Refusing unsafe workload?

[Ginger80]

I'm a new grad working in a nursing home. On nights, I have 120 residents under my care (with 4 CNAs). I can manage this relatively well on most nights. However, last night, I had 3 palliative residents (highly unusual), and I was asked to pick up an extra "area" of the nursing home, meaning I would have 165 residents.

I refused, telling the supervisor that I knew, especially as a new graduate, I could not handle this workload, especially with the 3 palliative residents that were receiving injections left and right to keep them comfortable.

The supervisor was speechless. I'm not sure anyone has ever refused extra residents before at this nursing home.

My question is: did I do the right thing? Is this something you all could get reprimanded for?

What are our rights in regards to refusing patient overload?

[mvg rn]

Laws very from State to State - In Texas, we have a Safe Harbor Act that we would have to fill out stating that we feel the assignment is unsafe and why prior to starting the assignment, but I don't think we can actually refuse an assignment.

Although, on a personal note, I say "Good for You!" Maybe if more of us spoke up employers would start looking at the safety of what they are asking us to do.

[SummitRN, BSN, RN]

165??????????

[Ginger80]

165??????????

I know!! My usual load is around 120 residents, and while manageable, I normally do not have any breaks. It can get crazy!

PS This is at the most reputable, government funded nursing home in my city.

[retiredlady]

Are you kidding, I would not have taken 120 by myself. Do you have any LPN's helping? The meds alone would be too much. How can you know about each resident?

[Ginger80]

"Are you kidding, I would not have taken 120 by myself. Do you have any LPN's helping? The meds alone would be too much. How can you know about each resident? :("

Just to be clear, the shift is from 2300 to 0700. I think only a total of 10 residents have scheduled meds within this shift, the rest are prns. And it's usually the same residents that request the same prns.

[azhiker96, BSN, RN]

In my state my license is safe if I refuse an unsafe caseload but the BON stays out of the employer/employee part. I could be counseled or fired for my refusal. I have refused an additional patient on two occasions because it would be unsafe and outside of my professional association guidelines. I've never had a problem but then I have good management and they didn't realize what I was dealing with when they made the additional assignment.

[Leelee2]

I give you credit for sticking up for yourself and the residents there. 165 patients to one staff is Insane.

The most I have ever had on a NOC shift in LTC is 60! What state do you work in?

[JDZ344]

wow, hats off to you AND the CNAs there. 120 residents, wow!

[Ahhphoey]

I couldn't imagine being responsible for 120 residents let alone 165! When I worked in long term care, the most residents I cared for on a night shift was 45 and that was with 4 CNAs. I think you were right to refuse the extra residents. As others have stated, you may get some flack from your employer, but at least your license is safe.

[Midwest4me]

Well Ginger80 that's abusive to you, the aides and the patients! Surely there are BON rules as to staff to pt ratios---At 165 pts that's 41 pts per CNA--asinine! Even caring or 120 pts means 30 pts per CNA and that's outrageous. Our state's rules are 1:25 on nights, 1:15 on swing, 1:10 on days(and THOSE numbers outrage me); the numbers do NOT take into account the patients' acuity. You are putting your license on the line working there! I am glad you refused the extra patients...now get the heck out of there!

[Redhead28]

I'm speechless. I've only ever worked in hospitals, so I never knew that you could assign that many residents to one nurse. What happens in the event of a fire? I would look for a new place to work.