New RN in charge of a 155 bed SNF. What?!?!

Nurses Safety

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Hey, all!

I'm a new grad. I've been working as a med nurse for the last month at a 155 bed skilled nursing facility. Repeat: I've been working as a nurse for ONE MONTH. Tonight the charge nurse called out sick and I was informed I would be charge, supervisor of the entire facility, the ONLY RN, no administrators, no docs. I panicked and then tried to collect my cool.

I had a fall, an admission, and a 911 call out for SOB. I had IVs and TPNs, all the while passing meds for my 26 patients. It was a rough night and bow that it's over, I'm looking for consolation.

Does anyone know of a law or policy in California that allows me to enact safe harbor before accepting an assignment? I called the DON and told him I was not experienced enough for the role but he insisted. I couldn't decline it and walk out, I'd be charged with patient abandonment! What can I do in the future if this happens again?

P.S. I submitted my two weeks notice.

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Hi,

The rule is once you ACCEPT the assignment and leave then you can be charged with patient abandonment. Coming onto work, calling the DON and saying "I won't accept this assignment" and leaving would not be considered patient abandonment.

However, while justified and not abandonment, not taking an assignment is a big deal. The situation has to be serious enough where you know and accept that you will probably not keep your job, or get a good reference as you seek a new job. Also, even with it not being abandonment, the employer who might incorrectly think it is abandonment will probably file a complaint with the state board that you will have to fight. All of this said it does sound like this was a serious enough situation to not accept the assignment.

Please see:

https://www.rn.ca.gov/pdfs/regulations/npr-b-01.pdf

https://nurseguidance.com/abandonment-what-it-is-and-is-not/

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Thanks so much for the input! God willing this doesnt happen again before I leave.

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This is a whole other can of worms, but California is an at-will state. You might also ask yourself, "Since I already know I'm not going to get a good reference from this job, what are my reasons for submitting a 2-week notice rather than quitting on the spot?"

While it is unprofessional to leave without a 2-week notice sometime it can be best under the circumstances.

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I thought about that. I have another job lined up so I'm not even sure why I bother. Especially when I feel like my license is jeopardized everytime I go into work. I was offered a per diem position there, which would be nice to have, but if I leave before my two weeks is up, that would be taken off the table. It would be a nice back up in case this new job doesn't pan out.

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On 4/8/2019 at 3:21 AM, FromMNtoCA said:

P.S. I submitted my two weeks notice.

Excellent.

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Glad you put in your notice!

Administration doesn’t care about you or your license. Which is obvious on the situation you were just put in. The most unfortunate part is those poor patients that aren’t getting the care they need!

I was in a similar somewhere situation years ago. It was awful! I still have nightmares...

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My goodness... I've been in that situation quite a few times. The snf I used to work had way more than 155 residents. And let's just say what could've went wrong did. Of course you are told if anything happens beyond your control you are to call the "on call" person and of course they don't answer their phone. We had no rn supervisor, staff bickering about assignments, patient going bad, fall's, complaints after complaints. This actually happened on the night shift where I use to work. We got through it and I swore I was quitting.

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Specializes in EMS, LTC, Sub-acute Rehab.

Sounds par for LTC. CA law states 1 RN per 59> Pts as charge nurse. 1 licensed nurse per 8 Pts.

I'm not sure of the legalese involved in your situation. But the facility can get a waiver for staffing shortages and still operate w/ in the law.

Here in FL it's 1 nurse per 48 Pts. No charge is required but an RN has to be on call, usually the UM or DON.

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Specializes in PICU, Pediatrics, Trauma.

I’m surprised patients survive at all in these situations. I’m so sorry you went through that. I hope you find a better position soon and it works out!

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Administration will throw you under the bus in a millisecond. I’m glad you put in your notice. I have never understood how novice nurses can be put in these situations. I feel like SNFs are just such a crap shoot. I was an ER nurse for ten years and am now an RN case manager for home health and I have seen really good ones and REALLY, REALLY bad ones that my patients come out of. I am a true believer that most of these places are run for profit and really could care less about the patients or the staff.

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Specializes in Gerontology, Med surg, Home Health.

My first day as the supervisor of a 140 bed facility- the DON, ADON,and Administrator all took the day off. Sheriff’s office walked in to serve a subpoena... you do what you have to do. You step up or you crumble

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