Off shift nurse supervision

[ckentrn]

I work in a small community hospital in an ICU unit that has only 6 beds. I have worked at there for the past 5 years. I applied for a prn relief supervisors position that was posted. At the same time that I applied for that position, they fired the 11-7 full time supervisor. Instead of hiring another full time person, the administration had come up with the idea to take staff nurses and have them do a dual role. Staff nurse/ supervisor. It went through the hospital, and only one unit agreed to do it on a "trial" basis. My unit, of course. There were three of us who agreed to do this. This occurred during our usually slow period of june-september. I was one of the three. Of course, the traditionally slow time didn't occur. We almost always had at least four patients in the unit. The trial period has come and gone, a meeting was held and we discussed about how it was working...now we are just about to our "busy" time. There were so many issues about this role that were never brought up. I found myself leaving one nurse in the icu to relieve an ob nurse for her break, people whining because they didn't get a break, and trying to deal with all the little things that occur as well as doing my other job. It was very difficult to divide my time. Eventually, much to the dismay of the administration, I resigned from the dual role because I felt as though the patients weren't getting the care that they were paying for, and deserved. The two other nurses are continuting on, risking their licenses. At times, they are gone from the icu two hours at a time, leaving one nurse to care for four patients. Any opinions or thoughts that anyone cares to express would be greatly appreciated.

Thanks

[KaroSnowQueen, RN]

IMHO, it sounds dangerous to me and that admin should just buckle down and hire another super. Leaving one nurse for four ICU pts is not good practice.

[htrn]

We went to a similar system a couple years ago, but only for day and pm shifts while the pharmacy was open. We have a 5 bed ICU and our hospital census runs from as few as 10 or less in the house to up to about 50.

The House Charge Nurse is a staff nurse that is scheduled specifically for the House Charge Nurse slot - not specific patient care at all. They are also ACLS certified so they can help out in ER or ICU if needed. These nurses are from all parts of the hospital, and unless another area is extremely in need of assistance, the House Charge will usually base out of her home unit and can help out there as needed.

Our Noc Nsg Supervisor is a separate position and they are on from 9pm - 7am and have special training to get and mix meds from the pharmacy if they are needed while the pharmacy is closed. These nurses are also scheduled ONLY in the role of Nsg Supervisor while they are doing that job. They do act as a back-up ER nurse during the noc if needed.

This system has actually worked quite well at our hospital. There is NO WAY it would work if these nurses were also assigned patient care roles - during any shift!!! If your hospital wants to continue this, then they need to quit having their noc supervisors doing primary patient care as well - not safe.

Good Luck!!

[Mulan]

people whining because they didn't get a break

Just curious, is this the unpaid 30 minute meal break that people are entitled to?

[cardiacRN2006, ADN, RN]

At times, they are gone from the icu two hours at a time, leaving one nurse to care for four patients.

Thanks

Not appropriate! Do you have staffing guidlines at your facility? Watching another ICU pt for a break is one thing, but 2 hours is dangerous...

[ckentrn]

Thanks to everyone who replied, and all the input. As far as the breaks were concerned, if the supervisor was too busy to relieve a floor nurse, then they were able to add the extra half hour on their time sheet. And, of course I would get reprimanded for not relieving them. Needless to say, the administration wasn't happy that people were getting paid a half hour overtime on the night shift. That was actually one of the deciding factors that lead me to resign from the position. I will keep you all updated on what happens.

oh, and yes, we have staffing guidelines. One patient-two nurses. Two patients, two nurses. In any situation in our unit there should always be two icu nurses. On occasion, depending on the patient, they have left one icu nurse with a nurse assistant.

[heartbeat2]

I have a bit of a question. The nurse that was left in ICU to care for 4 patients...did she ACCEPT the assignment or did she write it up and send it through the channels? If she didn't write it up, then she put herself in jeopardy.

[ckentrn]

I have a bit of a question. The nurse that was left in ICU to care for 4 patients...did she ACCEPT the assignment or did she write it up and send it through the channels? If she didn't write it up, then she put herself in jeopardy.

no, the events like this are happening almost on a daily basis. The concerns were sent through the appropriate channels. From the Clinical coordinator of our unit, to the coordinator of the nursing supervisors, to the Executive Vice president of Patient Care, who idea it was to not hire a full time 11-7 supervisor.