Question regarding minimum staffing

[smf0903]

Hey all! I am hoping someone can guide me in the right direction regarding safety policies.

I work in a 10-bed ICU. Administration is trying to implement a 1 RN in the unit unless there are more than 2 patients. What I mean is 1 RN and that’s it. No aide, no other human body back in the unit. I understand not paying a second RN be back in the unit but having literally no one else is absurd in my mind. Number 1, there is no one to watch monitors if I would be in a room with a patient. Number 2, we get combative alcohol withdrawals/overdoses. We have had nurses assaulted by other staff (I won’t go into that here but suffice to say it was not pretty). Irate family members, I can name a hundred scenarios in which having a lone staff member is unsafe.

Administration does not get this. We have one charge nurse that covers the unit and 3 med surg floors, so they can’t possibly be at our beck and call. The charge nurse is also the medication nurse for caths if we have a STEMI, so in essence they can be off the floors for a couple of hours if we have a STEMI roll in. We don’t have nighttime pharmacy so we are mixing our own gtts and overriding non-profiled medications, so we would literally have to call to have someone come back to witness a controlled med that hasn't been profiled yet by pharmacy (wastes as well).

We can go literally hours in the unit without seeing another employee. I don’t fault the charge or supervisor for this at all, they run their butts off every shift. I just don’t see how putting 1 RN in a closed-off unit is safe by any stretch of the imagination.

I already told my husband that if they implement this he can expect me to lose my job because I will refuse to clock in. But there are people working there that don’t have that luxury—this job is not our primary source of income, most people working the unit this IS their income.

It really ticks me off that our administrators don’t seem to have even the little sense that God gave an ant. In my eyes, this is a train wreck waiting for a time to happen.

Any advice? Thoughts? Directions in which I can get basic safety requirements? I’m in Ohio. I’m trying to find something to help us plead our case.

(And before you ask, yes I have applications out at other facilities.)

I appreciate your input! ❤️?

[sevensonnets]

I suspect the critical care medical director has not been made aware of this decision or had any input into making it. That's where the power comes from.

[nurseburst, ASN, BSN]

So, what may end up happening especially considering there is no one to watch the monitors is that someone may go into a lethal rhythm, the one and only person there will not see it and that said person may have an MI or God knows what else. When this happens, they will probably be REQUIRED to have someone sit at monitors 24/7. But unfortunately, it will happen after something really bad happens.

Also, if there is a code what is one single person gonna do? I realize that you can press that code blue button and a ton of people come running but the best that single person can do is do chest compressions until help comes. That isn't exactly ideal...

I don't understand where management thinks this is okay. You are caring for very sick and ill people. You need more hands, brains, and eyes!

[Nunya, BSN]

22 hours ago, canoehead said:

I've worked at a hospital where both the labor nurse and the ICU nurse were sometimes alone on their units. It was understood that the supervisor was their backup and their break relief. I worked labor and delivery there, and our manager said that in an emergency, hit the code button, no matter what that emergency is...irate family member, impending delivery, whatever.

I did a few years as supervisor there as well, and we'd end up stuck on OB, while ICU pulled a smart med surg nurse for an hour to get through a crisis. Or the second ICU nurse went down to the ER to stabilize their pending admit, and brought them up once they got orders. It worked, but only because the supervisors were comfortable taking over in any department, and the staff would help each other in a pinch.

I think leaving the unit for supplies is asinine. Most medical crises require getting supplies. And what about position changes that require two people? Would they consider a secretary overnight? Or CNA ? Give them a few incident reports and back strains to start them thinking.

A secretary to do patient care like position changes? I don't think so. Don't even suggest it. Your should have another RN or LPN.

[neuron]

On 8/29/2019 at 6:22 AM, smf0903 said:

Hey all! I am hoping someone can guide me in the right direction regarding safety policies.

I work in a 10-bed ICU. Administration is trying to implement a 1 RN in the unit unless there are more than 2 patients. What I mean is 1 RN and that’s it. No aide, no other human body back in the unit. I understand not paying a second RN be back in the unit but having literally no one else is absurd in my mind. Number 1, there is no one to watch monitors if I would be in a room with a patient. Number 2, we get combative alcohol withdrawals/overdoses. We have had nurses assaulted by other staff (I won’t go into that here but suffice to say it was not pretty). Irate family members, I can name a hundred scenarios in which having a lone staff member is unsafe.

Administration does not get this. We have one charge nurse that covers the unit and 3 med surg floors, so they can’t possibly be at our beck and call. The charge nurse is also the medication nurse for caths if we have a STEMI, so in essence they can be off the floors for a couple of hours if we have a STEMI roll in. We don’t have nighttime pharmacy so we are mixing our own gtts and overriding non-profiled medications, so we would literally have to call to have someone come back to witness a controlled med that hasn't been profiled yet by pharmacy (wastes as well).

We can go literally hours in the unit without seeing another employee. I don’t fault the charge or supervisor for this at all, they run their butts off every shift. I just don’t see how putting 1 RN in a closed-off unit is safe by any stretch of the imagination.

I already told my husband that if they implement this he can expect me to lose my job because I will refuse to clock in. But there are people working there that don’t have that luxury—this job is not our primary source of income, most people working the unit this IS their income.

It really ticks me off that our administrators don’t seem to have even the little sense that God gave an ant. In my eyes, this is a train wreck waiting for a time to happen.

Any advice? Thoughts? Directions in which I can get basic safety requirements? I’m in Ohio. I’m trying to find something to help us plead our case.

(And before you ask, yes I have applications out at other facilities.)

I appreciate your input! ❤️?

There are very little consequences for an administrator/CEO. They can simply hide behind the curtain and push buttons and throw staff under the bus. This is all the norm now for nursing.