Potential fallout of refusing additional pts

I had 7 patients a few months ago (very rare at our facility). one had just returned from surgery, one was getting blood, one was up to the BR every hour, another had hourly neurochecks, and we had not a tech. ER called to give me report on a new patient. I told our supervisor I wasn't taking another patient, and I was told I had no choice, because all the other nurses were just as swamped. So, I called our DON, told her the position I was in. It was about 5 hours till the end of the shift. She came in, and we redivided patients, and she took the new admit.

I was very impressed by her reaction, and i was told we should have called her a long time ago. The supervisor was told not to have us working under those conditions again, even if that meant she had to take patients. I would hope that is the reaction any DON would have.

My educated guess is that, unless the nurses are unionized, and STICK TOGETHER, the nurse who stands up for safe patient care will be shown the door. The lack of cohesiveness among nurses, and our lack of effective leadership at the national level leave us to be lambs brought to the slaughter if we try to be patient advocates. It has been nurses collective downfall that we did not unionized from the get go, and, in my opinion, WE are responsible for the mess that has become our hospital care.

Before I get slammed for my statements, remember, no one can take advantage of you without your permission. By not putting a stop to the overwhelming understaffing and de skilling that started ten years ago, WE ALLOWED the unsafe working conditions to become the norm. By not standing up and REFUSING to work under these condions, WE HAVE ALLOWED IT TO CONTINUE. The fact of the matter is, nurses, for the most part, were unable to stand up for themselves and refuse to take an unsafe number of patients, and not jeapordize their jobs. And our national organization failed us by never conducting studies as to the effects of unsafe staffing.

Why did it take an exodus of nurses from the profession due to the horrendous working conditions, to make SOMEONE take notice, and decide to conduct studies as to the effects on patient outcomes from poor staffing.

Why is it that other professions saw fit, when DRGs hit the country at the time, to make it their business to impress on the public the benefits of their profession on patient care and outcomes, and thereby ensure their piece of the health care $ pie?

These are questions that nurses have to answer for themselves, and decide when they will finally stand up and be noticed and taken seriously as health care professionals.

Lindarn, RN, BSN, CCRN

Spokane, Washington

I had 7 patients a few months ago (very rare at our facility). one had just returned from surgery, one was getting blood, one was up to the BR every hour, another had hourly neurochecks, and we had not a tech. ER called to give me report on a new patient. I told our supervisor I wasn't taking another patient, and I was told I had no choice, because all the other nurses were just as swamped. So, I called our DON, told her the position I was in. It was about 5 hours till the end of the shift. She came in, and we redivided patients, and she took the new admit.

I was very impressed by her reaction, and i was told we should have called her a long time ago. The supervisor was told not to have us working under those conditions again, even if that meant she had to take patients. I would hope that is the reaction any DON would have.

Wow - I've never heard of that. I am impressed with that DON! Kudos to you too for pressing the issue and not just rolling over at the first refusal for help!

When I worked on Progressive Care, if you asked management to help out it was like asking them to crap gold.

One night we were short two nurses, 1 aide and had no secretary, our assistant manager hid in the office to do her work instead of helping us out. We too were not allowed to refuse any patient no matter how short we were. Mind you, on our unit, some patients require vent support, have trachs, drips, q2hour vitals, poop every 10 minutes, confused. Our max was 4 patients which was very heavy. But our manager said "Never say never" to having five patients.

I feel that if the unit is that swamped and staffing is short, it's the manager's job to help out. I'm glad your DON helped you out. Thats something that would never happen at my hospital.

I recently went through this. As we all know with this seasons flu everywhere is swamped with pneumonias. Surgical floors too. I told our nursing coordinator the other day i would not take another admission unless we got more RN help. I dont fear for my job, and we did get at least someone to float for us. I worked to long and hard to put my license in jepordy and i refuse to go further than i feel comfortable doing.

They can fire me if they want, but i truely think in this day, we are not going to get fired for standing up for ourselves. Union or no union. The facilities are going to be to hard pressed to replace people. The last thing they want to do is fire someone for expressing their safety concerns.

When I worked on Progressive Care, if you asked management to help out it was like asking them to crap gold.

One night we were short two nurses, 1 aide and had no secretary, our assistant manager hid in the office to do her work instead of helping us out. We too were not allowed to refuse any patient no matter how short we were. Mind you, on our unit, some patients require vent support, have trachs, drips, q2hour vitals, poop every 10 minutes, confused. Our max was 4 patients which was very heavy. But our manager said "Never say never" to having five patients.

I feel that if the unit is that swamped and staffing is short, it's the manager's job to help out. I'm glad your DON helped you out. Thats something that would never happen at my hospital.

I think this is the type of situation that I'm trying to get a handle on about responsibility. The bottom line is that the BON holds the individual nurse responsible, not the institution (or the institution also, but that doesn't absolve the nurse). However, if the powers that be say you are taking "x" amount of patients no matter what and you can't leave (because that's abandonment), what is a responsible person supposed to do?

Of course we'd all hope that supervisors, NM's, and DON's do the right thing and help out, but experience will show that that doesn't always happen.

That's where I'm trying to get a reality feel for what nurses have experienced or witnessed first hand.

i have, written and submitted, "assignment accepted under protest": or "assignment accepted under duress".

i don't know if that would help me in a court of law- but felt it important enough to know that i did not take the assignment willingly...

that i recognized (and disagreed with) the dangers in accepting such a pt load.

leslie

When I worked on Progressive Care, if you asked management to help out it was like asking them to crap gold.

One night we were short two nurses, 1 aide and had no secretary, our assistant manager hid in the office to do her work instead of helping us out. We too were not allowed to refuse any patient no matter how short we were. Mind you, on our unit, some patients require vent support, have trachs, drips, q2hour vitals, poop every 10 minutes, confused. Our max was 4 patients which was very heavy. But our manager said "Never say never" to having five patients.

I feel that if the unit is that swamped and staffing is short, it's the manager's job to help out. I'm glad your DON helped you out. Thats something that would never happen at my hospital.

It is for this reason that nursing will be losing not only one more nurse(me) but another potential, cause i talked our tech out of attending nursing school. It is ruining my mental health because believe it or not, i like nursing, and when forced to do what is practically impossible(loads) i actually give a crap about doing my job right- it stresses me out that i cant take care of my people properly. Add on top of that the worry of being found negligent cause i couldnt do my job properly- do you think some family member is going to care that you were short staffed? after confused grandpa falls and breaks his hip cause we cant be in 10 places at the same time do you think that the family is just going- gee she must have been too busy?? no, you bet your azz i am going to get blamed for it. After all, the "corporation"( hospital admin, ha) will just can you and hire more of the new grads that the schools are spitting out. Because i actually have a conscience, i would absolutely feel horrible if harm came to someone, and i had no control over it.With the new customer service model( what a joke) pts and moreso their families expect you to bring crap to them on a gold platter- i have actually had family member c/o pt not getting washed up(gee maybe they could do it themselves, what would they do if they were at home???) and got upset that i didnt drop everything i was doing and help them. Gee sorry, maybe my guy with chest pain is more important right now than your family members clean armpits!( yes we had no techs that day). Its just a shame it has to come to this. I wish i could just talk everyone out of becoming a nurse- the most pathetically treated profession there is.

I told my manager that if I ever have to take five patients with the patient load that we have on our Progressive care unit, I would leave.

That's exactly what I did. Now I work at a different hospital on SICU and am MUCH happier.

My manager didn't even recognize the need for more staff even after we had a sentinal event that occured on our unit. Patient pulled his monitor leads off and then removed his trach. The nurse had four patients and was busy with another patient in an emergency and no one looked at the monitors at the desk to see that the patient was not on the monitor. THe nurse found her patient dead. So instead of finding more staff, they hired people to watch the monitors at the desk. Even four patients is too much on a floor like progressive care because the patients are of such high acuity almost ICU-like.

Needless to say, I'm glad I left but I still work contingent on that Progressive care unit a couple times per month. And everytime management there asks me how I like my new job, I tell them that I love it and don't care if its downtown and in the ghetto(It's a huge teaching hospital). Doctors are so much nicer there and actually listen to RNs not like the other hospital that I worked at.

AMEN sister you are so right, families are a pain in the derriere.

i have, written and submitted, "assignment accepted under protest": or "assignment accepted under duress".

i don't know if that would help me in a court of law- but felt it important enough to know that i did not take the assignment willingly...

that i recognized (and disagreed with) the dangers in accepting such a pt load.

leslie

It seems that the answer to the OP's question is that there is nothing we can do about it. If we say no, than that is abandonment. Unbelievable.

I guess the only thing we can do is try Leslie's suggestion & hope & pray that the crap doesn't hit the fan for the night.

My mom just got a call the NM in an area hospital. Reqruiting for a flr that has 50 pts, most of them with vents. She asked for the nurse to pt ratio & the NM responded 9. She promptly said no thank-you. I can only imagine how angry, exhausted & bitter the nurses who work in this particular hospital must be.

As someone has previously mentioned, legally it is the responsibility of the individual RN to refuse unsafe conditions...that is what the BON standards state. If administration insists that the RN cannot refuse and the RN does not feel comfortable resisting and risking discipline, then the nurse should document on assignment despite objection form, keep a copy for her/his own records, the situation, the names of administrators/managers spoken to and their response and send a copy to HR. If for some reason there would be legal action at least the nurse can demonstrate she/he saw the risk and attempted to go through the appropriate channels to rectify the situation.

If you have a cohesive unit that backs one another up, then each of you could simply refuse the extra patient.

By the way, the media would probably like to hear about the unsafe conditions...