Safe harbour or not

[ksettle]

I am a charge nurse w/i a LTAC facility that has seen changes in staffing/patient ratios with increasing staff turnover and increasing use of agency nurses.

The changes mostly stem from changing Charge Nurse to a Team Leader Resource position allowing him or her to take patients while coworkers= LVN's can now give more of their own IV meds, make rounds with Doctors, chart checks and in general more of the Charge Nurse responsibilities.

Plan hasn't fully been implemented and not everyone has taken class training, which brings me to last night ,coming into work.

1) Staffing was done by CCO and not communicated to floor so assignments had to be redone. R.N., and two LVN's and one CNA for 14 patients and 2 admissions.

2)One admission arrived 30 min prior to shift change, moderate acuity, restrained=encephalopathy/restless/garbled speech Spo2 89% and wet.

3) Admission #2 arrived at shift change and more stable.

4)I am Charge Nurse and knowing the patients, take four ,giving my LVN coworker each 5 + 1 admission. I feel this will be safest after conferring with House Supervisor that we can not pull a nurse from another floor, the House Supervisor states she is unable to help with the admissions or do Charge because Unit 2 Medsurg requires her their due to a more heightened situ with new R.N. doing Charge and only 2 LVN's with 23 patients. Opportunity for nurse to be called in for help refused by House Supervisor.

5) So this leaves me with Charge, 4 patients of moderate acuity, assisting 3 Doctors at beginning of shift, thankfully a happy outcome with problematic family who requires>30 min teaching, IV meds are done by Charge for LVN's except for Reglan ,Saline, Unit Clerk is utilized on ICU to input M.D.orders for my review. I write out and input all meds for new patients and formulate MAR for LVNs as well as override their meds through the night to provide the medications for the new patients.Chart checks on all patients and R.N. assessments on patients dayshift not able to do=4 plus my four. CNA/RN Report sheet for oncoming shift.

6)I talk to House Supervisor at beginning of shift invoking Safe Harbour based on not being able to recieve additional help for the next 3 hours of high activity and a new patient that hasn't been stabilized yet, DX stroke with HBP requiring intervention to acquire prn antihypertensives. She calls her supervisor=CCO whose response is to make sure assignments are safe but she is not going to change anything.

7)3 hours later, patient removes his NGT, 2 patients saved from falls-one by bed alarm and the other close vigilance, delayed medications on the new patient w/o adverse outcome and no variance, omission of med during daytime for Lasix 40 IV q12 x 24 hours on a CHF pt caught and variance written, HBP with frequent monitoring stabilizing and I enlisted the wife to stay overnight with her encephalopathic husband who is restrained based on this being a new environment and importance of her voice and familiar face over the next 24 hours which she agrees to.

8) CCO comes in at 2300 to round and all has quieted down and her assessment of the unit after a 10 minute stay is "Everything looks fine"

9) Should I choose to follow through with Safe Harbour paperwork. There was no major adverse outcome. I do not fully understand the law but have read about other R.N.s being retaliated against from their employer and weakness of the law in the state of Texas in itself.

10) I still may see retaliation from my employer Monday from initiating this action and their attempt to misconstrue my good faith at keeping a safe environment....especially if I don't fill out the paperwork.It appears the decreased staffing will continue in an attempt to force staff into the new roles even though there hasn't been a successful time span alloted for implementation. I have told my co-workers that we can't operate this way again next Monday and its time to embrace the change with my additional reassurance to assist them to learn their new roles. Their attitudes aren't favorable and resistant

11)Please assist with insight and any helpful suggestions...House Supervisor in the past has helped to overlap responsibilities on the unit necessary to stay caught up but is now being told not to do charge functions to promote changes.....Thank You

12) Form was edited to clarify and impart accuracy and definitely not all inclusive...9/29/07

[SaderNurse05, BSN, RN]

I have not worked in LTAC, but this sounds like an absolute nightmare. I cannot imagine how this can be safe for anyone. I did have some experience on a high acuity stepdown unit, and my summation of Safe Harbor is that it is a joke. I was advised by several more experienced nurses that the only people who filed one did not work there anymore. That is one of many problems with working in an at will employee state. The other problem with SH is that the people who wrote it seem to think that the problems are unknown by higher ups and as soon as it is known issues will be resolved. The admin practices are what sets up the unsafe staffing in the first place. I would seriously look into something with less liabilty. My prayers are with you, the residents and your fellow employees. I admire your attitude of looking for solutions and I really hope someone with more experience in LTAC can provide some solutions for you.

[ksettle]

Sader, thanks for the response and prayer. First thing I did when I woke up this morning was come to this forum. I know there are no answers and this being an employee state pretty much beginning to feel like oppression by the "HAVES" vs the "HAVE NOTS". Going to follow up on a recruitment lead to an other LTAC facility and throw my name back into the limited job market this town has to offer. I did CCU for 14.75 years prior to what I thought was decreasing the stress in my life after a CABG x 3 coming to an LTAC for the last two years was like heaven...and we all know, things are always changing....I don't think this is one change I will be able to ride through....Sweet Niblets

[caliotter3]

I would have to agree with sadernurse and urge you to start your job search. This is not going to go anywhere good and you will bear the brunt of negative actions. Better to leave of your own accord at your own timing than to leave adm with the upper hand and start wondering when they are going to axe you. Your other alternative is to put up with everything as it is, say not a word, and still wonder when you will face some kind of retaliation. Good luck.

[SaderNurse05, BSN, RN]

Have you looked in public health or occupational health nursing? With your experience I think either of those might offer you a good opportunity. Also, most of them are days, no weekends or holidays, not a bad thing.

[ksettle]

Update...feeling I have nothing to lose since I am going to proactively look for another job... I completed the Safe Harbour paperwork prior to the 48 hour deadline and just handed it in to House Supervisor. I feel I did this right even if it turns out all wrong...It will be my learning experience and hopefully provide more insight for others. I will share the information as it unfolds. I also learned of another great way to involve yourself if you want to learn more at www.nnoc.net for Texas Nurses looking for a solution to poor staff/ patient ratios

[RN1989]

Congrats for being willing to fill out the papers. Most people won't because it can be time consuming. Unfortunately Safe Harbor really doesn't do anything to help staffing get better. All it does is give you a way to officially register your concerns with the hospital. Of course there is no guarantee that they will do anything but sweep it under the rug. Good luck with your job. Unfortunately this scenario is playing out more and more often in all areas of nursing.