Reporting a facility for staff ratio issues?

I'm sorry this is happening to you.

At the start of each shift that is not safe document in writing exactly what the situation is and give a copy to your manager or shift supervisor. If your union provides an "Assignment Despite Objection" (ADO) or "Disclaimer" use that and keep a copy. If you don't have a form use paper. Write, "In our professional judgment this assignment is unsafe because the facility failed to provide sufficient staff. As a result the facility is responsible for any adverse effects on patient care.

Write details on the one given to management.

It is not a HIPAA violation to provide information to hospital management or to a regulatory agency.

Write an exact quote of what you were told and the name of the manager or supervisor. The date, time, location, number of nurses, number of patients, and room numbers of patients should be written on the form or paper.

If something happens remember the name of the patient and the room number. Don't write it anywhere and don't look at the chart when you are not assigned to that patient.

That form can be used in court or a disciplinary hearing. It is best for all nurses on the shift to sign it, but do it alone if they won't.

It can save your license, your job, and protect you in the event of a malpractice lawsuit.

I'll type the text of a flyer on reporting to the state:

Quote

HOW TO COMPLAIN TO THE DEPARTMENT OF PUBLIC HEALTH

INTRODUCTION:

The Department of Public Health (Licensing and Certification Division) is the agency that determines the compliance of health facilities with state and federal laws, rules, and regulations. To accomplish this goal, the Department conducts periodic inspections of health care facilities and is empowered to take remedial action. Such remedial action may involve suspension of licensure, curtailment of public funding, and other enforcement actions. More frequently, the Department will cite the facility for a violation and request an acceptable plan of correction.

Reports on the result of each inspection of a hospital along with the plan of action and hospital comments are kept on file in the department. All inspection records, lists of deficiencies, and plans of correction are open to public inspection.

THE COMPLAINT:

1. Anyone can file a complaint: RN, patient, family member, others.

2. Avoid anonymous complaints. The whistle blower protection laws in long term and acute facilities provide protection against retaliation. Speak to your labor rep first about the problem. Go through the PPC or other facility-based structure. These avenues are often effective in resolving patient safety problems.

3. File the written complaint with the local DPH field office & notify CNA.

A. The DHS evaluator will be best able to investigate the complaint if provided the following:

• Name and address of the facility.
• Date, time, and location (unit or room number). Name(s) or medical record # of patient(s) involved. Names of involved staff.
• Staffing assignment sheets if available.
• Description of incident with quote from Title 22 (include number of section).
• Desired remedy IE Nurse staffing must meet or exceed established ratios at all times.
• Ask for implementation not just improved documentation.

4. The Department will conduct a complaint investigation.

5. The person signing the complaint will be contacted prior to the investigation of the complaint and also will be informed of the Departments findings upon conclusion of the investigation.

Find your local district office and mail your complaint there:

District Offices

This section of hospital licensing law outlines the responsibilities of an RN. It makes it clear that every patient must be assigned to a registered nurse:

§ 70215. Planning and Implementing Patient Care.

The ICU ratio since 1976 is here:

§ 70495. Intensive Care Service Staff.

The "new" section with competency, orientation, and staffing requirements:

§ 70217. Nursing Service Staff.

Feel free to send a PM and I'll try to help.

If ordered to go to lunch I would ask, "Who will take over my patient(s) while I'm at lunch?"

If there is no one I would say, "I would if I could, but I cannot abandon my patient.'

If ordered to i would ask with other staff to witness, "Are you ordering me to leave my patients without an assigned nurse?"

Sometimes they then understand that they are ordering you to violate the Nursing Practice Act and the law.

Here is an examples of a hospital fined after a patient was harmed due to ratio violations:

Palomar Medical Center (PDF)

555 E. Valley Parkway, Escondino, CA 820211, San Diego County - The hospital failed to ensure the health and safety of a patient when it did not follow its patient care policies and procedures. This is the first administrative penalty issued to this hospital. The penalty is assessed at $50,000.

The statement of Deficiency is in the column on the left. The right side has the required Plan of Correction.

Generally unless a patient is harmed there is no fine. The hospital must provide an acceptable Plan of Correction.

morte said:

Find out what law firm represents the hospital in liability issues, have the union start with them. Of course, it should have been reported the first time that it happened..... I know, easier said than done.

I remember being told that an orthopedic unit was horribly under staffed. one of the nursing assistants filled out an incident report because the nurses could not administer pain medication in a timely manner. She sent the hospital attorney an incident report, a copy of the staffing sheet showing nurses assigned up to 12 patients when the ratio at the time was five or fewer patients per nurse, and a written description of how it distressed her to see patients suffer.

The next shift the attorney and upper management were on the unit. That is a great idea, that I'd forgotten about.

Yes. Give the date and other information to the state.

I'm not sure it is a good idea to refuse the assignment unless there is a plan with all your colleagues.

I heard in a class about a group of nurses who sat in the break room refusing to take report until sufficient staff was provided. They had already planned so the previous shift nurses continued caring for patients.

When handing the ADO to management you have put them on notice that if there is a fall, late medication administration, or failure to rescue it is their responsibility. you then do the best you can under the circumstances because if you leave it will be worse.

BUT don't stop there.

Nurses at this hospital testified before the city council:

RNs at Watsonville Community Hospital to Testify at City Council on Unsafe Patient Care Conditions | National Nurses United