Understaffed Surgical Unit

[rnz17]

I am concerned because for the last few months, my unit has been understaffed. Ratio is 1:6, but Most of the time we end up taking 7 to 8 patients. The worst part is not only the understaffing itself but that management and administration have failed to do something about it. I believe that patient safety it's been compromised since even when we're understaffed we have to be taking ER admission or transfers from other units and even if we try to refuse, management just says that we have to take the patients. I have thought about calling Safe harbor but I'm a little bit hesitant to do so. What would be the next step (report to the board of nursing), since administration clearly just cares about taking in patients to keep making money even if they dont have enough staff? Has anyone had a similar situation? Or have done something that has worked for them?

[MunoRN, RN]

Other than mandated ratios, there not much to be done about it, so long as management calculates they can save more money than they'll lose due to the effects of understaffing.

Keep in mind that safe harbor does not protect your job and does not enable you to refuse taking additional patients, it does help protect your license. If you refuse to take additional patients you can be terminated and you don't really have any recourse.

[libran1984, ASN, RN]

Keep on trucking along

[firstinfamily, RN]

Does your facility have a "corporate compliance program" ? One of my facilities had this in place so that any concerns could be communicated to upper management through an anomynous help line. Anytime patient care or safety is compromised it is a major concern for nurses and for management. Patient safety is one of the JACHO primary flags, is your facility willing to take this risk?? Are there incident reports being filled out for patient falls? If so, tracking these can be used as a tool to present to management to bring more attention to the issues of patient safety. Start a Falls program for your unit, there are many resources on the net to find how to start a falls program. When I worked LTC we used bed alarms which helped because they would alarm before the patient was out of bed and at least that helped to prevent falls. You must realize that acuity levels are not usually addressed to justify staffing. It is usually related to a numbers game or pt census, you will always be expected to take patients no matter what is going on and you will be stretched to the max. If you feel management is not listening to you, then perhaps it is time to bring their attention to it in a manner that is professional and conclusive. Start tracking the falls and safety issues. Get your rollar skates on because it usually gets worse before it gets better.

[Deepinthegame]

Only suggestion- Don't let nothing happen on your watch . It's going to be your fault no matter what . Just watch your 6 . Something bad always happens -dont let it be you.

[lindarn]

Tracking fall, and other other significant patient safety issue, is a great idea. it makes the problem concrete. Keep copies of staffing forms for documentation of staffing.

My next step would be to contact the senior partner of the Law Firm, who defends the hospital.

Make it known, that the nursing staff is keeping track of patient incidents, etc, and that if the hospital gets sued due to a patient issue, that you will be happy to provide the opposing counsel with these documents.

Throw THEM under the bus for a change.

I also have advocated, making copies of ALL INCIDENT REPORTS!!

If something happens, i can assure you that any report that would exonerate you, and find fault with the hospital, would quickly disappear. You don't have to make it obvious you are doing it. Take a picture of the report with you smart phone, and e mail it back to yourself.

You can also sent the reports to Risk Management yourself. Reports that exonerate nursing staff, but implicate the hospital will never make it to Risk Management.

An ounce of prevention is worth a pound of cure.

JMHO and my NY $0.02

Lindarn, RN, BSN, (CCRN)

Somewhere in the PACNW

[RNperdiem, RN]

If you have been working there long enough, figure out if this high ratio is a temporary problem (will resolve once new hires finish orientation and nurses return from maternity leave) or is a chronic problem.

If there are some nurses who have been there a long time, they will be able to tell you if it is chronic. If there are no nurses who have survived long-term to ask; there is a serious problem.

Is your resume up to date?

[kbrn2002, ADN, RN]

Only problem with making copies of incident reports is that they are considered company property. If you are caught doing that you will most likely be fired immediately, if not worse. Even if you are never caught you probably wouldn't be able to use the reports without serious repercussions for yourself anyway, again because they are considered company property.

[lindarn]

If you take a picture of it with your smart phone, it is YOUR property!

As usual,

JMHO and my NY $0.02

Lindarn, BSN, CCRN (ret)

Somewhere in the PACNW

[herring_RN, ASN, BSN]

You can keep a diary. Each and every shift.

Whenever staffing is insufficient tell a manager or supervisor. Write who you told and what you said in the diary.

If there is a sentinel event or error put that in the diary. Note when an incident report was made.

If you do it every shift it can show the mitigating condition of unsafe staffing, that management was told, and nothing was done about it.

Even better would be to write a letter and have all who agree sign it. Physicians should want safe staffing so you should consider asking them. Clerks, monitor techs, and nursing assistants too should sign.

Go up the chain to the CEO, if possible.

KJeep it. It can help in court.

If you ONLY write when something happens it will be suspect so write shifts when patients did well and everything done on time too.