Okay, might not sound like a lot to you guys, but that's what our supposedly 25 bed hospital has right now. And a full to capacity ICU. That's what my husband told me when he came home to eat lunch with me.
And I am one of the 4 nurses scheduled tomorrow. I called our super, and she said that was true, and they are having no luck finding a nurse to agree to come and help out.
I'm pretty good at math, and to me that equals a helluva bad day for me tomorrow.
That's 8 patients per nurse. Sad to say, but I've done it before, with a myself and a tech, more times that I care to say. Frequently we do 7:1 where I work on med-surg. Maddening.
The other day they were fine toothing one of my rapid responses situations. "Did the nurse notice the trend of vitals over the last few days getting worse......". My answer: high ratios equal poor outcomes.
Specializes in Med-Surg, HH, Tele, Geriatrics, Psych.
I work in a small rural hospital, and lately we have been working with 3-4 nurses, no free charge, and 2 CNA's. This is Night shift. Usually we have 8-10 patients each, and the aides have 11-15 patients each. Personally, I think that is too much. It is very difficult to give adequate, safe care.
Every day, administration gets complaints from patients and families about the substandard care, but then administration blames it on us.
If I were you I would write a letter stating something along the lines of "Due to the staffing shortage and the high census I believe that this is not safe practice, I will work my shift and care for my patient assignment to the best of my ability, but can not guarantee safety for all patients." Make a copy for yourself, and that way if you were to end up in court you will have something to lean on. There is nothing wrong with that, and if you walk due to high census isn't that patient abandonment?
You also might want to include a letter to the senior partner of the Law who represents the hospital. Include a note that you made a copy of this letter for yourself in case a patient sues. This way the responsible party will be held accountable.
I disagree. Stating in a letter that you will do the best of your ability is not wrong. Whats the alternative? You walk, screw your co-workers even more, and the patients are in even more jeopardy. Ratios as described as above in my hospital would probably only happen in a environmental disaster, and in that situation you work to the best of your ability.
I'm not saying it's "wrong." I'm saying that such a letter is written evidence that the nurse knows the situation is unsafe, and chose to go along with the facility's bad ratios.
As I said, the hospital has a problem here. I will not make the hospital's problem my problem. They have the alternative of getting enough nurses in there to care for the patients.
The situation the OP described was not a disaster of any type: it was a normal (for that facility anyway) situation that was known about in advance. Nurses who work under such circumstances are aiding and abetting a facility's mis-management, opening themselves up for disciplinary action by the BON, and -- in a worst case scenario -- a court case.
Specializes in Assisted Living, Med-Surg/CVA specialty.
I'm not saying it's "wrong." I'm saying that such a letter is written evidence that the nurse knows the situation is unsafe, and chose to go along with the facility's bad ratios.
As I said, the hospital has a problem here. I will not make the hospital's problem my problem. They have the alternative of getting enough nurses in there to care for the patients.
The situation the OP described was not a disaster of any type: it was a normal (for that facility anyway) situation that was known about in advance. Nurses who work under such circumstances are aiding and abetting a facility's mis-management, opening themselves up for disciplinary action by the BON, and -- in a worst case scenario -- a court case.
So what would you suggest the nurse do?
Refuse to take more than 6-7 patients? Leaving 2-3 for other nurses to pick up? Call out/Not show up at all?
Refuse to take more than 6-7 patients? Leaving 2-3 for other nurses to pick up? Call out/Not show up at all?
This isn't complicated.
A nurse shows up for work at a facility, and finds that she will be caring for, say, 8 acutely ill patients.
The nurse has to make a call if this is a dangerous ratio or not. If it's dangerous, the nurse must announce -- to a supervisor, "This is a dangerous and unsafe nurse-patient ratio, and I will not work under these circumstances." If the supervisors do not modify the ratios, the nurse must -- without having accepted care of the patients -- walk out.
(If the nurse has accepted care of the patients, she is abandoning them if she leaves).
The hospital has chosen to accept a certain number of patients, and it is their responsibility to ensure that there will be adequate staffing for those patients.
Of course, a nurse who makes such a judgment will likely lose her job, but better to lose one's job than to lose one's license.
I have no quarrel with someone who feels it's safe to work with X number of patients. But the idea that under non-disaster conditions we should work with whatever number of patients are given to us is ridiculous. Not to mention dangerous.
If you provide unsafe, inadequate or sub-professional care, a board of nursing won't care if you had 8 or 20 or 100 patients. You chose to accept that number, and did not protest. You will be held to a reasonable standard of care whether you had 1 or 1,000 patients.
A nurse shows up for work at a facility, and finds that she will be caring for, say, 8 acutely ill patients.
The nurse has to make a call if this is a dangerous ratio or not. If it's dangerous, the nurse must announce -- to a supervisor, "This is a dangerous and unsafe nurse-patient ratio, and I will not work under these circumstances." If the supervisors do not modify the ratios, the nurse must -- without having accepted care of the patients -- walk out.
(If the nurse has accepted care of the patients, she is abandoning them if she leaves).
The hospital has chosen to accept a certain number of patients, and it is their responsibility to ensure that there will be adequate staffing for those patients.
Of course, a nurse who makes such a judgment will likely lose her job, but better to lose one's job than to lose one's license.
I have no quarrel with someone who feels it's safe to work with X number of patients. But the idea that under non-disaster conditions we should work with whatever number of patients are given to us is ridiculous. Not to mention dangerous.
If you provide unsafe, inadequate or sub-professional care, a board of nursing won't care if you had 8 or 20 or 100 patients. You chose to accept that number, and did not protest. You will be held to a reasonable standard of care whether you had 1 or 1,000 patients.
The letter covers you in that situation. Granted, if you give a wrong med or cause harm then you are most likely going to face the BON. But if you didn't get to something that so be it, you stated your concerns in writing. In this situation it sounds like a extenuating circumstance, if it happened twice, then you better believe I will quit.
I understand that you want to protect your license, but there are lives in jeopardy here. I wouldn't want to know that I walked to protect myself, and that someone else could potentially die because of it.
A nurse shows up for work at a facility, and finds that she will be caring for, say, 8 acutely ill patients.
The nurse has to make a call if this is a dangerous ratio or not. If it's dangerous, the nurse must announce -- to a supervisor, "This is a dangerous and unsafe nurse-patient ratio, and I will not work under these circumstances." If the supervisors do not modify the ratios, the nurse must -- without having accepted care of the patients -- walk out.
(If the nurse has accepted care of the patients, she is abandoning them if she leaves).
The hospital has chosen to accept a certain number of patients, and it is their responsibility to ensure that there will be adequate staffing for those patients.
Of course, a nurse who makes such a judgment will likely lose her job, but better to lose one's job than to lose one's license.
Until you've taken report, it will be difficult to judge if *that particular* set of 8 patients is unsafe.
Of course, managers will suggest that it's *your* lack of skills if you find that assignment unsafe and as you noted refusing as assignment could easily end in losing one's job.
If everyone did that? Then the facilities simply cry "nursing shortage!" and lobby for the right to bring in foreign nurses.
As individuals, we can't make much of inroads into staffing issues. It would be great to see more of a united front among nurses but there currently isn't an organization that really unites nurses in this way... eg ANA alienates many nurses.
I don't know if its just texas but the state board has something called "safe harbor" that is basically like the letter above. It says that basically the nurse feels it is an unsafe situation and anything that might happen could not be held against the nurse by the board. IF anything was to happen the board could not hold it against the nurse. the forms are on the internet and there are pages and pages to fill out by the nurse and it goes up to administration. I called safe harbor one time and had administration on the floor to see what they could do to help out in less than 30 minutes....I would refuse to take more than 6 pts. and it falls off the nurse that refuses and goes on up the chain. stand your ground
trmr, do you really take care of 8 or more patients per shift on a med-surg floor and if so, what shift are you working and if so, where is this hospital so I can be sure never to go there!!! Girl, that is so unsafe and in my experienced opinion, impossible to do. I really feel sorry for you and your license if you do have to handle that many patients. Do you have a union or any nurses standing up for nurses' rights and patients' rights? I' stunned.:uhoh21::uhoh21:
Our facility in upstate NY has 11 pts on nights on a med surg floor. If a nurse calls in and there is no replacement... 14 patients. They used to staff only 2rns for 34 beds... they ended up unionized... but the union does not mandate nurse to patient ratios.
Luckily I've only come across this a few times... our day shift coworkers stopped us at the time clock. We waited until management found additional help. This means that the prior shift has to help by staying with their assignments. Administration, in their good senses offered bonus $$ to anyone coming to staff. I'd never leave, but I wouldn't clock in until it was safe.
I now work with people who'd just start taking report, too fearful to say no to anything.. I like my license.
Refuse the assignment. If you don't this will set a bad pattern. It also puts you in a terrible position should anything go wrong.
I agree with James about the letter. I know there is something in some states where you fax a letter to that effect to an outside agency in the event of a tragedy. If however someones does get injured, etc. they have you on record knowing it wasn't safe. You're doomed and your license will probably be history.
They can call an agency if need be. They haven't exhaused all their options.
Yes all of you, I am serious. But our medsurg floor is a little different. We don't get 32 patients anymore because now we are a critical access hospital, so we only get 25. On a typical dayshift we have 2 RN's, 1 LPN, 2 CNA's. We also have respiratory. On rare occasion if it is totally nuts, we get to call in someone to help extra, that is if they will come. Also approx 8 of those patients are long term patients that will stay at our facility until they die. Our supervisor is very good about lending a helping hand, and we have a discharge planner so we don't have to worry about that. Our hospital is small and we don't get some of the "really sick" people that most of you are probably thinking of. Also weekends and nights there are house supervisors to help too.
Tweety, BSN, RN
36,337 Posts
That's 8 patients per nurse. Sad to say, but I've done it before, with a myself and a tech, more times that I care to say. Frequently we do 7:1 where I work on med-surg. Maddening.
The other day they were fine toothing one of my rapid responses situations. "Did the nurse notice the trend of vitals over the last few days getting worse......". My answer: high ratios equal poor outcomes.