Unsafe Environment for Graduate Nurse?

kbrn2002, ADN, RN · May 22, 2019

Yeah, that's so not OK. Expecting a nurse still in the beginnings of orientation to accept a full patient load is just asking for trouble.

OldDude · May 22, 2019

We have this option in Texas...don't know about your state.

"Safe Harbor (SHPR), which may be initiated by a LVN, RN or APRN prior to accepting an assignment or engaging in requested conduct that the nurse believes would place patients at risk of harm, thus potentially causing the nurse to violate his/her duty to the patient(s). Invoking safe harbor in accordance with Rule 217.20 protects the nurse from licensure action by the BON as well as from retaliatory action by the employer."

Emergent, RN · May 22, 2019

7 patients is too much for an experienced ER nurse!

ruby_jane, BSN, RN · May 22, 2019

While waiting for some ER nurses to weigh in- We never drill for this. So now's your chance to practice what you would do in your own head. Decline the assignment initially, seek advice from the manager (and given the situation you've described, there may not be much help forthcoming.)

You're in a different situation. You have some familiarity with how processes and equipment work. That may give you a boost even though you're not currently an RN.

It may also have been thusly: These seven may have been walking well and the preceptor may have felt that the nurse had skill enough to monitor seven uncomplicated and brains enough to realize if someone began to CTD. Or that nurse may have decided already that the grad nurse isn't fit for the ER and tried to make (a very unsafe) point.

JKL33 · May 22, 2019

Try to secure a position elsewhere.

I wrote more and erased it because this scenario as described is a total non-starter. Don't try to lay down the foundation of your career this way.

KMcRN19 · May 22, 2019

Absolutely agree. I am in the state of PA so I’m not sure if we have an act like that, I definitely need to get in touch with that. The other thing that complicates everything is my boss’s last day was yesterday, so NOTHING was done about it at all. Currently waiting for them to hire a UD & new clinician too! So the entire structure of our ER is not there at all. It’s so sad to say that because I love the people I work(ed) with & it’s all. Changing. Nurses who have been there for 10+ years are leaving. But, my heart I don’t think this will set me up for success. I really appreciate all of your responses

JKL33 · May 22, 2019

Seven patients means the most prudent ED nurse will not be delivering prudent nursing care even if in the end they all turned out to have sprained pinky toes and sore throats. But this place gave the 7 patients at a time to a nurse who not only has negligible familiarity with the ED but is also newly licensed. And is supposed to be learning, not serving as a warm body working a conveyor line.

Don't do it. Even if you're smart, quick, and fairly resilient, you will be rightfully scared [blank]less even in your dreams. ?

KMcRN19 · May 23, 2019

Update: I called talent acquisitions and informed them I want to apply for new positions yet stay in house with the company. She sets me up with a few med-surg interviews in the area, which im ok with to get my feet wet; within an HOUR the DON calls my cell phone. Trying to explain that staffing is bad everywhere (duh), it’s not as bad as I think (that’s why we have to shut half the ER down due to lack of staffing), they’re hiring 2 SWAT nurses, bringing back one RN (yeah the one they caught sleeping on the job in front of family members!) things will get better & more established after we get a new unit director / clinician, that we have plenty of experienced RN’s that aren’t planning on leaving (yeah, 5 of them. 4 full time... and that’s not what they tell me!) and that maybe I don’t realize that med/surg is stressful too & maybe I need to shadow before I interview there... I worked as an intern in their med surg, CCU, and 1 year of ER. I know how things differ between units. Sounds to me she is fully aware of the staffing situation and she is trying to not be one less RN. Thoughts?

Guest219794 · May 23, 2019

Good news- Your license is far more durable than you think. There is a really weird and inaccurate belief among many that our licenses are fragile, and need protection. Go to your BON web site and have a look at how nurses get disciplined in your state.

I am not sure what you are asking here. Is a 14 bed ER staffed by a competent ER nurse and a new grad safe? No. Simple answer.

Should you take a job there and see how it plays out? Hard to tell. It depends on what your goals are. If you want to be a well trained nurse working in a safe environment, you will have to find a place with a well established training program, that has earned a good reputation for safety.

On the other hand, your priorities may be more focused on pay, commute time, and other factors.

What are your priorities?

rzyzzy · May 24, 2019

3 hours ago, hherrn said:
Good news- Your license is far more durable than you think. There is a really weird and inaccurate belief among many that our licenses are fragile, and need protection. Go to your BON web site and have a look at how nurses get disciplined in your state.

Excellent advice, except for the part about licensing being anything other than “fragile”, which is highly state-specific.

In my state, a simple accusation made to the state makes your license info turn red & puts an “under investigation for XYZ” within a day or two of the accusation being received by the state. Six months or a year later, sometimes two or three years later, you’ll have an opportunity to prove yourself innocent. My state’s board meets three times a year, for two or three days at a time & you can count on one hand the number of nurses who walk away without at least a “letter of concern”, which they don’t consider to be discipline - tell that to a jury when you really do make a mistake!

please don’t be flippant about the BON unless you have first hand knowledge of how the process works. I do - I was falsely accused and one of the handful who walked away “unscathed” - if you don’t count the scarlet letter on the licensing site for seven months, the lost wages for seven months or the $2000 in attorney’s fees to clear my name.

Anyone can make a complaint to the board & if that complaint isn’t glow-in-the-dark “innocent”, you’ll have at least six months of anal-puckering to deal with. (In my state).

frenchtoastwaffles, BSN, RN · May 24, 2019

I would be interviewing with other units if I were you. If a 14 bed ER only has 2 nurses on it, what happens on the days when it's that nurse with a 2 week orientation and you alone after your orientation is cut short? This is setting you up for failure, moral distress, injury, poor patient outcomes... get yourself out of there and trust your gut on this one.