need advice

Psi · Mar 10, 2005

I really need some help here. I work on a small thirteen bed unit in a community hospital. My boss has opened up six more beds for observation patients. The original concept was for it to be a 24 hr. short stay area, during which time it would be decided if pt was able to be discharged or needed rolled over to inpatient status. This unit is tucked away at the back of the Gero Psych unit separated only by a curtain from the elderly patients. The unit hasn't been used as was originally planned. Pts are being held there who are too violent to be incorporated into our general population, borderlines are being held there. One bpdo set himself on fire last week. They had to do a take down on him in the Gero hallway when he escalated one day. All the oldsters were present. It was a miracle nobody got knocked down in the ruckus. This unit was initiated without any forethought. No extra staff was hired. We're expected to come in extra hours and staff it through mandatory overtime. I worked there last night and admitted four patients. I had one who was MMR, schz, and has second degree burns over 20% of her body, IV's, dressing changes, paranoid and fragile as all get out. Admitted a bpdo, who wanted to take the thermostat apart and carve herself, an alcohol detox came in early withdrawal, a 24hr detention with cut wrist who had come with screwed up paperwork on her detention papers. I had to iron that out with state police officer standing there glaring at me like it was my fault. I was loaned a new clerk for a couple hrs. She was too green to be much help at all. My equiptment was a small table, a laptop in the hallway. The charts were placed on the floor. There is NO confidentiality because the patients mill around where all the documents are exposed and try to read charting over your shoulder. All the supplies were located up the hallway about eighty feet, well out of sight and sound of my patients, so in effect, everytime I had to run to get supplies, I was leaving patients alone. I know that this breaks every regulation in the book and I'm putting my license and life on the line by working in that area. My boss poo poo's every concern staff mentions. She calls us "Queen Bees". I don't want to quit my job but I'm about ready. There are about four other nurses who are as fed up as me. The rest of the staff is fed up but too afraid to complain to the boss. Am I over- reacting here?

No you aren't over-reacting. The unit is heading for a disaster, you've made them aware of the problems. You need to get out of there as quickly as you can so that they don't take you down with them.

elkpark · Mar 10, 2005

I agree you are not overreacting. The situation you describe is a disaster waiting to happen. You have communicated your concerns to your NM and not gotten a satisfactory (to you) response. You have the option of going farther up the chain of command, if you choose ... The hospital has someone responsible for implementing/enforcing HIPAA regulations -- you could talk to that person about your concerns about client privacy. Your hospital QA (QI, TCI, whatever we're calling it this month ... :) ) program has some kind of safety committee -- you could share with them your concerns about the safety of the gero clients "across the curtain" from younger, sometimes violent patients (citing the actual dangerous situations that have occurred). In fact, all of these are concerns that could/should be brought to the attention of your unit QA committee. What does the unit medical director think of this situation -- is there any help/support there? Surely the hospital has some sort of nursing policy/procedure for minimum staffing numbers, inc. on the psych unit -- does the staffing for your unit, including the new "observation" unit, meet the hospital's requirements for staffing, or are you understaffed by the hospital's own standards? Your unit should also have written policy/procedure describing admission criteria and what sorts of conditions/circumstances would make a client unsuitable for the psych unit -- typically, patients with serious, acute medical problems like burns, needing IVs and complicated dressing changes, don't get admitted to psych units. Is your unit failing to follow its own policy/procedure in admitting clients to the "observation" unit? Perhaps you and the other concerned nurses can do a little research (the policy/procedure manuals are your friends! :) ) and document your concerns in terms of failure to follow hospital policy/procedure and HIPAA regs.

You also have the option of going outside the hospital -- you could, if you chose, share your concerns with your state agency that licenses and regulates hospitals. Although it gets called something different in every state, it is typically a division of the state Department of Health & Human Services (or whatever that is called in your state ...), and there is an 800 number for taking complaints. Many states require that hospitals get approval before opening/operating new units or beds -- I wonder if the state is aware that your hospital is operating the new unit, if it has been approved by the appropriate state agencies, and if it is in compliance with all the rules/regs that apply? I worked for that agency in my state for several years -- we got lots of calls from people like you, who were concerned about client care and safety in their workplaces. If it sounded like the situation could be in violation of state and Federal rules/regs and putting clients in danger, we investigated. We also kept confidential the identity of the person who made the complaint (however, that doesn't mean that the hospitals didn't sometimes figure out on their own who must have made the complaint. But they didn't hear it from us).

You may also want to check with your BON about your responsibilities and options regarding your license. Many years ago, I was in a work situation where several of us felt that the situation was becoming unacceptably dangerous -- we called our BON and discussed the situation with them, and they were v. helpful about advising us about our legal responsibilities and what steps we could take to protect ourselves and our licenses.

I know it is v. hard in this kind of situation to decide whether to just walk away, or keep trying to advocate for the well-being and safety of the clients and staff. Please, though, either work on changing things or walk away -- don't just stay and put up with the situation! Best wishes --

Nesher, BSN, RN · Mar 10, 2005

Are you kidding - you are NOT over reacting! I would move up the chain of command as suggested by another poster - if you don't get it changed- contact the media...tell your story to the world!

Nesher, BSN, RN · Mar 10, 2005

Oh yeah - document document document...

CharlieRN · Mar 11, 2005

Yet another reason why nurses need unions.

Much good advice has been given. Do not just sit tight. You are a nurse. Your primery responsiblity is to provide a safe environment. Safety is always the number one concern. Your licsense, and those of your fellow nurses, is what assures the consuming public that your facility gives safe care. It clearly states that you are responsible to the state, and the general public, not to your employer. Your employer hires you so that they can be covered by your lic. This, not the tasks you perform, is your real job.

margo123 · Mar 11, 2005

Your advice is much appreciated and I know I must do something and soon. There was a staff meeting today and I was very vocal about my thoughts re all this. I told my director that I think this unit is a disgrace and a tragedy waiting to happen. She agreed with me and said, "I know but my hands are tied. I have bosses, too." I asked her if she thought they realized how many fundamental care principles have been breached and she said, "They don't care, they just want to fill beds." She made all kinds of promises about how things are going to be reworked to make it a safe unit. When I mentioned specifics, she got evasive. I think I'm pretty much out of luck getting anywhere thru her. She feels compelled to "go along" with her higher-ups. Her personality is one of the people pleaser and people pleasers talk from both sides of their mouth. After a half hr she announced that we had "talked enough" about this subject and moved on to subjects that are trite in comparison. I have considered the options you have suggested and think I'll put the wheels in motion next week. Thanks to all for the input.

CharlieRN · Mar 12, 2005

Margo,

Being a responsible citizen is a b****, but that is what we promise when we accept our licsence. Go get'em Nurse.

Psychaprn · Mar 31, 2005

RUN as fast as you can to a new job or return to school etc. They won't change and you'll exhaust yourself-I've been there, done that and got the t-shirt. Try to get out of inpt. psych.-it's all like a psych. ER these days! Good luck.