taking extra patients

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Specializes in Director of Nursing.

LTC/SKILLED FACILITY QUESTION: So we have 3 units each unit is aprox. 26 patients for each nurse)  Typically we have 1 nurse per unit. However, there are times when someone calls in last minute or we just can not find coverage.  If we have the 2 nurses split the other unit (which would be up to 10 patients extra) how should I handle refusals by a nurse to take the additional patients? 

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Specializes in Psych, Addictions, SOL (Student of Life).
HARLEYDNS said:

LTC/SKILLED FACILITY QUESTION: So we have 3 units each unit is aprox. 26 patients for each nurse)  Typically we have 1 nurse per unit. However, there are times when someone calls in last minute or we just can not find coverage.  If we have the 2 nurses split the other unit (which would be up to 10 patients extra) how should I handle refusals by a nurse to take the additional patients? 

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You need to take this to your DON and/staffing department.

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With all due respect every nurse should be refusing to take 10 extra patients. 1 nurse to 39 patients is a wildly unfair / unsafe ratio. 
 

The problem here isn't the nurses refusing to split the extra patients. The real problem is that any nurses have agreed to.  Finding additional staffing isn't an urgent priority for managemnt if your current staff will basically do an extra nurses work for free on top of their already significant work load.
 

Please do yourself and the other nurses a favor and stop worrying about ways to force other nurses to work in an unsafe environment and understand that everyone refusing is the only way to force a change. 

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Specializes in NICU, PICU, Transport, L&D, Hospice.
HARLEYDNS said:

LTC/SKILLED FACILITY QUESTION: So we have 3 units each unit is aprox. 26 patients for each nurse)  Typically we have 1 nurse per unit. However, there are times when someone calls in last minute or we just can not find coverage.  If we have the 2 nurses split the other unit (which would be up to 10 patients extra) how should I handle refusals by a nurse to take the additional patients? 

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Do you think that is a safe nurse/patient ratio? 

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kp2016 said:

With all due respect every nurse should be refusing to take 10 extra patients. 1 nurse to 39 patients is a wildly unfair / unsafe ratio. 
 

The problem here isn't the nurses refusing to split the extra patients. The real problem is that any nurses have agreed to.  Finding additional staffing isn't an urgent priority for managemnt if your current staff will basically do an extra nurses work for free on top of their already significant work load.
 

Please do yourself and the other nurses a favor and stop worrying about ways to force other nurses to work in an unsafe environment and understand that everyone refusing is the only way to force a change. 

This ^

HARLEYDNS said:

how should I handle refusals by a nurse to take the additional patients?  

I'd activate whatever your plan is for securing appropriate staffing when you have a call-in. If the only plan is to have the remaining nurses work in (even more) unsafe assignments then that is not a legitimate/reasonable plan.

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Specializes in New Critical care NP, Critical care, Med-surg, LTC.
JKL33 said:

I'd activate whatever your plan is for securing appropriate staffing when you have a call-in. If the only plan is to have the remaining nurses work in (even more) unsafe assignments then that is not a legitimate/reasonable plan.

The problem I ran into at my old SNF job was that it's not considered an emergency to management if they still meet the staffing ratios mandated by law. There were times I would end up with 60 patients alone at night because the two units on the floor were just four halls with a shared nursing station. So if the nurse on one of those two units called out, the other nurse would just have both units, four halls, 60 patients. I called the DNS a couple times to tell her the other nurse called out and she would respond, "okay", and that was about it. Because overall the staffing still met the minimum required by the state. And there were nurses that were fired for escalating complaints so if you really need a job, you do take these assignments, and hope for the best. 

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JBMmom said:

The problem I ran into at my old SNF job was that it's not considered an emergency to management if they still meet the staffing ratios mandated by law. There were times I would end up with 60 patients alone at night because the two units on the floor were just four halls with a shared nursing station. So if the nurse on one of those two units called out, the other nurse would just have both units, four halls, 60 patients. I called the DNS a couple times to tell her the other nurse called out and she would respond, "okay", and that was about it. Because overall the staffing still met the minimum required by the state. And there were nurses that were fired for escalating complaints so if you really need a job, you do take these assignments, and hope for the best. 

 I understand the situation. I could be mistaken but I felt there was possibly a particular implication in the OP question; what to do about "refusals by a nurse;" that is what my response was directed toward. I do not support an action against a nurse for refusing an unsafe assignment. What employers choose to do is on them;  generally speaking I do not support RNs taking actions against each other due to employers' malfeasance or supporting it in any way. I realize there will always be exceptions and also that many people are and/or feel powerless.

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1st -- Happy Holidays Everyone!!

2nd -- Holy Hell, I didn't even know this was a thing.  This sounds scary all the way around.  I too thought the OP wanted to know what to do about a nurses refusal, cause it's ridiculous!?    WHYYYYY are you trying to punish the nurses even further???

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Specializes in New Critical care NP, Critical care, Med-surg, LTC.
JKL33 said:

I do not support RNs taking actions against each other due to employers' malfeasance or supporting it in any way.

Oh me neither, and I never would have thought you would either. I guess I just misread the initial post and then that made me also misunderstand the responses. 

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HiddenAngels said:

1st -- Happy Holidays Everyone!!

2nd -- Holy Hell, I didn't even know this was a thing.  This sounds scary all the way around.  I too thought the OP wanted to know what to do about a nurses refusal, cause it's ridiculous!?    WHYYYYY are you trying to punish the nurses even further???

Happy holidays to you as well ! 

And, this is exactly why I left long term care.   It wasn't the patients, it wasn't the families, it was this BS that went on every single day.....Thirty minutes into your shift :     " Oh, Sally isn't coming, so you and Suzie will have to take an extra 15 patients each.  "     Nope. Nope. Nope. 

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kp2016 said:

With all due respect every nurse should be refusing to take 10 extra patients. 1 nurse to 39 patients is a wildly unfair / unsafe ratio. 
 

The problem here isn't the nurses refusing to split the extra patients. The real problem is that any nurses have agreed to.  Finding additional staffing isn't an urgent priority for managemnt if your current staff will basically do an extra nurses work for free on top of their already significant work load.
 

Please do yourself and the other nurses a favor and stop worrying about ways to force other nurses to work in an unsafe environment and understand that everyone refusing is the only way to force a change. 

I mean even pre COVID known night folks at LTC/SNF to take 30 to 50 patients. Have seen SNF/LTC average 15 to 20 patients during the day after COVID. Probably some out there with 50 during the day though.

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