unsafe staffing

[sockov, ADN, ASN, BSN, CNA, LVN]

Hello

I was under the impression from a legal standpoint that if your unit is short staffed and you get unsafe pt. assignments due to it, the safe thing to do to protect your license and not get accused of patient abandoment is to do the best you can and "write it up" as an incident report. For the incident report is to prove you tried to fix the problem but administration won't fix it, and it proves to the courts (incase there's problems) and the jury that if something were to happen because of this, then the jury would be more sympathetic to the bedside nurse for trying and notifying the right people. At my hospital, I found out that one of the nursing administrators told us that it was innapropriate to use the write up system for that purpose. I feel that is wrong.

what you all think? and any advice on how we can have legal paperwork when staffing isn't good but yet you are expected to work like you are fully staffed.

thanks.

[LilyBlue]

I once asked a nurse attorney about this, and she said it was a good idea as far as showing you had intent to get help, but that when it came down to it, you would still be liable for any damages a patient receives under your care, regardless of the fact you have ten patients or whatever.

[BradleyRN]

Refuse any assignment you feel to be unsafe. If you accept, and something goes wrong, it will be all on you. The admin will not be there to back you up. In fact, they will blame you for accepting an assignment you knew you couldnt handle. You owe it to your patients and your license to refuse. I dont know where you heard that you should just accept an unsafe load and write it up afterwards, because that would be a breeding ground for negligence, and it will be all yours. I wish there were an easier way, but we simply must stand up for ourselves.

[Tweety, BSN, RN]

They are telling you it's "inappropriate" because they don't want you to rock the boat.

The above poster is correct. If something happens, it's still your license. The nursing board is going to ask you "why did you accept this unsafe assignment". Your case is going to be greatly enhanced when you answer, "I didn't want to abandon the patients, but there is documentation that I accepted with objection".

A few years ago our day shift was going 9:1 on med surg. during a staff shortage. Complaining to management and each other did nothing. What fixed it is when risk management was made aware of the situation. It is perfectly appropriate to notify risk management of an unsafe situation.

Rock the boat. Make a stink. Be labeled the trouble maker. Be a patient advocate not a victim. Always document unsafe staffing. We will be given as much crap as we are willing to take.

[meandragonbrett]

I just refuse the assignment.

[lindarn]

They are telling you it's "inappropriate" because they don't want you to rock the boat.

The above poster is correct. If something happens, it's still your license. The nursing board is going to ask you "why did you accept this unsafe assignment". Your case is going to be greatly enhanced when you answer, "I didn't want to abandon the patients, but there is documentation that I accepted with objection".

A few years ago our day shift was going 9:1 on med surg. during a staff shortage. Complaining to management and each other did nothing. What fixed it is when risk management was made aware of the situation. It is perfectly appropriate to notify risk management of an unsafe situation.

Rock the boat. Make a stink. Be labeled the trouble maker. Be a patient advocate not a victim. Always document unsafe staffing. We will be given as much crap as we are willing to take.

And don't forget my favorite mantra: MAKE COPIES OF EVERYTHING THAT YOU TURN IN, BECAUSE AS SURE AS THE SKY IS BLUE, THESE FORMS WILL DISSAPEAR IF THERE IS ANY NEGATIVE RESULT FROM THE UNSAFE STAFFING!!! I will also add, get a group together, put your ducks in a row, and make an appointment with the senior partner of the law firm who represents the hospital. Tell him the facts of life concerning what is going on, and that, if the doo-doo hits the fan, that you have the documentation to put the blame where it belongs- on the hospital. JMHO and my NY $0.02.

Lindarn, RN, BSN, CCRN

Spokane, Washington

[Jules A, MSN]

It is perfectly appropriate to notify risk management of an unsafe situation.

Rock the boat. Make a stink. Be labeled the trouble maker. Be a patient advocate not a victim. Always document unsafe staffing. We will be given as much crap as we are willing to take.

I absolutely agree with notifying management but when it comes to making a stink how often does it really help and not get a bull's eye painted on your butt? Its been my experience that there will be times when we are short staffed, largely because of call outs and other unexpected problems. I don't know the best solution but when all the other units are strapped due and we can't get an agency nurse to come in sadly I've found its best to just pitch in and do what you can. I'd like to discuss this more and hear others thoughts and strategies on how to deal with it. Its always easy to act like demanding the perfect working conditions is the only thing to do but frankly around here we are quite an incestuous bunch so having a good reputation is important and not being a team player isn't very conducive to getting work.

[nicurn001]

. Its always easy to act like demanding the perfect working conditions is the only thing to do but frankly around here we are quite an incestuous bunch so having a good reputation is important and not being a team player isn't very conducive to getting work.

Actually I think in the circumstances you describe , it is not easy to demand adequate staffing ( NB. no one is demanding perfect working conditions , that state will never be achieved ) , It takes courage to stand out and , point out the obvious , that staffing is inadequate .

As to reputation , shouldn't we as nurse , recognise the members of our profession , who are trying ro ensure safe staffing and thereby safe care of our patients , rather than encouraging nurses to be good team players , who when they commit an offence ( poor patient outcome ) are sent to the penalty box ( risk losing their license ). Whilst the team management , can say " we were not aware of poor staffing , nobody made us aware of the problem ", then walk away scott free without penalty and no incentive to change their behavior .

[Tweety, BSN, RN]

I absolutely agree with notifying management but when it comes to making a stink how often does it really help and not get a bull's eye painted on your butt? Its been my experience that there will be times when we are short staffed, largely because of call outs and other unexpected problems. I don't know the best solution but when all the other units are strapped due and we can't get an agency nurse to come in sadly I've found its best to just pitch in and do what you can. I'd like to discuss this more and hear others thoughts and strategies on how to deal with it. Its always easy to act like demanding the perfect working conditions is the only thing to do but frankly around here we are quite an incestuous bunch so having a good reputation is important and not being a team player isn't very conducive to getting work.

I'm mainly talking about chronic understaffing. Sometimes when you accept chronic understaffing they do nothing about it, as was the case on my unit when they routinely gave day shift nurses nine patients. It wasn't until a stink was made that it stopped.

Now when the unit is understaff due to circumstances beyond anyone's control we just bite the bullet and move through it. That's going to happen and there's no need to stir up trouble for isolated incidents.

[diane227, LPN, RN]

Please review your state board rules. The general view is that you cannot abandon a patient. But there may be different stipulations to this according to the board rules where you live. In our state, Washington, our board rules say that you cannot be held accountable UNTIL you accept the patient assignment. Once you have accepted the assignment, you are responsible for the patient and you are liable for your actions, no matter how short you are. In our hospital we are part of a union and when we have a day where we are short, we will out the form and forward it to the union. They then take up the matter with this hospital. In addition, we notify manager directly and nursing supervisor directly. Keep copies of everything that you send to anyone. Know your staffing standards. If your manager does not have a written staffing requirement based on either the number of patients or the acuity, they need to get you one. We staff by our matrix on each shift. We have some flexibility however when we have a lot of patients who require almost 1:1 care of if the have a lot of patients on isolation. Because we have a very cooperative and concerned nursing management staff, we rarely have short staffing problems.

[eriksoln, BSN, RN]

The hospital I'm working at now uses a nice "acuity" system that affects assignments and staffing. Red dots for people without a sitter who are 1:1 and yellow for heavy needs pt's. They make sure the dots are spread out evenly and if there are a lot, extra help by way of an extra CNA is allowed.

[nurstang]

Incident reports are not part of a patient's chart, and almost all hospitals will do all that they can to prevent the courts from learning about them. It only states simple facts and can be very dangerours to a hospital in a court.