I am currently a new nurse working on a Telemetry unit in NC. We recently changed to an acuity based scheduling system. It is a small (8 bed) unit and the way the staffing is set up, there is a possiblity that we could have 5 to 6 patients with only one nurse and no CNA. I know this is not ethical for the nurses or the patients but my question is are there any legal issues with the staffing? I have searched the internet and was unable to find any actual laws in reguards to patient/RN ratios or if you can only have one RN on the floor. It just seems that it would be a very bad idea to only have one RN on the floor, even if they are stable patients things can go down hill very fast. Thanks for any advice for this situation.
Apr 10, '12
Since no one else seems interested: check with your BON. Alternatively, you can also dig out the facility Policy & Procedure manual, and scrounge through it.
In similar circumstances, it would be worth a $50 consultation fee to talk with a local malpractice attorney to see about the best CYA plan. My suspicion would be that if you want to stay employed, don't be overly confrontational, but a carefully worded, "I am concerned about patient welfare...", letter to the DON/Unit Manager(with your attorney doing the mailing, not on legal letterhead) may be a reasonable step.
Apr 16, '12
I've had recent concerns with hospital staffing as well. I don't think this is safe practice whatsoever, but I think California is the only state with mandated ratios. In your situation, you should atleast have an aide at all times, just in case something is wrong and you aren't there.
Apr 16, '12
AFAIK in a lot of states it's legal to have only one nurse on the floor...check with your BON for the most accurate ruling.
My concern about being the only nurse on the floor is: what about breaks? You can't legally take a break as that would be patient abandonment--you have no nurse of any variety covering for you. And I'm sure most facilities would look the other way if you took a break under these conditions...until something happens to a patient. Then guess who's going to get thrown under the BON bus for abandonment?
Apr 17, '12
how would you witness drugs? What if you are with one pt and another has an immediate need?
Apr 17, '12
I cannot see any circumstances that justify any facility caring for human being , in which there should be less than 2 members of staff scheduled to the floor at all times .To me this is a matter of ethics not economics , we are human beings things happen that at any moment can mean we cannot carry out our duties , so if there is only one person on duty , how long could that staff member be incompasitated and patients uncared for before the situation is discovered.
Apr 18, '12
You can not take a break as the only RN on the floor....
There should never be just one person on the floor with 5-6 patients bc with acuity aside (which really should not be placed as a non factor on a cardiac floor) , how many obese patients can u maneuver on your own? If any incidents occur you have no help.
That's abuse from management in order to save money.
Apr 18, '12
That sounds really unsafe. I wonder how it would make the "powers that be" feel if they knew their loved one was one of the 6 pts. with 1 RN. Or, if those that make staffing matrix choices were put in your shoes; how would they feel? Unfortunately it seems that this will NEVER happen. But why? We as nurses put up with too much. I know some nurses think this is just how it is. It's normal not to eat lunch, it's normal for your raise to get taken away, it's normal to have dangerous nurse/pt. ratios, it's normal to have your 401K taken away, it's normal not to get a break, it's normal to have have to answer phones/call lights/doctors questions/radiology tech questions at the same time with a smile. Enough already! We need to stand together with a clear unified voice and tell management etc. IT'S NOT OK!!! If we weren't afraid that standing up for ourselves and making waves would result in losing our jobs, maybe things could change. If all nurses said this is bull****, and we won't work under these circumstances then there wouldn't be anyone to work in unsafe conditions. Now how to make this happen??? Union??? Any California nurses have any info/input about this?
Apr 18, '12
Quote from Bubwa
That sounds really unsafe. I wonder how it would make the "powers that be" feel if they knew their loved one was one of the 6 pts. with 1 RN.
I bet that if the family member of a hospital VIP was a patient on the unit, the unit would be staffed to the gills. Or more likely they'd dedicate staff to tend to just the VIP, possibly at the expense of the rest of the unit.
Apr 25, '12
IIRC, Medscape just had an article on one of the apellate courts recognizing "potential" as grounds for finding malpractice, with regard to physicians. I.e., inadequate survey/testing/assessment leading to injury.
While I am sure we will all agree that patients should have a head-to-toe, psycho-social, etc., between each change of care-providers and at least once more in the shift, this is unrealistic.
Trickle-down is coming, we just haven't felt it yet. With all the moaning over defining professional standards, mandatory "entry level" degrees and so forth, the truth is that respect is green ($$). Until we carve a chunk of the ICD model out, we will continue to be seen and treated no differently than disposable equipment.
When competent nursing has a positive fiduciary result, not simply a defensive one, we will see positive changes for our profession. I have yet to hear of any of the new PhDs in Nursing going after that cow with a saber.
Apr 26, '12
I turned down a job for this reason years ago, even though the pay was better than the job I took. Paying me a little extra did not make up for the stress and risks.
May 2, '12
I am the only nurse on my floor where I work. I go to clock out for my MANDATORY OR I WILL BE FIRED breaks, come back to the floor and eat (against facility policy and JCAHO policy, yes, but I am not comfortable leaving the floor for 28 minutes with just the aides there) then go clock back in. I don't chart or provide any care off the clock. If an emergent need occurs, I go clock back in, then come back and deal with it. I have been written up for "not taking long enough breaks" well, sorry but my patient just got readmitted from the ER and I am not gonna make her and her family wait while I finish my break to get her situated and start the process. It's so discouraging. I need a 2nd nurse. Any problem- get the nurse! I am always bombarded. Never dull I guess. =/
May 2, '12
PS- I work rehab/ltc with 50 patients to myself. Ridiculous in my opinion.
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