This seems unsafe to me..

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Specializes in Med/Surg & Rehab.

I'm hoping to get some opinions. Recently management has come to me asking why I did not take a break a couple of times in one week. The simple answer is, I don't feel it's safe for me, the only nurse on the floor, to leave the floor in the charge of a single LNA. An LNA that has only been an LNA since Oct.

I work on a rehab unit. Sometimes I have 20 patients, other times census is low and we get down to 9 or 10. Normally there are 2 LNAs but when census is low, they cut one and I'm down to one aid. Last week there were only 9 patients and we had 1 LNA and myself. 4 out of those 9 are on bed/chair alarms and are in rehab for fx sustained from falling. These people are very confused and impulsive, especially in the evening (I work 3-11). I am expected to leave the floor with these impulsive patients on alarms in the care of an LNA. What if while one alarm is going off and she is in with one patient, another alarm goes off. If she is tied up with one, the other could end up on the floor. I expressed this to the DON and she really didn't acknowledge my concern, only telling me, "you need to leave the floor for a break." If they really want me off the floor, they need to send some coverage to my floor so I can leave. It's my license, not there's. I've worked other places and the nurse NEVER left the floor without another covering the patients.

What should I do?

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Specializes in Critical Care, Education.

Hang in there - you're absolutely correct. If you have any doubts, just imagine yourself trying to answer this question from a plaintiff's attorney.... "So, Nurse X, can you explain why you thought it was OK to abandon your patients for 15 minutes with only an LNA to care for them?" Although we all are expected to comply with employer policies, we have a much higher duty to abide by our own professional regulations/obligations. You can always get another job.... another license, not so easy.

If administration wants you to take breaks, you need to have coverage by someone who is qualified to do so.

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Specializes in Trauma/Critical Care.

What is the break policy of this facility?

Does it state that a licensed nurse needs to be on the floor, at all time?? If so, you can use this opportunity to initiate change, by pointing this out. If not, I am going to be the devil's advocate, but I can also see where your employer is coming from.

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Specializes in Infectious Disease, Neuro, Research.
What is the break policy of this facility?

.

Their policy is pretty much irrelevant, in this situation. The problem is, they don't want to be charged with violating labor laws, nor do they want to hire more staff so that they wouldn't have to be in violation.;)

Keep every bit of paperwork you can, regarding your punch-in/punch-outs. It would not surprise me for the time keeper to "insert" comp-time, in place of OT, as OT raises more eyebrows during an audit.

Edit: to be politically "safe", and still address the issue, sending an email to the effect of, "I have been reluctant to take my breaks based on the needs of the residents, and the inexperience of the support staff. blahblahblah... Is it possible to re-evaluate the staffing matrix, now, or in the not too distant future...?" Ultimately, its CYA. Once you inform the Facility of the risk, they are responsible. Yes, you have a responsibility to your patients; you also have a responsibility to be "safe and competent", which by Fed labor law, means you have a break or two.

Don't push it too hard, but absolutely keep an email trail.

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Specializes in Infection prevention and control.

I have been in similar situations and have on several occasions taken a break in the courtyard of the facility with a couple of my high risk residents. I would pull my paper charting and the my two lil ladies who could not seem to keep themselves off the floor out there with me and kill about 4 birds with one stone. Leadership had a HUGE issue with it but I cleared it up with this: If you don't want to come in here and help me reduce the liability that will fall on my license you are just going to have to deal with it or fire me.

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Specializes in Med/Surg & Rehab.
What is the break policy of this facility?

Does it state that a licensed nurse needs to be on the floor, at all time?? If so, you can use this opportunity to initiate change, by pointing this out. If not, I am going to be the devil's advocate, but I can also see where your employer is coming from.

I believe the policy of the facility is irrelevant. The policy of the facility may not be the policy of the BON. The facility isn't the end all be all of my licensure, the BON is. The policy just puts policies and procedures in the to cover their bums, we are the ones as licensed personnel that are in charge of knowing what is right and wrong based on our practice acts. The facilities are just businesses that are out to make money, not protect us or our licenses.

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Specializes in Med/Surg & Rehab.

Thank you everyone for your replies. I appreciate them very much.

I agree that a paper trail is the way to go. Last Thurs. I got an admission at 5pm, and everyone from admissions was gone for the day. The patient's name wasn't even in the computer, I had to literally start the process from scratch, not to mention a full assessment as well as paperwork. During this time I also had a patient that was actively dying and I was tending to him as well as comforting the family at his bedside. I also had 9 other patients to handle. Keep in mind, this is not a nursing home, these patients are not residents that LIVE there.. they are in the facility because they have medical reason to be there and are not stable to be home. I have IVs to tend with Q1h medications in some instances, and many ortho patients. These are not stable patients that are just "up in age." Regardless of policy (which I'm unsure of but will look up tonight), it's never safe to leave patients in the care of an LNA. JMO.

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i would totally go with rob72's advice.

you can consider me a paranoid nurse, but i believe in cya at all times...

knowing the employer is not your friend.

leslie

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Specializes in Infection prevention and control.
i would totally go with rob72's advice.

you can consider me a paranoid nurse, but i believe in cya at all times...

knowing the employer is not your friend.

leslie

Agreed. Best lesson I ever learned that was not taught in nursing school. I get picked on by other nurses because I chart and document so much but I will tell you this, I have had to go head to head with the State of MI as well as surveyors and my documentation has always held up where as other nurses are not so fortunate because they did not heed the warning CYA!!!

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Specializes in Home Health.

You might discuss this with you BON and with Department of Health and Hospitals in your are to see what your liabilities are.

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Specializes in NICU, ER, OR.

god bless you, and all others that do the kind of nursing thst you do. You guys are a better nurse than me, I couldnt do it. This is why I work in the OR. (the best kept secret in nursing!!!)

but your management is getting scared of the labor laws, and afraid of them getting dinged for no breaks...... but if its not safe, its not safe..... DO NOT leave if you think its not safe, no matter what they say about your mandated breaks and nonsense..... but I think you allready know that...your doing the right thing.....

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
Their policy is pretty much irrelevant, in this situation. The problem is, they don't want to be charged with violating labor laws, nor do they want to hire more staff so that they wouldn't have to be in violation.;)

Keep every bit of paperwork you can, regarding your punch-in/punch-outs. It would not surprise me for the time keeper to "insert" comp-time, in place of OT, as OT raises more eyebrows during an audit.

Edit: to be politically "safe", and still address the issue, sending an email to the effect of, "I have been reluctant to take my breaks based on the needs of the residents, and the inexperience of the support staff. blahblahblah... Is it possible to re-evaluate the staffing matrix, now, or in the not too distant future...?" Ultimately, its CYA. Once you inform the Facility of the risk, they are responsible. Yes, you have a responsibility to your patients; you also have a responsibility to be "safe and competent", which by Fed labor law, means you have a break or two.

Don't push it too hard, but absolutely keep an email trail.

I agree with leslie.."you can consider me a paranoid nurse, but i believe in cya at all times...

knowing the employer is not your friend." and Rob72......The problem is, they don't want to be charged with violating labor laws, nor do they want to hire more staff so that they wouldn't have to be in violation.;).....and to leave without being relieved is abandonment.

Nurse's Duty To A Patient

The Board has investigated and disciplined nurses in the past for issues surrounding the concept of abandonment as it relates to the nurse's duty to the patient. All nurses, regardless of practice setting or position title/role, are required to adhere to the NPA and Board Rules. The "core" rules relating to nursing practice, however, are Rules 217.11, Standards of Nursing Practice, and 217.12, Unprofessional Conduct. The standard upon which other standards are based is 217.11(1)(B) "...promote a safe environment for clients and others." This standard supersedes any physician's order or facility's policy, and has previously been upheld in a landmark case, Lunsford v. Board of Nurse Examiners, 648 S.W. 2d 391 (Tex. App. -- Austin 1983). The concept of the nurse's duty to promote client safety also serves as the basis for behavior that could be considered unprofessional conduct by a nurse. http://www.bon.texas.gov/practice/position.html

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