Safe Harbor when to evoke it?

Erbasketcase · Jun 4, 2005

It is now 7 am and your medication pass begins at 7:30. What would a Prudent Nurse do?
Time now is 10:30 and you just begin your med pass. You notify the DON around 11:30 and evoke "safe harbor" expaining that the situation is unsafe because you dont have a med aide, even though passing meds is the reponsibility of the Nurse, whether she/he does it or deligates it.
Then around 12:30 the med aide arrives and the R.N. retracts "safe Harbor" .
The med aid reports upon her arrival the med pass from the morning was not finished.
I know where I have worked the RN (weather they worked doubles one shift) always passed the meds until a suitable replacement came in. That would be agency or a med nurse staying over from another shift. I understand that Rn's (not all...and I have nothing against Rn's, I'm going from LPN to RN) don't do well with Med passes, mainly because they don't do it on a full time or regular basis. Even the ADON's and DON's have pitched in until there is someone else to help. But I do have to agree that if she doesn't feel comfortable because she didn't get enough sleep between doubles that she shouldn't be doing the doubles and she is not confident enough to be doing her job.

fab4fan · Jun 4, 2005

I think it's unfortunate your nurses have to risk their licenses by working with med aides, but that's another thread. :stone

Jdon · Jun 4, 2005

Read RN Update published by the TX BON for Jan 2002, and it sounds like safe harbor was appropriate. She notified the sup and filed the paperwork. Really the only question one might have is whether she did so in good faith. Again, I'm not ready to hang the nurse based on one half of the story. It's unfortunate that so many fellow nurse are happy to burn her at the stake. Do we know what was happening on the unit? Were there extenuating circumstances? Do we know what was being communicated from the med aide about time of arrival? Do we know of any other staff present? It's unfortunate that 20 patients for each nurse is considered a safe situation in any setting. Perhaps stats have changed, but if I'm not mistaken, most nurses punished by their BON work in the long term care setting. Yet another reason there is a shortage of nurses willing to work at the bedside.

Actually, I was in the bldg on that morning, working in Medical Records and I left aprox 10 am and saw both Nurses before I left and they informed me that the med aide had not arrived yet but would be there when she got the tire fixed. Not one of them said that they were in trouble or needed help (they both knew that i was in the bldg since 7am). I thought that they were done with the med pass and all was okay. So told I them okay, I have my cell phone if you need me. Then I left, when i arrived home the RN called and said the med aid had not arrived still and she was evoking safe harbor. I asked her if she had heard from the med aid as to the time she could make it, she said no. I then instructed her call her and find out, and authorized her to call one of the other nurses to come in and help if they felt like they needed it(as it would be overtime) and if no luck call me back and i would come in to help. I diagreed with her claim and told her so that the med aid was optional to begin with and all the rest of the staff was present ( 2 nurses, 4 cna's and a 3rd nurse that I have just to be in the dr at beakfast & lunch she cant be assigned pt care due to her age). There were no emergencies or admissions or any thing time intensive going on. The RN works as a charge nurse and has no additional supervising duties assigned. I take care of all that myself. She did call me back and said the med would be there in 45 min.(it would have taken me that long just to get back to the bldg.) I asked her to call me when she arrived . When she called back I asked if she had the forms to fill out for safe harbor, I explained that even if i disagreed with her claim I would provide the avenue to express her concerns and drive back out to provide the forms and then we'll convene a nursing peer review comittee to address the issue. She stated that she retracted the claim because the med aid arrived. I didnt find about about the meds being late until mon. I hope that answers your quetions. Again thanks for your input.

begalli · Jun 4, 2005

but that's another thread. :stone

...or three or four.

Jdon · Jun 4, 2005

Thanks for the sound advice, I plan on meeting her in the morning before her shift starts to discuss these concerns. I'm sure it won't be civil as she was yelling at me on the phone and ultimately hung up on me.

Just got a phone call from both nurses who quit effective now due to duress. Its late fri eve and now I have doubles x 2 sat and sun to cover. :angryfire Unreal!

Jdon · Jun 4, 2005

I think it's unfortunate your nurses have to risk their licenses by working with med aides, but that's another thread. :stone

Try and get them to understand that!!!! That's what this is all about, that they feel that its unsafe without them. I agree but i cant get Nurses to work without them. I spend a great deal of time educating the CMA.s but I fully agree with you.

begalli · Jun 4, 2005

Just got a phone call from both nurses who quit effective now due to duress. Its late fri eve and now I have doubles x 2 sat and sun to cover.

Oh gosh. So sorry.

Jdon · Jun 4, 2005

Yikes! and Wow!
You sound like a very understanding and conscientious manager, but for the sake of your patients, whose well-being you sincerely seem to care about, don't let this individual walk all over you.
You didn't need to go in that morning because as you say, med aides are not required so your unit was not understaffed.

Both nurses quit this eve without notice. I' ll be working doubles this week-end after working 60 hours this week. ugh :angryfire It's tough doing the right thing and trying to hold nurses accountable for their actions.

begalli · Jun 4, 2005

Is it possible for you to use agency RN's?

PMHNP10 · Jun 4, 2005

I take it you don't work in Nursing Homes? 20 patient's per Nurse is a light case load. Most Nursing Homes have 30-35 pts per Nurse in my area. I wish the ratio was different but given the current practice our home has the best because were a small facility. In addition we run with Med aides (not required) to allow the Nurses to spend more time on assessments and interventions. In addition we have two CNA's per Nurse or 20 pt's. On the week-end I also have a third Nurse for 4 hrs on sat and sun that will monitor the dining room at breakfast and lunch to also free the nurses to be on the floor to give better care. I do not feel that this senario is "usafe" even if the Med aid is taken out of the equation. Again, a med aid is not required. In fact I am probally the last Nursing home in my area that has them because of ppd's they all have been cut from budgets. The bottom line is always money sad. I fight hard to keep as much staff as I can. The med aid lives about 1 1/2 hrs away and it took time to get someone out to her and repair the tire then travel the distance to the home. This med aid is always puntual and has never missed any days since she started working with me. She did'nt give a time of arrival when she 1st called as she didnt know. The Nurses had no crisis or admissions or anyone that required time intensive care. I hope ive answered your questions. Thanks again for your input. I appreciate it.

I haven't worked in a nursing home per se, but did work in a prison environment which did have several long term care pts in addition to a group of acute psych pts. We were staffed with 1 or 2 CNAs and typically 3 RNs for up to 24 pts. While 20 might be a light load relative to nearby homes, it's still not the safest situation, which I believe you agree with.

As for your nurse...Please don't think I'm actively trying to bust your chops, I just like to have a broader picture of the situation before committing to saying a nurse is in the wrong. That's just who I am; but at least you know that if it's you on the firing line, I'd afford you the same courtesy.

Bottom line on this situation--I heard all I needed to hear about the nurse when you posted she quit without notice. My condolensces, and good luck to you this weekend.

mommatrauma, RN · Jun 4, 2005

Both nurses quit this eve without notice. I' ll be working doubles this week-end after working 60 hours this week. ugh :angryfire It's tough doing the right thing and trying to hold nurses accountable for their actions.

It does stink that you have to have that added stress, but in the long run..your patients and your facility will be way better off.

suzanne4, RN · Jun 4, 2005

Medications should have been her priority, she knew in advance that the med tech was not there. Just because she has someone to assist her, it is still ultimately her responsibility to make sure that they are passed. Same thing if there was a storm in the area, and no one could leave or come in, whoever is there working: medications take priority, then you worry about the other things. Assessments can get done later on, baths can get done later........

I would hate to have someone like that caring for me or anyone else...