Protecting my license/patients now paranoid.........

SouthernLPN2RN, MSN, RN, APRN, NP · Apr 20, 2006

If you felt the assignment was unsafe, you were within your right to refuse it, IMHO. Let them talk, your pts are well-cared for. I don't see how they could fire you over this, but they may trump up anything else they *think* they can find, so be careful. I'd also keep a journal for now just to document what's going on among the other employees. Good luck and be proud of yourself for standing your ground.

Daytonite, BSN, RN · Apr 20, 2006

Well, I think your assessment of your future at this facility is probably correct. The problem you have is that once you are on the grounds of the facility, you are kind of stuck with whatever gets thrown at you or you run the risk of being accused of abandonment. People in a lot of places are working understaffed and getting floated to units they haven't been cross trained to work in. I know that when I was a supervisor similar situations came up and I worried about them. I didn't want anyone to get into trouble based on a staffing decision I had to make. What you have to do is just work smart. When you're working short you prioritize and determine which of the routine nursing tasks get dumped. The stuff that you can't get done you just have to make a notation about in a company memo (not the chart) to cover yourself. It is OK not to do q4h vitals on everyone, as an example. I would hope that a smart supervisor would be reassuring you that she knows you might need backup and keeps in close contact with you when you are floated to see how you are doing. In your case I would have had an ICU nurse on deck ready to zoom over to where you were to help out if a situation arose that required it--that is part of what a supervision/management is supposed to do--corral and distribute nursing resources.

I'm asking that you put yourself in the facility's position. How else do you feel the situation could have been handled that morning? Be fair and put yourself into the shoes of the people in charge who had to deal with a staffing shortage and the people who actually did show up to work and still make sure that the patients got their basic needs met. The patients, unfortunately, are always the ones who ultimately get stuck holding the bag.

Note to new grads reading this: When a new grad is not receiving the orientation they were promised and/or end up having a parade of preceptors when they were promised to have one, red flags should go down all around you. Something is wrong. Places that can't keep staff don't have enough staff to orient new employees!

grinnurse, RN · Apr 20, 2006

well, i think your assessment of your future at this facility is probably correct. the problem you have is that once you are on the grounds of the facility, you are kind of stuck with whatever gets thrown at you or you run the risk of being accused of abandonment. i was called at home prior to accepting assignmentpeople in a lot of places are working understaffed and getting floated to units they haven't been cross trained to work inthat's fine to be "floated over" i guess (even though i still don't agree with this practice) as a staff rn, but i thought it was dangerous for me and my license to be put in charge. i know that when i was a supervisor similar situations came up and i worried about them. i didn't want anyone to get into trouble based on a staffing decision i had to make. what you have to do is just work smart. when you're working short you prioritize and determine which of the routine nursing tasks get dumped. the stuff that you can't get done you just have to make a notation about in a company memo (not the chart) to cover yourself i would not have been able to put in any orders, attend the meeting that would have been required regarding all the patients under my care, nor been able to run a code had it occurred r/t the fact that no one over on the unit would have been acls certified. it is ok not to do q4h vitals on everyone, as an example. i would hope that a smart supervisor would be reassuring you that she knows you might need backup and keeps in close contact with you when you are floated to see how you are doingfirst off this supervisor that called me was going off duty when i would have been on that unit. again, this would have been great, but now, due to the new don we have no one in such a capacity as a house supervisor during the day. the only other people that i could have relied on was another person who was put in charge (not the regular) r/t low census who would have had 5 patients of her own who btw doesn't answer the phone if she has to carry patients and takes her name off of the charge position. in your case i would have had an icu nurse on deck ready to zoom over to where you were to help out if a situation arose that required it--that is part of what a supervision/management is supposed to do--corral and distribute nursing resources.this looks really great and logical posted on here, even doable, but i know how the facility operates this would have been great but was never mentioned when the assignment was being discussed with me at home on the phone. when we work short staffed, which is often the case and i know it's not just at my facility, lots of things go undone for the patient such as what you mentioned- q4vs, baths, and linen changes. we are usually carrying 6-7 patients and all the other departments are working short staffed as well so am quite sure that there would not have been an availble icu nurse to come to my aid not to mention the fact that the other facility is 10 minutes away if you don't get caught by the train that runs through the middle of town.
i'm asking that you put yourself in the facility's position. how else do you feel the situation could have been handled that morning? staffing should have been left as it was scheduled the night before. after being confronted in the breakroom by the don i talked to my nurse manager who said and i will quote "staffing didn't need to be changed. i had it set up where it would work, i don't know why she was trying to change it"be fair and put yourself into the shoes of the people in charge who had to deal with a staffing shortage and the people who actually did show up to work and still make sure that the patients got their basic needs meti think that you misread some of my post b/c all of this transpired 2 hours before the shift would have begun. the patients, unfortunately, are always the ones who ultimately get stuck holding the bag. at what point do we start holding the facilities accountable for poor staffing?? i can certainly guarantee that if i had accepted that assignment and some one would have coded, with the staff that i would have had (which as told to me was me- an rn of 10 months, and lvn who has only had her license for 3 months, and an aide, and the patient would have died, do you think the facility, the don, the nm and the person who did the staffing is going to stand behind me/us????? cause i am not thinking so. we would have been left high and dry by the facility. i have asked numerous times to be oriented properly over at the facility and asked to be taught how to put in orders so when i went over there i wouldn't feel like a "burden" to the other nurse and my response from the don was this "they are just happy to have a warm body, let them do that" yet this is the same don who told me to "step up to the plate". i am sick to death of people/places that "talk the talk" but refuse to "walk the walk" when they see there staff drowning!!
note to new grads reading this: when a new grad is not receiving the orientation they were promised and/or end up having a parade of preceptors when they were promised to have one, red flags should go down all around you. something is wrong. places that can't keep staff don't have enough staff to orient new employees!

keeping staff at this facility is not the problem either as a majority of the nurses have been with the facility for 15+ years. i did get nearly 6 weeks of orientation on the floor from several great nurses who are longtime employees but no orientation per se related to "paperwork" etc. but i agree this is a good piece of advice for new grads why is it that when nurses begin standing up for themselves and the safety of the prospective patients and their license they are made to feel ostracized??? here's my piece of advice to new nurses. stand your ground from the get go and don't let management bully you, or make you feel guilty for wanting to protect your patients and your license

thanks daytonite for the insight maybe you will have more words of wisdom for me when you read this reply. i appreciate the input.

clee1 · Apr 20, 2006

Good for you, grinnurse!

I am still in school, but my instructors and preceptors in clinicals all tell me I am going to be a good nurse.

I tell you this, though. Previous life experience has told me that people will push you only as far as you let them. I WILL keep a running journal of activities/issues at any facility I work in, and will NOT keep that fact a secret.

It will be known from jump street that clee1 won't tolerate unsafe conditions or being bullied unto doing so or keeping quiet about it.

They hire us for our licenses and skills; don't let them put your career into jeopardy.

PANurseRN1 · Apr 22, 2006

clee: Telling an employer you're keeping a journal is a bad idea. First, it sounds confrontational from the get-go. Second, you want your journal to be private, something you control. Public knowledge that you're keeping a journal could mean your being asked to hand it over as "evidence" if there is a problem.

Even though you have "life experience," don't say you won't allow yourself to be put in a bad situation. It's very easy to get blindsided in this profession. It's also very easy to say what you will/will not do when you still have the cover of being a student. IRL, nursing can be a completely different ball of wax.

Your resolve is admirable, and I'm sure you will be a good nurse.

clee1 · Apr 22, 2006

clee: Telling an employer you're keeping a journal is a bad idea. First, it sounds confrontational from the get-go. Second, you want your journal to be private, something you control. Public knowledge that you're keeping a journal could mean your being asked to hand it over as "evidence" if there is a problem.
Even though you have "life experience," don't say you won't allow yourself to be put in a bad situation. It's very easy to get blindsided in this profession. It's also very easy to say what you will/will not do when you still have the cover of being a student. IRL, nursing can be a completely different ball of wax.
Your resolve is admirable, and I'm sure you will be a good nurse.

All valid points; well taken; and will be considered. There IS such a thing as conservation of ammo and "keeping your powder dry". Thanks for reminding me of that.

However, as to the last point of being blindsided and what you will/will not do.... I look at it like this: in the final analysis you have to be able to look at yourself in the mirror, and live with the image that you see. I never have, and never will, allow an employer to force me into a situation where I have to sacrifice my integrity. Other than my family, that's all I really have.

I DO appreciate your perspective and advice.

Antikigirl, ASN, RN · Apr 22, 2006

Been there done that a few times, and let me tell ya...patient safety is A #1 for me, and was the reason I became a nurse to begin with! To advocate for that!

Now yes, I choose my battles well asking myself with full honesty...would putting myself or career on the line for this cause be worthy vs me staying and fixing it another way???? That is something you learn over time...how to fix things from within....

But I will admit...if more nurses stuck to patient safety issues when it comes to demands on your abilities or high ratios....then we may not have this problem as bad as it is...

I have even taken on loads bigger than I should chew...but at no time was anyone in danger because..well, frankly...I made that poor charge nurse that assigned me those unsafe ratios a life of living hades because I made her help or asked so many questions to be safe it drove them nuts! LOL! Or asked for help more than than they wanted (which some, one time is too much despite the real need!!!!!!!).

Yes..this took time!!!!!! But after that time I have been confident and use the same tools of the trade now in my agency job...and lets just say I am now booked two months in advanced with a wonderful hospital 5 days a week! (I have been an agency for only 3 months!!!!!)....yep,

Always stand up for yourself and patients..but think hard and plan before going to fast against or for something..think...would I be better going with some of this for a while to fix things internally...or is it worth it trying in the unemployement line???? (and sometimes it comes to unemployement line! I quit two jobs because of unsafe practices at facilities I couldn't fix despite trying very hard!)....

Good luck!

PANurseRN1 · Apr 22, 2006

All valid points; well taken; and will be considered. There IS such a thing as conservation of ammo and "keeping your powder dry". Thanks for reminding me of that.
However, as to the last point of being blindsided and what you will/will not do.... I look at it like this: in the final analysis you have to be able to look at yourself in the mirror, and live with the image that you see. I never have, and never will, allow an employer to force me into a situation where I have to sacrifice my integrity. Other than my family, that's all I really have.
I DO appreciate your perspective and advice.

I never said anything about being willing to sacrifice your integrity. But I don't know a single licensed nurse with experience who has not, at one time or another, been caught off-guard by something that happens at work (not pt. related; I mean more "work related.")

But like I said, I admire your resolve. I just don't think you can know ahead of time how you'll handle situations when you aren't even a practicing nurse yet. This isn't meant to be a put-down.

clee1 · Apr 22, 2006

I just don't think you can know ahead of time how you'll handle situations when you aren't even a practicing nurse yet. This isn't meant to be a put-down.

Agreed... and I didn't take it as such. :)

grinnurse, RN · Apr 24, 2006

Been there done that a few times, and let me tell ya...patient safety is A #1 for me, and was the reason I became a nurse to begin with! To advocate for that!
Now yes, I choose my battles well asking myself with full honesty...would putting myself or career on the line for this cause be worthy vs me staying and fixing it another way???? That is something you learn over time...how to fix things from within....
But I will admit...if more nurses stuck to patient safety issues when it comes to demands on your abilities or high ratios....then we may not have this problem as bad as it is...
I have even taken on loads bigger than I should chew...but at no time was anyone in danger because..well, frankly...I made that poor charge nurse that assigned me those unsafe ratios a life of living hades because I made her help or asked so many questions to be safe it drove them nuts! LOL! Or asked for help more than than they wanted (which some, one time is too much despite the real need!!!!!!!).
Yes..this took time!!!!!! But after that time I have been confident and use the same tools of the trade now in my agency job...and lets just say I am now booked two months in advanced with a wonderful hospital 5 days a week! (I have been an agency for only 3 months!!!!!)....yep,
Always stand up for yourself and patients..but think hard and plan before going to fast against or for something..think...would I be better going with some of this for a while to fix things internally...or is it worth it trying in the unemployement line???? (and sometimes it comes to unemployement line! I quit two jobs because of unsafe practices at facilities I couldn't fix despite trying very hard!)....
Good luck!

The facility for which I work has been steadily going down hill since Oct/Nov and that is kind of how we have been looking at the situation, not wanting to throw in the towel hoping that issues will resolve. So far, it has continued to get worse. I have begun putting resumes out to other facilities as of this weekend and hopefully will be able to turn in my notice shortly.

I agree that we as nurses have to stand together to make any change. I have discussed this with every nurse that I work with and we have all reached agreement that we will not work like this any longer!!

Thanks for all the comments.