unsafe staffing

[sockov]

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.

[nurstang]

I know that in California, you have the right to refuse a patient, but it must be done before taking report. Once you take report on a patient, you cannot refuse them.

[Tweety, BSN, RN]

I know that in California, you have the right to refuse a patient, but it must be done before taking report. Once you take report on a patient, you cannot refuse them.

Some states take the view that if the nurse shows up on the unit, then they are agreeing to take care of their delegated assignment, and refusing and leaving is abandoment, even if this occurs prior to report and "accepting" the patient. In other words you accept the assignment when you walk in the door. Crazy.

[eriksoln, BSN, RN]

Some states take the view that if the nurse shows up on the unit, then they are agreeing to take care of their delegated assignment, and refusing and leaving is abandoment, even if this occurs prior to report and "accepting" the patient. In other words you accept the assignment when you walk in the door. Crazy.

I wonder if there is a list somewhere stateing which states are which in this case. PA (I'm 90% sure) is one where you have to take report. WA too. Again, I'm not an expert, but I'm pretty sure.

[nicurn001]

Some states take the view that if the nurse shows up on the unit, then they are agreeing to take care of their delegated assignment, and refusing and leaving is abandoment, even if this occurs prior to report and "accepting" the patient. In other words you accept the assignment when you walk in the door. Crazy.

Tweety , I would be grateful if you could clarify , which states you are aware of , that take this wide reaching view upon abandonment of patients , because I sure as heck would want to avoid working there. That policy enshrines poor staffing levels as legally valid .

As`an earlier poster said , we are all prepared to pull together when the Pschitt hits the fan , but if ,when the schedule is published there are obviously shifts uponwhich there are shortages of staff , then low and behold on those days , the shift is short of staff , then management have not managed and only have themselves to blame for the staffing problem . That includes the staff rightfully may fill out whatever reports of staff shortages are available in their state.

[gentlegiver, ASN, LPN, RN]

I wonder, if management is composed mainly (or partially) of Nurses, why can't they jump in and help short staffed units??

[eriksoln, BSN, RN]

I wonder, if management is composed mainly (or partially) of Nurses, why can't they jump in and help short staffed units??

LMAO, oh my. "And if you think happy thoughts you can fly". LMAO. A manager doing work of this nature. Whoa, let me catch my breath.

Ok, but seriously, onto your question. Why? Because........those three hour long meetings about dead end interventions (hourly rounding sheets, plastic pins for 10 year anniversary etc) are much more important. Why, the earth would tilt on its axis and cause widespread life threatening consequences if they didnt have their meetings. Oh my........sorry, I'm being a horse's behind and all but, your question was just too funny.

[nicurn001]

Gentlegiver I wonder if the realities of nursing Eriksoln alludes to , have anything to do with your note in years of experience re. 4 years and leaving nursing . I am sorry if that is the case , but wish you well in your future endevors .

[eriksoln, BSN, RN]

Gentlegiver I wonder if the realities of nursing Eriksoln alludes to , have anything to do with your note in years of experience re. 4 years and leaving nursing . I am sorry if that is the case , but wish you well in your future endevors .

Oh my, I didnt see that. Hey, I might be leaving it too. Landscapeing looks more and more tempting as I read posts in here about already bad ratios being pushed higher and hospitals enjoying it (give the "if you dont like it, leave, we can replace you and good luck out there finding something new" attitude).

I'm moving back to PA just to get out of travel nursing, which was a complete dead end for me. My wife and I do it only because we were interested in seeing more of the country. We accepted contracts where we knew we were getting underbid........it was the area that attracted us. Now, there is no freedom to go where you are interested in.......so there is no attraction to it for us.

Yeah, hope things get better Gentlegiver.

[rngolfer53]

One thing to remember is that in a lawsuit, only one thing matters: money and winning. Er... only two things matter (with apologies to Monty Python). Any justice that is served will be coincidental only.

Once you accept an assignment, it really doesn't matter that you write an incident report or other form of documentation. It may instead hurt you, since you are showing that you knowingly accepted an unsafe patient load. The exception could be that you were not given all the facts, such as you were told you would have PCTs that you didn't get, etc.

Lawyers will not care in the least that you stand to lose your job by refusing assignments.

Make sure your professional Liability Insurance is paid up.

[eriksoln, BSN, RN]

One thing to remember is that in a lawsuit, only one thing matters: money and winning. Er... only two things matter (with apologies to Monty Python). Any justice that is served will be coincidental only.

Once you accept an assignment, it really doesn't matter that you write an incident report or other form of documentation. It may instead hurt you, since you are showing that you knowingly accepted an unsafe patient load. The exception could be that you were not given all the facts, such as you were told you would have PCTs that you didn't get, etc.

Lawyers will not care in the least that you stand to lose your job by refusing assignments.

Make sure your professional liability insurance is paid up.

Except for the insurance, I agree.

[CaOTn96]

I've always loved the allnurses mods and staff but I feel compelled to put my 2 cents in here. I really wish this thread hadn't been moved from the general forum to a forum that doesn't have a prominent tab or frequent visitors. Most users of allnurses check the general forum frequently but don't scroll down top the other less popular forums.

In my opinion unsafe staffing is THE MAIN CAUSE of the nursing shortage. imho I feel it would have been better to leave this thread where it would be seen by more and garner more comments. -- The forum for general nursing posting.

[CaOTn96]

some states take the view that if the nurse shows up on the unit, then they are agreeing to take care of their delegated assignment, and refusing and leaving is abandonment, even if this occurs prior to report and "accepting" the patient. in other words you accept the assignment when you walk in the door. crazy.

tweety, i've always enjoyed your posts and trust you information. what you said here really worries me because i always felt that not accepting an unsafe assignment was my only recourse. a safety net for my patients as well as my very livelihood (meaning my license). since i don't know how unsafe the assignment is until i walk in the door this news is enough to drive me out of nursing. i've had several hospitals try to assign 10 ortho pts per nurse on noc with only 1 cna for the whole floor. (no ward clerk and and the charge nurse had to accept a full pt load of 10.) one night when they split a census of 21 between myself and another rn we had a 2 cna's but one (the better cna was pulled by the house supervisor to tele).

that left me and the charge with 21 pts and a cna that was in her late 60's and very hard of hearing. two hrs into my shift, as i was running around an swing lights, giving meds, hanging blood and 3 doing enemas, i walked into one of my pts rooms and found him dead. he apparently had panicked or become disoriented and pulled off the 02 mask - he was wearing the 02 mask on his head when i found him dead. he on 100% non re breather mask and no one told me he was desatting into the 70's without the mask. he was way too sick to be on a med/surg/ortho floor but because i was so overwhelmed with work i didn't get a chance to call the doctor who had visited him on day shift and decided he was safe and didn't require icu admit.

that was 10 yrs ago and i have never stooped thinking that i should have done more for that man. thinking of that night makes me sick inside. but how could i be in the room when he needed me and how could i have fought the nursing house supervisor or the md who didn't want to transfer him when i had 11 other pts calling for me?????

not accepting the assignment has been a tactic i've used a few times when i knew someone could be at risk of dying from the hospitals practice of short (meaning cheap) staffing. if just walking onto the floor means i've accepted their cheap staffing then i have no safety net for my pt's or my license.