Unsafe Practices: What to do?

[NurseAimee]

Good evening everyone, I have not posted very much on this site however I have read quite a bit and have a friend who posts a bit so I feel very comfortable coming here. My question is this - who do you report it to you when you feel you have unsafe staffing practices? I work in a postpartum area doing couplet care and basically we are always given at least 5 couplets from the start and that does not count new admissions, one day I came in and had 7 couplets to start. How is this safe? Its not! And sometimes we have no help, no unlicensed help. We are responsible for everything with the couplets including meal trays, vital signs and call lights. I will say if we have 6 or more couplets we do sometimes have an unlicensed person to help but thats only if they have not called out.

Other nurses have tried to talk to management about it and get told that its not that bad, etc. So how do we as nurses find a way to show them it is that bad? Is there some authority figure that comes in and does suprise inspections? A friend has called the board of nursing and they said that they do not make decisions regarding the number of couplets. I'm sure that I've read in AWHONN that safe is 4 couplets to one nurse but obviously someone doesn't care? I don't know. I do not want to leave and find another job because I love where I work plus I have a financial obligation there due to schooling anyway but I do enjoy my job I just wish I could get them to stop putting us in unsafe practices. And you can't really refuse an assignment because then you would be leaving your teammates with that much more work, plus I'm sure they'd fire you for doing that anyway so we all just deal.

Any suggestions for who to contact for this type of thing. It's not every day but most days.

[Turtle in scrubs]

Unfortunately I don't know the answer to your question, but I sure wish I did. This would mean finding a person who both cares, and has the power to change things, and I don't know anyone who has both.

The sad truth of it is that when an employee complains about staffing ratios it usually gets turned around that the employee is slow and can't hack it.

[clairebearrn]

OMG that is so unsafe! Is your hospital unionized? If so, contact them. Otherwise, I would join the nurses on my floor and would go directly to the CNO of the hospital to let him/her know about the situation. Does your state have ratios for nurses?

Clara

[RN1989]

In order for someone like the BON, the state regulatory agency, or JCAHO to step in, you MUST have documented how this staffing has affected care and show that there have been poor outcomes related to staffing. If you guys are only have near misses - you don't have much of a case for a regulatory agency to come in and investigate.

I recommend that you do research on the subject, finding standards from AWHONN, etc. and write up a complete and rational proposal outlining possible implications, etc. Give it to your manager as well as all the VPs, CNO, Risk/quality managers etc. See where that gets you. You need to follow the chain of command on this unless you have already had a documented incident that you can report to regulatory authorities.

If you don't get anywhere with admin, consider a journalist in the area. They are always looking for good stories if you have the documentation to back you up.

Don't expect anything to happen overnight. DO anticipate all hell to break loose and your job to threatened. Good luck!

[bagladyrn, RN]

The only suggestion I can add to the posters above would be to document your concerns in a memo to the Risk Manager for the hospital, including copies of documentation such as the AWHONN standards for safe nurse/patient ratios on mother-baby. I'd emphasize in the memo both my concern for patient safety (and satisfaction!) and for the legal liability of the hospital given that OB is such a high liability area if any untoward outcome should occur related to inadequate staffing.

[cherokeesummer]

This is a very important question and one I am wondering too, same types of things going on here.

[babyktchr, BSN, RN]

I agree with the above. Everytime you are out of standard (couplets over 4) you should be writing some sort of safety tracking tool or whatever your institution calls it and forwarding that to risk management along with AWHONN guidelines for staffing. This at least will be on record if something were to ever happen. They get enough of them, and they will listen. I would also forward them directly and not thru your manager. Seems sneeky, but management can file those in the circular file before anyone ever sees it.