Unsafe assignment?

[_Skittles_]

I'm not sure how to handle this but yesterday I got to work and was assigned a very heavy assignment. A new chemotherapy, a rapidly dying patient, a pt that needed blood but has very severe reactions every time no matter what and a pt who was in SVT just the night before. 2 were new admissions and one had sugars in the 400s.

I told my assistant manager right off the bat that this was an unsafe assignment and the nurse I got the group from (minus the chemo pt) told her it was extremely heavy. She told me she would help but proceeded to go MIA for the entirety of the shift despite multiple requests for help until I walked into the room she was sitting in looked her in the eye and said "you need to help".

Even then when my pt died she didn't help with anything - she knew I was a new nurse and this was my first death and didn't even say a word about what the process is in terms of donation and pronouncing. Question is: what can I do so this never happens again? How should I deal with this assistant manager?

[Galendria]

Is your assistant nurse manager also the charge nurse? If not, were they available to help? Its also ok to ask other nurses for help (and ideally on floors with good teamwork, they should be offering to help you if they see you are drowning). Some hospitals (especially those with unions) have a form you can fill out that says you are taking the assignment against your better judgment. We have a form like that, and if a nurse fills it out it goes to the union, our nurse manager (who has to file a response to the complaint), and the departmental manager.

Sorry to hear about that day. Days like that are the pits

[Yave]

Hi Skittle,

I am so sorry to read your unsafe assignment story. I empathize with you. I am not sure what nurses get from making assignments that seem almost impossible for the tasks to be completed. I see those nurses as burnt out. When an assignment is unsafe; the people that suffer most are the patients. The situation can be very difficult. Sometimes assignments are made with personal feelings much more as a way to get back at a nurse. I am not accusing you of being at fault for any misdoings. I think you should have a talk with the nurse. Try not to complain to anyone else, because complaining to other nurses might come back to bite you. Tell the nurse that you need to have a talk with her and discuss the safety issues for the patients. I would have said to her. I will appreciate if you will help me vs. you need to help. Expect to meet more like her in your career. I tell nurses try not to do the same to other nurses. There were times when I felt so angry towards other nurses, but I made a fair assignment. Making a fair assignment puts less of a burden on me.

[MunoRN, RN]

What is or isn't an unsafe assignment is unfortunately very poorly defined. It varies by nurse; what's unsafe for one nurse might not be unsafe for another, and the perception of what's safe varies by facility and unit; an assignment that nurses in one facility find unsafe might an assignment that nurses in another facility might find much safer than their normal assignments. In reality you could argue that all acute care nursing assignments are unsafe.

The most effective way for us deal with disagreements about assignments is to be able to clearly define what can be expected with a particular assignment, and to communicate that.

As an example, the OP's description of their assignment could be anywhere from easily doable as a med-tele assignment, or beyond impossible as a med-tele assignment. How many patients in total are there? What are the expected time requirements of each patient? Is there more going on with the chemo patient beyond just chemo induction? Has the patient with SVT yesterday shown any signs of continuing instability? It's generally not difficult to show that your patient's needs in terms of time exceed the amount of time available, but it's still something you have to show in order to make a good case.

[Gooselady, BSN, RN]

If you can't get your manager or asst manager to pay attention to your concerns, I don't know any other way you can go about avoiding this happening again Especially when you requested help and she ignored you over and over again. Good grief!

Something is wrong with the management where you work, I'm sure you could rattle off a few more issues that occur off and on due to management not listening to the nursing staff (or helping them FGS).

We had forms to fill out specific to unsafe assignments. I remember once being in charge on a horrid night, and a float nurse ended up with a very difficult patient load, definitely inadvertently as I don't deliberately assign things that way. I helped her as much as I could, and requested extra nursing staff which could not be supplied by staffing. She asked me about where we keep the unsafe staffing forms, and we turned the unit upside down looking for them! Finally a nurse with computer geek skillz (probably not saying much ) found them in our Docushare. They weren't exactly easy to find, which was interesting.

We printed up a bunch of them and 'hid' them, after another nurse mentioned she'd printed a bunch of them up and they 'disappeared'. Sounds a bit paranoid to me but heck, who knows.

From your OP I agree your assignment was unsafe and is a perfect example of the issue. It's a matter of going to the effort it will need to take for you to find the form, fill it out and then . . . follow up. That part is the hardest, because by then, you're 'over it', it's days later and you are busy and preoccupied with whatever is going on NOW. So nurses don't always follow through (raising hand to include myself) and then complain that 'nothing gets fixed'. Whether or not following through WILL fix it, at least we're doing what is available to us TO do.

Your situation is made worse by a particularly USELESS asst nurse manager, don't forget that. There are management issues that contributed heavily to this issue. IMO, management issues like that are deal breakers, if they keep on happening, I'd start looking for work elsewhere out of sheer self preservation