I worked until recently on a "critical care area" called Neuro-Stepdown. We routinely accepted ventilator dependent, hemodynamic altering drips, multiple tubes and frequent OTBS with a staffing matrix that states we should have a 1:4 ratio. Gradually the ratio increased to 1:5, but recently and more frequently was 1:6. On many occasions, my co-workers and I had talked about how taking more than 5 patients on our floor is dangerous. Now was the test time, 3 nurses scheduled with 6 patients a piece, one pct, and 1/2 shift unit clerk/monitor tech. Two of the three nurses refused to take that assignment, but we were looking for alternatives. The supervisor, NM, and Director of Critical Care told us "there is no help to send you and no beds to move any patients to. Either take report or consider yourselves voluntarily resigned." We left and in 2 hours 2 nurses were brought in to take our 6 patients, but "there is no help to send you" rang through my mind.
I am planning on still attempting to receive unemployment since I believe I was left no choice, but to lose my job, a patient, or possibly my license. You must draw a line somewhere and stand by it. I will not put my patient's lives in jeopardy for a hospital or money. I have been in this situation once before and patients died, because of short staffing. Now there is
research showing what safe staffing levels are and there is no more excuse for managers or nurses. That level is 2 in ICU, 4 in PCU/Stepdown, and 6 on the medical/surgical floor.