6:1 ratio in ER....abusive?

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I need help.

I started a travel assignment with Parallon 2 wks ago at understaffed Northwest Medical Center's ER in Margate, FL. Their ratio is 6:1...their average ER pt's age is 85. Almost with no exception, they are full workups, and half of them unstable: CVAs, MIs, OR, etc. I am not being targeted, most nurses have 6 pts.

I am considering sending in my resignation, but since this is my first travel assignment, I do not want to appear "weak". On the other hand, I would rather have my pride hurt rather than my license.

Am I being unreasonable?

Are predetermined ratios guaranteed in a travel contract? If not, how do you object to unsafe ratios? I do not recall receiving a written contract when Parallon flooded me with initial paperwork!

Thank you!

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I would consider 6:1 unsafe. On the other hand, when I sit in on ED RN interviews, I suggest hiring RN's who have worked in the south, as they usually have great time management from 6:1 and higher ratios. The most I have ever had was 8:1 non-critical, 4:1 acute and criticals. Now I am in California where the legislature helps us out. Definitely easier, safer, more enjoyable. Still busy.

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No doubt that 6:1 ratios are unsafe under the conditions you describe. However the liability is on the hospital, not you. If you apply your knowledge and experience appropriately and work to the best of your ability, your license should be safe. That is not an absolute, but just look at the number of staff nurses and travelers working in similar situations in Florida. The nursing board couldn't possibly hold all those nurses responsible.

Try to stick it out if you can. You will be a better nurse afterwards.

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"The liability is on the hospital, not you".... if you sincerely believe that, I have some swamp land to sell you. All kidding aside, one of the first things I always advise a new nurse is to purchase . Although a hospital or facility will usually say that you are covered...who covers you when you are fired, sometimes coinciding with an impending lawsuit? When lawsuits are brought.... usually everyone who had anything to do with the patient becomes listed in the lawsuit. Use your own judgment with regard to accepting patient ratios. Hospitals and health care facilities are run as a business by business professionals, not medical practitioners which means maximizing profits and staffing levels come into play with regard to profit margins.

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Professional runs around $100 a year (except in Texas). That should tell you how likely it is that a particular nurse will need it. Any insurance that is cheap is usually a ripoff. That said, it is so cheap as to say, "Why not?" Fair enough and there is actually a better reason to get it: legal representation if your license is threatened by a board of nursing. That happens a lot and it is telling that the benefit amount is much lower than for malpractice.

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Thank you all for your input.

Just so I understand, I should:

1. get professional ($100/yr) in case the Board of Nursing tries to de-license me. This would not cover me if sued for malpractice by a patient.

2. look into in case I hurt a patient. (Much more costly).

I was always told that when suing for malpractice, the attorneys leave nurses pretty much alone unless they carry malpractice insurance. Is there any truth to that?

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California seems much more regulated, also with their generous overtime rates. It seems perfect for a traveler who does not have to pay their astronomical state income taxes...or do we, even if we live in another state and the assignment is less than a year?

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"[Now I am in California where the legislature helps us out. Definitely easier, safer, more enjoyable. Still busy.]"

Great, California seems much more regulated, I love their 9th hour overtime concept but would hate to have to pay such high state income taxes. If we live in another state and work in CA for less than a year, we do not have to pay California taxes, do we? Only our home state income taxes?

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">Now I am in California where the legislature helps us out. Definitely easier, safer, more enjoyable. Still busy."

Great, California seems much more regulated, I love their 9th hour overtime concept but would hate to have to pay such high state income taxes. If we live in another state and work in CA for less than a year, we do not have to pay California taxes, do we? Only our home state income taxes?

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When I referred to in a previous post, I was referring to profession ...yes it is inexpensive, relatively speaking, but does provide you with a level of protection in the event of a lawsuit. The best advice I can give would be to visit websites that offer this insurance for more detailed information. In regard to taxes, you might want to find a tax specialist that specializes in travel professions...they do exist...good luck!

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Professional liability is synonymous with malpractice. Nursing professional commonly available to individual practitioners through such companies as NSO include a benefit for license defense as part of the policy, no separate policy required.

No one knows that you have insurance unless you tell them, or unless an insurance provided lawyer shows up to represent you in a deposition and informs the court of that relationship. Not that it really matters. You are a contract employee of the hospital who carries insurance. They try to shift the insurance liability to the agency who also has a policy covering you. But the bottom line is that they go after deep pockets, and if a nurse makes a mistake, almost always the employer is deemed at fault in an acute care setting. Workload too high, or oversight failure (direct manager, or appropriate assessment of abilities and assignments). It is extrodinarily rare that the nurse involved is dinged and insurance rates reflect that. It does happen of course.

As far as state taxes goes, your work state has first claim on your wages. If you are working temporarily away from your IRS tax home, you will also owe state taxes to your home state (if it has income tax) but you will receive a credit for those work state taxes from your home state. Effectively, the amount of state taxes you pay will equal the higher taxing state. If you are itinerant (without a home) you will owe state income taxes only to the work state for income earned only in that state.

Yes, working away from home in the same general area for more than one year is one way that your tax home will shift to your work state. If that happens, you will lose the tax benefits of working away from home, such as tax free housing and per diems.

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Ok, it makes sense. Thank you for the clarification!

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