with your issues. Unless you can involve your employer's regulators, you're pretty much stuck.

Actions have consequences. If you aren't willing to deal with them, you have to deal with the status quo or leave. Your license is not your employer's problem.

kbrn2002, ADN, RN · Mar 9

A group of somebodies made the decision that this was OK behind some closed door meeting somewhere. Those somebodies make way more money than the nurses, techs and any ancillary staff that might exist. The only likely option to say this is not OK is to quit. Any other job has to be better than this insanity, If there are no other employers in the area I would seriously consider moving somewhere else to get away from a employer that thinks this is OK for patient and staff safety.

If you want to stay and fight this, why worry about corrective action? Say no, absolutely not, we can not safely accept another patient and let the chips fall where they may. It sounds like the response is to take that patient despite concerns voiced by staff since that was already done, in which case there's not much you can do while you are on the clock without putting your license at risk. There are regulatory agencies and news media that you could involve. Call them, report these unsafe working conditions to anybody and everybody who will listen.

KathyDay · Mar 13

The situation of nurses being between a turd and a hard place...is decades old. Without a remedy, and/or staff nurses standing up for themselves, their patients and protecting their licenses to practice...........patients will be harmed and or die, and guess who will be held responsible..yup, the staff nurse. This is probably the biggest reason younger people are not going into nursing, and staffing is hard to come by. You can only abuse people...patients and nurses...so much, and they will revolt. Our profession is under attack and has been for a long time. By not standing up for ourselves and in turn, our patients. we buy into the abuse of both.

guest1039278 · Mar 15

Djadia said:

Can I legally refuse an admission d/t patient safety without receiving a corrective action? Last evening we had exactly that situation. We called the DON when ER called with an admission- a 21 yo. with severe hypocalcemia/ tetany. This was not an appropriate admission given the risks of cardiac arrest, seizures etc. We already had 12 patients - including 3 tube feedings w/ q4h flushes, 4 patients that required 2 person transfers/repos. 1 covid pt & 2 fresh surgicals.

The DON asked if we felt safe taking the admission. We obviously said no. He said he'd call us back. When he did his response "I told ER to send the patient to the floor" - no questions asked!

I don't want to jeopardize my license - but it's not safe. Can I refuse to take an admission without retaliation from management or getting fired?.

As someone who worked their entire career in a state that did not have formal nurse:patient ratio laws, I can say that if your state does not have formal limits in place in terms of number of patients per nurse, you won't have that to fall back on. I have seen ICU nurses get 3 patients, all super high acuity and intubated with a crap ton of drips running, and not really anything they can do about it. One time they tried to give me 1:9 when I was on medsurg (fortunately this did not happen). The hospital can write you up for whatever it wants to, and unless there is a formal law in place that says this is beyond the scope and/or safety of your defined role or it's a limitation specific in your own contract, it's gonna be a harder hill to climb to put up a defense for it. I am not saying it's right, but in states that do have these protective laws, the conversation ends SO much faster if you catch my drift. Honestly, this is morbid advice I got, but a valuable insight I was told by someone was always check the assignment before you clock in. If you don't clock in, you then see your assignment, you now have time to make a quick choice as to whether you decide to quit and give a 5 minute notice, or keep going. I honestly don't know if this steadfast, but this person who told me this is experienced in facility-based leadership. According to this individual, 2 week notices are a courtesy, and while a 5 minute notice is not so much of a courtesy, a 5 minute notice is different than clocking in and quitting "on the clock" where the words 'abandonment' may actually carry some real weight to them. Will you get blacklisted and maybe even a bad review? Will you be hesitant to include that facility on your job history in case they are contacted by any future employer? Maybe. Maybe more stuff too. But for the hospital to argue that you genuinely committed to work that shift and then later committed 'abandonment' (when you otherwise never clocked in and ultimately came to your workplace at a very inconvenient time wearing clothing you happened to have next to your bed that morning so you could turn in your badge to the day charge nurse and send a resignation email/text after you leave, your reasons for doing so aside) would be much easier to do if you actually clocked in.

Again, it's absolutely sad as hell we have to talk about this stuff, but this is our industry now.

There are people out there may have pissed off former employers to no end for not bending over backwards to accommodate the suits-wearers, but at least they still have RN after their name.

Again, IDK if this is something that is steadfast, but according to this mentor of mine, you do what you gotta do to put distance between your license and the chopping block, even if pisses people off.