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.
I agree with filling out paperwork which brings to the forefront unsafe staffing.
To those who say I will not accept the assignment. I have a question. If they have already tried to get in more staff for that shift and are unsuccessful. If you then refuse to accept the assignment , just who in the heck is suppose to be taking care of those patients. I see it as putting everyone in a bind then and making matters even more dangerous than it was to start with.
I have worked shifts in which a nurse will say I am not taking that many patients. So then they try and redistribute. Often that works. More times than not, it means me who usually works primary care without an aide will get more patients as I am seen as able to handle it. Now that irritates the heck out of me. Why should I have 6 patients alone, when someone else has 8 patients and a CNA with them.
I agree with filling out paperwork which brings to the forefront unsafe staffing.
To those who say I will not accept the assignment. I have a question. If they have already tried to get in more staff for that shift and are unsuccessful. If you then refuse to accept the assignment , just who in the heck is suppose to be taking care of those patients. I see it as putting everyone in a bind then and making matters even more dangerous than it was to start with.
I have worked shifts in which a nurse will say I am not taking that many patients. So then they try and redistribute. Often that works. More times than not, it means me who usually works primary care without an aide will get more patients as I am seen as able to handle it. Now that irritates the heck out of me. Why should I have 6 patients alone, when someone else has 8 patients and a CNA with them.
In the free market economy , if the price is right someone will come in to fill the gap in staffing . The problem is that whilst management can rely on some nurses , taking on the unsafe assignments , what incentive have they to address the problem of chronic inadequate staffing ?. Management of facilities that have chronic understaffing , are effectively underfunding their nursing budgets , having weighed the risks of underfunding against the finacial gains the facility can make , then come to the conclusion this is an acceptable strategy , particularly as they can brightly say( if the staff shortages are not documented )," we didn't realise there was a staffing problem ", then place the blame for adverse occurences upon the overwhelmed nursing staff .
Bottom line if you are prepared to accept an unsafe assignment , be it upon your own head , because when the Pschitt hits the fan , you won't be able to keep up with the administration running as fast as they can from you .You better hope you have good Liability Insurance , because even if the Hospitals policy defends you , if there is a settlement against you , due to Policies and Procedures not being followed ( if understaffed , we all take short cuts ), the Hospital can sue you for that loss .
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.
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.
Tweety, I've always enjoyed your posts and trust you information. What you said here really worries me to drive me out of nursing.
I learned this information from a nursing journal. It really stood out to me and I never forgot it, but I don't really have a source or remember which state(s) the writer mentioned. I'll try to find out, but take any information you get from someone on the internet, myself included, with a grain of salt.
If you don't have a contract with an RN union I suggest writing two identical letters to a supervisor or manager stating the WE are notifyinh you that this assignment is unsafe. Then briefly explain why (IE not enough staff).
As a result ***** Hospital is responsible for any adverse effects on patient care. We nurses will attempt to care for our assigned patients to the best of our ability because to refuse would further jeopardize our patients.
Date and time both with the unit and the name of the manager one copy was given to.
Make copies for all staff who signed it and note it in your diary or journal.
I once read that a similar form saved a nurse from being sued. She went from the defendent list to the witness list.
Hospitals must not be allowed to short staff and harm patients. WE have to advocate for our patients.
To those who say I will not accept the assignment. I have a question. If they have already tried to get in more staff for that shift and are unsuccessful. If you then refuse to accept the assignment , just who in the heck is suppose to be taking care of those patients.
In LTC, i refused assignments many times. We had at least a dozen agencies in my town and a company policy that "we do not use agency". Well, i bet if i had left, they would have had no choice but to cough up the extra cash. They always wound up somehow producing another nurse though.
My coworkers were too scared to refuse, and though i felt sorry for them for having nearly 60 patients (dayshift), it was their own fault. If i refuse and still show up tomorrow with the same job, why does that not set an example for them? I can not take care of 60 patients (dayshift) adequately just so a facility can generate more profit. Anyone that does weakens our fight and endangers the well being of their patients. The facility has an obligation that they will meet, whether you refuse and go home or not.
I learned to say, "I would if I could but I can't accept the assignment because to do so would place my patients at risk."
or
"I cannot accept the assignment because there is not enough staff to safely care for the patients."
And management actually accepted that? Did you take on fewer patients or go home? I'm really curious because I can only imagine what would happen if we tried that. Not saying we are always super short staffed or that the patients are in imminent danger but certainly very tight so a call out can be a disaster. Interesting.
Specializes in Critical care, tele, Medical-Surgical.
And management actually accepted that? Did you take on fewer patients or go home? I'm really curious because I can only imagine what would happen if we tried that. Not saying we are always super short staffed or that the patients are in imminent danger but certainly very tight so a call out can be a disaster. Interesting.
Well we have an RN union. Management knows the next step would be all the staff signing an "Assignment Despite Objection" form. This places the responsibility on the facility NOT the nurse. Here is a sample form:
Previously they would claim to have called everyone and all the registries. Then the next night a registry nurse would say she was available and not called.
We have had a state mandated ratio of two or fewer patients per nurse in critical care for MANY years.
I have never left. Always stayed. "Helped' with patients not assigned to me. We do our best but the hospital knows that if there is a sentinel event or med error the hospital not the nurse is responsible.
That prevents planned short staffing.
It is irresponsible for them to staff so tight that one sick nurse or another admit places patients at risk.
lpnflorida, LPN
1,304 Posts
I agree with filling out paperwork which brings to the forefront unsafe staffing.
To those who say I will not accept the assignment. I have a question. If they have already tried to get in more staff for that shift and are unsuccessful. If you then refuse to accept the assignment , just who in the heck is suppose to be taking care of those patients. I see it as putting everyone in a bind then and making matters even more dangerous than it was to start with.
I have worked shifts in which a nurse will say I am not taking that many patients. So then they try and redistribute. Often that works. More times than not, it means me who usually works primary care without an aide will get more patients as I am seen as able to handle it. Now that irritates the heck out of me. Why should I have 6 patients alone, when someone else has 8 patients and a CNA with them.