Refusing unsafe RN:pt ratio

Tweety, BSN, RN · Jun 3, 2006

I echo, Traumamamma, on this. These type of decisions come about by those higher up in the hospital food chain. The charge nurse works from the guidelines given to them. Folks need to realize this. Being in charge is not a coveted position...it is often a position caught between a rock and a hard place...but, someone has to step up to the plate any way.

I hate being in charge because of that rock and a hard place. I resigned being a fulltime charge nurse because of hassles such as these. Often our busy ER would need to empty out the trama room. If "my" nurses were "maxed out" numberwise, the administrators while sympathetic, needed to clear out the trauma room and admit the patients to the floor regardless.......rock and a hard place for me the charge nurse.

grinnurse, RN · Jun 4, 2006

Yes you can refuse any assignment that you feel is unsafe. That's your obligation.
Sometimes we creep above our normal ratio and I realize that it's just an occasional occurrence that can't be helped and I don't make a big deal over it.
They are just numbers. People sometimes get so caught up in the number of patients it can be irritating. Sometimes I have five patients and the charge nurse wants me to take a sixth and I simply can't, so I have to beg off. Sometimes I have six and I volunteer to take a 7th so save someone else who is busy. It all depends on the patients, not the number.

That is what happened to me on the 2 occasions that I refused pts. and thank goodness for the Charge Nurse that I had b/c she was right there backing me up both times. I knew that she was only doing her job so I went to the House Supervisor, who just happened to be the DON and told her that I thought that it would be an unsafe assignment for me. In each of these instances I had 3-4 total care patients and one time was working a split hall. Both times she had the nurse who was our wound/skin care nurse start taking pts, who btw was surfing the internet!!

If I have 4-5 pts who are for the most part who are independant and 1-2 total care I have no problem taking another pt and after I get my a.m. meds done, if I see one of my team members struggling, I do what I can do to help out.

God Bless the ones who get stuck in that position b/c I darn sure wouldn't want it!! My motto is "Just say no to Charge!!" :nono:

TachyBrady · Jun 4, 2006

We are fortunate in that our management is willing to work with the charge nurses in providing more staff when needed. But this goes both ways.... when we have extra staff or are slow, we have to be willing to let our staff be pulled or lend our aids or cover breaks for other depts. The same concept applies to staff nurses. It's give and take and team work. As a charge nurse, even though I have a full patient assignment, I try to take the first admission to show that I'm there to pitch in and work. The next admission I give to the nurse with less patients or who appears to have an easier assignment. It's no problem if a nurse can't take a patient, I just go to the next nurse. Not everyone has a terrible assignment or busy day. If a nurse habitually refuses, then eventually I quit asking if they can take an admission and just give it to them. Those nurses don't usually last long.

melinated · Jun 10, 2006

i usually have from 7-9 patients....on rare occasions may get stuck wit 10-12. where i work we can protest our assignment, which doesnt mean u r refusing but means that u have documented that u feel unsafe with whateva amt of patients. that way...if one of those patients ever files a lawsuit or something about their care while in the hospital, it is documented.

our charge nurse helps out as much as she can.