Safe Staffing, long but pls read

Poochee · Sep 24, 2007

I went to a Nursing Law seminar on last Monday, even though we went over this in school, it's always good to refresh your memory and be updated on anything new that is happening. I work in a large hospital on a post surgical/ trauma 36 bed unit. A lot of times mostly @ night we are inadequately staffed. For instance we'll have 5 nurses and 2 PCT's sometimes, 5 nurses and 1 PCT. A good night for us is having 6 nurses with 3-4 PCTs. In any event, we sometimes have a lot sitters for pt's who are cunfused, combative, attempted suicide, etc. Many elderly pt's w/ broken hips and trying to get out of bed, trachs, and tele pt's. The other night, there were 5 nurses 1 just off orientation, 3 PCTs, 3 pt's on sitters, 3 trahcs 1 stable, i.e. not trying to get out bed, 1 trying to get oob,and combative he had a 1:1 and one who can't communicate as he has 4 broken limbs...1 CMO on a morphine drip RR @ 7-8. Oh the most senior nurse had 3 years of experience. In any event, the clinical supervisor calls us at 11pm, change of shift, to indicate that we have to pull one of our PCT's to be a sitter because the sitter was needed somewhere else. We argued with her, informing her that our floor was full we had lots of post ops who need vs q 4h. We told her we had an unusual amount of acute pt's on the floor and really needed the help. To which she replied, don't question my authority, we need to pull a sitter. We begged her again to reconsider and informed her that we felt as though it was unsafe. In one ear and out the other. We had no other choice but to send the sitter and the have a co- worker sit. Needless to say it was the night from hell. 3 of us nurses still @ work writing notes @ 9am. In any event, I suggested we file an incident report r/t that situation. I told the nurses that I learned that we have the right to do that according to what I learned from the seminar. At first the nurses were all on board but then changed their minds. We work at a non union hospital so it may that the nurses were afraid to be reprimanded by the administration. I'd like to know what you guys think about the situation ? What could we as nurses working at a non union hospital do to protect our license ? I have 9 months of exp, is this normal and we simply deal with it? I appreciate every and all responses. Sorry this was so long.

I think many of us nurses have been in that situation. Mostly we do the best we can, I personally have resigned positions, in repeated incidence of short staffing, because being short of staff does not save your license. As for complaining in a non union hospital....I would probably request a staff meeting and see if they have any resolutions in site, will their budget be allowing more staff. Hope I helped.:welcome:

VegRN · Sep 25, 2007

Ok, you may not like this but, your staffing doesn't sound that bad compared to places I have worked at. 6-7 pts per nurse on a night shift with PCT's and a few sitters. I have heard far worse numbers. Not saying it is ideal but could be worse.

I agree with Poochee. request a staff meeting and see what they say. Try to get as many nurses as you can involved. If things don't seem to be looking up and your feel it is unsafe and your license is at risk, you may consider going elsewhere. The good thing about the nursing shortage is that the job market is in your favor. I wouldn't risk my license if I felt things were unsafe. Plenty of other places to go.

Good luck

oualie20 · Sep 25, 2007

Thanks to both of you, that was great advice which I will be implementing at the next staff meeting.

New2ER · Oct 13, 2007

I'm not sure what state you work, but several state, including california and Florida, have addressed this issue. You can make a formal complaint in writing to the BON detailing the unsafe staffing situation. Essentially, it covers your butt should you get sued later on for something that may have been prevented with adequate staffing. It probably won't change the hospital's stance on staffing, but it could be a license-saver.

There is a term for it but I forget. Maybe someone else can help with that?

pickledpepperRN · Oct 13, 2007

You describe some very sick patients so acuity is clearly an important issue.

I think to protect your individual licenses keep a diary and record every time you informed your manager or supervisor that staffing was unsafe.

Write the date, time, and quote the response in their exact words.

(We use the ADO form. The most common response is, "I'm sorry.") Also write if you had to give medications late or if your charting could be incomplete because you had to postpone documentation to care for your patients.

In the event that you are sued or there is a complaint against your license the diary will be evidence that you tried to change the unsafe situation and accepted the assignment because to leave would make it worse.

Maybe the staff meeting will lead to improvements. If most of the staff is willing to do it together you may want to inform your manager that the hospital not the nursing staff is responsible for staffing so any harm to patients as a result of unsafe staffing.

HM2VikingRN, RN · Oct 23, 2007

This is why safe staffing laws are needed on the federal level:

Like truck drivers on the highway, tired nurses can hurt other people, as well as themselves, when they make errors. In 2006, RN Julie Thao was in her sixteenth hour of work when she connected the wrong bag to an IV tube in a teenage girl about to give birth in Madison, Wisconsin. The baby survived, but the mother died after a painkiller designed to ease her labor stopped her heart instead. An experienced nurse with a good record, Thao was fired, then prosecuted by the state. After a negotiated guilty plea, her license was suspended and she can never again work in critical care.

With healthcare union backing, nurses have won curbs on mandatory overtime in a few places. But even one of the best state laws, in Maine, gives them the right to refuse additional work only after twelve hours. And there's a big difference between leaving overtime decisions up to individuals and capping everyone's permissible hours to protect patients from any hospital staffer--nurse or doctor-in-training--unable to work safely. Nurses are allowed by hospitals, often with union acquiescence, to work as many shifts, twelve hours or longer, per week as they wish. Meanwhile, American Medical College Association guidelines allow notoriously sleep-deprived interns and residents to be on duty eighty hours every week. Both practices fly in the face of studies showing that, among nurses, error rates increase after ten hours on the job, plus personal health suffers because of more back, neck, shoulder and needle-stick injuries, stress-related illnesses, smoking and drinking, and after-work car accidents.

Source: http://www.thenation.com/doc/20071105/early_gordon

lamazeteacher · Oct 25, 2007

Since all of you have less than a year's experience, it seems that the turnover of Nurses there is a problem. A positive way to resolve the situation, is away from it, in a committee under QA/QI. They'll get the report you filed, and will be interested in not getting more......

Supervisors like it when their staff is "part of the solution". There should have been "acuity" studies previous to deciding how many staff are needed for the patients, and that should be reviewed in committee.

Whenever retention of employees is a problem (and it seems to be one, where you work), there's a reason. It could be that the supervisor who told you not to question "authority" has her priorities out of whack, and needs to be at your unit to see firsthand what's happening, before pulling a staff member. "Resolution training" is worth the expense to the hospital, as courses like that working from the top down save money, as orientation and training for new employees is extremely costly. The frequency of errors is greatest for new staff, who are not familiar with their setting, and those can cost hugely. So getting the "controller" on board would be QA/QI's first step, with the good old, scare tactic motivation of lawsuit liability.

It sounds like your unit is an extension of recovery, and therefore increased staff is warranted and required. Be sure you clarify to those with whom you discuss the situation, that it isn't an "us vs. them" kind of thing, as you view them being on your side, since staff retention is in everyone's (especially the patients') best interest. If necessary, resort to the facility's goals and objectives taught in orientation.

Good luck. I hope this helps.

Nursing Administration needs to keep a list of on-call "sitters" who will come in immediately when called 24/7, if a situation such as the one you described happens frequently (and I'll bet it does).

caringchic · Feb 19, 2009

I am burned out of nursing d/t this very issue, as I am typing this tonight I worked 12hrs and stayed an extra 70min to ensure accurate documentation on an acute MI pt directly admitted from doc's office. No meds, no nothing on board, oh did I mention I have 4 other pts and no cna, my other 4 pts you ask, 1 vented PMV trial #2 (previously failed earlier in the day), pt #2-pulmonary HTN, MRDD, acute change in HRR, pt #3 acute onset CHF audibly wheezing, paging doc for appropriate orders (for the third time)!

Hospitals dont want to hear it, staffing costs money, and lawsuits take awhile! Feds are too busy saving our economy and global alliances, and pt's our poor sick pts suffer.

I have traveled, been a staff nurse and it is nationwide a problem except for the few states that have really addressed the issue.

Major burnout producer..