Katillac

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No. If they ask you to take an assignment in a unit you're not trained for (ICU, peds, L&D) and you refuse and they fire you, you can likely collect UI. In that case they would be firing you without appropriate cause. If you refuse to take a bedside position (say, med/surg or COVID unit without vented patients) simply because you don't want to, and you get fired for it, it's unlikely you can collect UI. See the difference? And yes. Without union protections and/or unless you are a member of a protected class and are fired for being a member of said class, you can be fired for pretty much anything.

https://wehavins.com/nv-nurses-legal-handbook/chapter-6-nursing-responsibility-and-the-law/ This citation concerns Nevada, but the laws are similar in many states. Nurses face serious potential consequences both legally and to their licenses for bad outcomes subsequent to care for which they are unqualified/untrained. Your employer, on the other hand, can likely terminate you for refusing an assignment, even an unsafe one. The fact that you were once a bedside nurse suggests you were adequately prepared at one time, so it would seem reasonable from a liability perspective to ask you to go back on the floor. However, working in a specialty unit would be a different story. Nobody can force you to resign. If you refuse an assignment, you can be fired. The employer will say it was with cause. You could appeal that, but again given your previous bedside work, unless the hospital was asking you to work in a specialty you hadn't been trained in, you'd be unlikely to prevail. Additionally, the hospital could say they downsized the informatics department d/t COVID and you were simply laid off, which wouldn't qualify you for unemployment. Or the hospital could claim you were adequately trained, you just didn't want to. Again, no unemployment. Not taking a floor assignment will likely result in consequences of some kind. Up to you what it's worth to refuse.

Here are my two favorite ways of responding in these situations, when someone doesn't get polite hints that I am not sharing personal information. 1) When asked something you don't want to get into, get a super quizzical look on your face and say, "Hmmmm. . . " as if you are pondering something. Then after a few seconds smile VERY brightly, and cheerfully say, "Nope. I don't have anything to say about that. But how are you?" 2) With an equally blinding smile, ask, "What makes you ask?" Whatever they respond with, you reply, "Ohhhh, I see," and then change the subject. If they persist, see #1.

For those who may be wondering, home made masks (which should really be called just face coverings) are primarily meant to stop virus-carrying large droplets from being spewed from the mouth of the wearer and being transported to the mouth or nose of the uninfected. Those droplets can be expelled when speaking, singing or laughing in addition to coughing or sneezing. Additionally, studies show a two layer tightly woven cotton face covering prevents approximately 50% of large droplet viral particles from reaching the wearer from an infected source. More protection is achieved by a third non-woven layer in the middle. In neither case is the protection as good as a quality manufactured surgical or procedure mask, and is far from as good as a properly fitted N95 mask.

This is truly reprehensible. Corporations have masks in supply, so they are reporting no shortages. Yet they are refusing to use them supported by poorly defined contingency level guidance from the CDC. The CDC in turn bows to the White House and supports the whole charade. Corporations save money and reputations, and people die. I actually heard in a meeting yesterday, "If everyone uses them for every COVID-19 patient, we will run out." The implication obviously is, "So we will hoard them for some imaginary future (when the masks are somehow more necessary?) use while putting HCWs at risk today." If this was proposed for a movie script, it would be discarded as too far fetched.

Included in the people talking about nurses' social contract and their duty to care is the Oregon State Board of Nursing. If the BON suggests a social contract is binding on nurses so should the facilities' part be in that same social contract - to keep nurses safe while in their employ. When one part of a contract is broken, the whole thing is null and void. ETA: It was GoodNP I was quoting. Not sure how that happened. Sorry, GoodNP and kindredspirit2021

Thank you so much for this! I looked into it, and by God Oregon actually has a plan ! The following is from Oregon Crisis Care Guidance: "The professional “duty to serve” must be balanced with the ethical principle of reciprocity, as healthcare workers should be assured of the safety resources they need to do their jobs." Can you tell me where it says that procedure masks are sufficient? I'm not being argumentative, I really want to know where that comes from in light of what they say in their crisis plan. Edited to say: Never mind, I found it. Minimum PPE for evaluating COVID-19 patients is face mask. AGPs require minimum N95. Minimum PPE necessary to evaluate patients with respiratory illness, suspected COVID-19, or confirmed COVID-19:•Face mask (I.e., surgical or procedural mask)•Eye protection (face shield or goggles)•Gown•Gloves Some procedures warrant a higher level of protection. See “Aerosol-Generating Procedures in Hospitals”. Aerosol-GeneratingProcedures (AGPs) in HospitalsAGPs (Appendix I) are much more commonin ED and hospital settings.When conducting AGPs for patientswith fever or respiratory symptoms, or with known or suspect COVID-19, HCP should utilizestandard, contact, and airborne precautions, including:•N95 mask or higher respiratory protection (includes powered air purifying respirators [PAPRs])•Eye protection(face shield or goggles)•Gown•Gloves

Does anyone have a credible reference to support that any state's BON would take action against a nurse who refused to work because of lack of appropriate PPE? I don't mean they might, or they could, or my cousin said her co-worker. I mean a source from a Nurse Practice Act or your state's BON regulations.

Good heavens. Here I was thinking the inadequate PPE was because these places couldn't get masks etc. because of shortages, not because they were too stingy. I'm so naive.

ICU One Pager:

I did a search in the PDFs of the nurse practice regulations for PA, and didn't find the word mandate, disaster or crisis. They are the folks who would censure your license. PA Act 102 specifies that you can be mandated to work overtime (including complete extra shifts) in times of "unforeseeable national or state emergencies". But that's a Department of Labor thing and allows them to fire you with cause (not take action on your license) for not working when they want during a crisis like this one. Nothing is said in either about penalties for quitting during emergencies, as long as you either have handed off in report or didn't take an assignment to begin with. Maybe it's a union thing?

The CDC is saying - responsibly, I think - that in the absence of an approved mask a scarf, a bandana or (by inference) a home made mask is better than nothing. The Deaconess post makes it seems there are CDC approved designs. Not so. There's a chart out there showing the % of viral particles various materials filter. HEPA fabric is way up there, but unfortunately you can't breathe through it. The cloth people are making masks out of in there homes filters around the 50% range. In fact non-N95 masks in general are far better for keeping the wearer from spewing droplets into the air than they are for protecting a wearer. I've made a bunch of masks but am only giving them to people I can specifically tell that they won't protect you from COVID-19.

I couldn't agree more. Being treated as a necessary but inconvenient cost burden hardly inspires selflessness and sacrifice. That makes, in my eyes, those who choose to stay and take the informed risk all the more heroic (casting no shade on those who for whatever reason choose not to stay). Times were strange already with corporations wanting to be granted the same rights as people while their employees are treated like disposable pawns in a profit and loss game. Utterly bizarre that those same corporations now expect the pawns to morph into martyrs.

I think you should try several different designs if you have material and skills! The critical piece that home made masks won't have is a special filter that's heat spun? heat formed? (can't remember the term). I think a piece of furnace filter is a great idea, if the mask is still able to be laundered. Any barrier is better than no barrier, and something that keeps it away from the nose is better than just cloth against the nose and mouth. Keep us posted with the best design you find!

Allowed to quit? Do you mean can you be forced to stay? In my state there is nothing in the Nurse Practice Act that would allow the BON to censure a nurse for quitting during a pandemic. Technically, the lack of PPE would not prevent the BON from censuring you for abandonment IF YOU ALREADY TOOK REPORT on a patient. But these are uncharted waters.

I think most good nurses have times when they say to a colleague, "Got a sec to walk this through with me? This just happened, so what I think I should do is this, and then this. Am I missing something?" But that's very different from asking the same question multiple times, or frequently looking for validation because you feel insecure in your practice, or asking for answers you could have easily found on your own. Even those questions aren't necessarily dumb or annoying - but after a while it could make colleagues concerned you aren't developing a confident, sound practice. I think a lot of new nurses are challenged by finding the right balance between asking enough questions to be a safe and effective practitioner anddeveloping and then growing in confidence in their own knowledge base.Twenty years later, I still remember the gut-wrenching fear of doing something that would harm a patient because I was new. That fear would then make me lose confidence I could trust myself to do anything right. In those moments, I quite frankly was incompetent, because my knowledge and even common sense would abandon me. Here are some things I found helpful: As has already been suggested, before asking questions, stop and mentally run through what you DO know about the situation. That can help stop that "mile a minute" feeling you describe.If you need to choose between two responses, think through the consequences of both courses of action to help you decide.To help build your confidence, mentally (on your commute, break, etc) review the assessment/intervention choices you're already making independently and appropriately.Sometimes it helps imagining yourself teaching someone else how to work through what you're facing. That can help you find the pieces of the decision-making process you need either more information on, or mentally "hear" that your process is sound.Realize that you will make errors. Nobody is perfect. Your list of questions tells me you have very good instincts about the relative significance of different aspects of nursing care. Remember to breathe. It really helps to just do a quick mental "time out" like they do in the OR, but on your own - step back and look at the situation. I wish you the best in gaining confidence and satisfaction with your practice.

You're kidding, right? Hospitals don't have a "bank of temp nurses" even now, when they aren't Covid-19 affected. Nor do most devote enough resources to provide safe staffing. The money it would cost to quickly recruit, train, and keep on stand-by this legion of nurses would be astronomical - at a time when hospitals try to get by with as little staff as they can without being sued for wrongful deaths. Nurse organizations can put out all the lovely lists of demands they want, but they have no teeth.

Possible that HR or corp ignores it, of course. That happens sometimes, especially in smaller companies. But if the employee then complains to the EEOC (federal) and they investigate and find the complaint founded, the company can get pounded with big fines. No company wants the EEOC sniffing around. The employee can also sue the employer in some states, and most employment law firms will take a case that has merit (and this one does) on contingency, taking their fee out of whatever settlement is won.

This is a terrible situation to be in. Classic blaming the victim for the perpetrator's behavior. My heart goes out to you. Best of luck as you move through it. This isn't just harassment, it's assault, defined as intent and action causing apprehension of harm or offense in the subject. Not assault and battery, because there is no physical contact, but it meets the legal standard for assault. But a manager stupid enough to support the perpetrator's behavior and try to intimidate you into silence about it will likely also try to retaliate if you escalate this to HR or beyond. Hopefully, HR will have your back and prevent your termination, but I imagine the day-to-day under this manager will get pretty tough. I can't agree enough that an email (print a copy!) to your manager documenting the events and the manager's response is critical going forward. I also agree more discussion with this manager is a waste of time. Your choices are to continue to suffer the harassment and assault, to find another job, or to escalate to HR or beyond. You'll then possibly need to find another job either because the workplace gets so hostile or the manager figures out a way to fire you with cause.

Yup! And when you think about it, dialysis nurses in an acute setting are typically sole practitioners in that there's nobody else immediately available that knows the specialty. So if something goes Dixie, you're it. As a future potential services consumer, it's good to know the person with my kidneys completely in their hands may be paid less than housekeeping, no insult to environmental services intended.

This is from an ad for a dialysis nurse in Syracuse, New York. The pay range quoted is $17 to $31, far from competitive in the market. I mean, maybe given no access to narcotics they will work with someone who has a conditional license, or on monitoring. And their benefits package looks good. But seriously, how can corporate look at what they are requiring for the compensation offered and wonder why there is a "nursing shortage"?

Lube will not be helpful in getting a handle on most things. Makes it harder. ?

Of course they would like to have more notice and in fact would probably prefer you not leave at all. But a resignation letter isn't asking for permission to leave, it's informing your employer you are no longer available for work as of two weeks from now. Period. If you are leaving a good employer on good terms you may want to do them the courtesy of a few words of explanation: personal reasons, leaving the area, an opportunity to develop your skills more fully in the XYZ specialty, etc. In in your situation, I'd say stick to the facts as one person already stated similarly above: "Effective two weeks from today (on March 18, 2020) I am no longer available for employment at Wrong Way Long Term Care. I appreciate the opportunity I've had to learn and develop my practice as a registered nurse while caring for Wrong Way residents." No explanation is necessary. If they try to talk you out of it, just say, "I appreciate your interest in my continued employment here, but I've made other firm plans (or I have accepted an offer elsewhere.) Pivot your way out of anything else, and DON'T give in to the temptation to give them a piece of your mind. But having been in the position of sending and getting resignation letters, it's a very unusual situation where what you say after you tell them your last day matters to HR or whomever. You owe them nothing except a professional thank you. Congrats on the new gig!

I'd take the caseload of 10. The other situation sounds really ripe for the list of "other duties as assigned" to grow by the week, and you have no idea how effective as team members the LPNs are. Additionally, with a staff of 13 RNs there's more room to spread the wealth around when the stuff gets deep. But there are a lot of crazy hospices out there, it all hinges on whether leadership is sane.