Staffing

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I am desperately looking for a "rule" or policy or something to take to upper management that says you must have TWO staff members in a department when there are patients. I work in an observation unit where they are currently staffing only one RN at night with no ancillary staff, no aids, monitor tech, desk secretary, no one! The observation unit is supposed to be part of the ER but it's in a separate area. My director says that there is a charge RN available in the ER for help if you need it. Currently we are taking 6 patients, by ourselves with NO help from anyone! And we also are responsible for drawing all our own labs and doing our own EKGs. There isn't even a person in the department to answer the phone when you are in a patient room. How are you supposed to walk your 85 year old patient to the bathroom and get that phone at the same time? We all know that this is crazy and that when it gets nuts you often don't have time to call someone over from another super busy department. To boot I am now orienting a brand new nurse to work ALONE on midnights. I feel like it's a sentinel event waiting to happen but no one is listening. I need something to open their (managements) eyes to what a major problem this is and how unfair it is for this brand new nurse. Any help would be great!!

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I agree with you. We once had admitted overflow patients in a conference room awaiting their beds to be ready on the floors. No 02, no nothing, 1 nurse, a floating aide, no call bells, but we did have a phone to call the ER if needed.

The patients were stable, what could possibly happen?

All was fine and dandy until the 1 nurse fell in the middle of the room and broke a bone, calling for help until someone down the hall heard her. She sued for a bundle and won.

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Can you imagine if something happened to the patient? And we all know there are 23 hour obs patients that have no business being in observation all the time! Just today I had a hospice patient who was going to pass away and 4 other patients BY MYSELF! How can I give him the care he deserves and take care of 4 other patients with absolutely no help and orient someone who is brand new? I am not superwoman! They seem to have taken the admit vs. observation criteria and thrown it out with staffing guidelines. So much could go wrong it's just a matter of time until someone dies, someone who's not on hospice.

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Specializes in Critical Care.

Unfortunately, outside of California there are no defined staffing requirements, but every state does require nurses to be able to take their legally required breaks and employers are required to provide a licensed person to hand patients off to during a break. How do you take breaks currently?

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Specializes in SICU, trauma, neuro.

So upper management has their heads up their colons...what does risk management say?? That totally seems like a sentinel event waiting to happen. At my previous ICU, they converted a small room into an overflow area during renovation. The more stable pts were kept there, but even if there was only one pt, there was always a minimum of 2 RNs.

What do they say is the plan for a violent pt? A code where one RN is on his/her own--they happen more often than you'd think in my hospital's obs unit. An incapacitated nurse like Farawyn mentioned? Who covers for breaks like MunoRN asked? What is their plan for OSHA compliance with a lone RN and a 2-assist pt?--wheelchair bound people can need a 23-hr hospitalization as much as elite athletes can. What is their plan for backup for this very novice new nurse?--she WILL make new grad mistakes, more so if she has no expert to ask questions of?

Yes, I'm very curious to know what risk management thinks of this plan.

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Specializes in Critical Care.

What's the plan for a code? Yes, I know you can code someone on your own in the field, but I think (at minimum) the public perception of a nurse running a code alone in a section of the hospital would be unfavorable.

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Specializes in Critical Care.
Can you imagine if something happened to the patient? And we all know there are 23 hour obs patients that have no business being in observation all the time! Just today I had a hospice patient who was going to pass away and 4 other patients BY MYSELF! How can I give him the care he deserves and take care of 4 other patients with absolutely no help and orient someone who is brand new? I am not superwoman! They seem to have taken the admit vs. observation criteria and thrown it out with staffing guidelines. So much could go wrong it's just a matter of time until someone dies, someone who's not on hospice.

This happens on the floor all the time (a comfort care who's actively dying + four other patients.) Not that it's right, or feels any better, as the caregiver.

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I would report to risk management as well as compliance.

You should at least have one CNA who can do double duty of answering the phone and helping. Or an ER tech who can draw your labs and do your EKG's.

I would not want to be responsible for 6 patients and no backup.

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Specializes in Med/Surg, Ortho, ASC.

That's nonsense. Our 2-RN minimum comes from our written policy. If your managers truly do not understand such a basic need, then I think you're hosed. (and they're idiots) Personally, if I showed up for that assignment, I would decline it as unsafe for patient safety. Then I would march to Risk Management (as previously mentioned) and file a report on unsafe working conditions.

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In the middle of the night a co-worker would have bled to death, had there not been a second person on duty at a military site where I once worked. Notwithstanding that there had to be two people on duty to comply with security's 'two-person integrity', there were two people on duty for safety reasons. If the military can see the reason for common-sense safety, there is no excuse for a civilian healthcare facility.

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Update: I came on shift yesterday at 7am and there were 9 patients in the unit (full house). The nigh shift RN had done 8 of those admissions after 10pm. She had only the help of the ED charge RN (who was never trained on admissions or in the obs unit) floating over. I implored the new night shift RN not to take so many patients by herself. I've had this discussion with her in the past but she doesn't wasn't to make waves being so new. My shift (days) got two RNs (plus my orientee RN), a CNA who was awesome, and a monitor tech for the same patient load. One of the patients asked if he could speak with the charge RN to make a complaint. Kind of baffled because I had just got there and had only been in his room once, I got my charge and went in the room with her. The patient was very upset about the care he had received on nights. He said he had his call light on for hours before someone checked on him. He said that the RN was nice but was totally overwhelmed. He said he was scared all night because he knew if his blood sugar were to bottom out again that the nurse wouldn't catch it until too late. He was sneaking food from the unit kitchen just in case. He comes in frequently for sugars in the 20-30s so it's a very legitimate fear. He was nice about his complaint, not blaming the RN just wanting to make the unit more safe at night. I had him write down all his concerns on a unit questionnaire we have. Then I asked if I could have my manager speak with him. He said absolutely he'd love to. So I had her go into his room. She was there for about 30 seconds before she came out and told me he needed pain meds. 😕 she completely blew off all his concerns. So frustrating!! I made a copy of his questionnaire with his permission and sent it to risk management like others suggested. Probably will piss off my boss but whatever. How bad does it have to be when patients don't feel safe because of staffing.

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