You show up for work and there is no one there. What to do?

[Leonardo Del Toro, RN]

I am dreading the day when I show up to work and find out that I'm the only nurse on the floor. And I think that day is coming soon. The other unit RN, or LVN didn't show up. What are we supposed to do in a case like this? Certainly not sign up for the nurseless unit. But will you be held responsible for that unit? What are your rights? Are there any? 

[dream'n, BSN, RN]

I need more information. What type of facility do you work in? How many patients? What are your and the other nurses' usual responsibilities? Are you a RN? Is there management also in the facility? Please paint me a more detailed picture.

[Leonardo Del Toro, RN]

Small SNF, 40 beds, two RN's or LVN's for each side. I'm an RN, DON not in facility. Charge RN. 

[JBMmom, MSN, NP]

If someone else doesn't show up, wouldn't one of the people already there have to stay with you? You can refuse to take report on all the patients and if you haven't assumed responsibility it's not patient abandonment.  There are legal minimum staffing requirements for skilled nursing facilities in every state and while they allow for ridiculously poor staffing levels, it would probably require that someone come in, even if it's the DON. I would check out the legal limits in your state so you have the information prepared, just in case. 

[Leonardo Del Toro, RN]

Thanks. They have always pinned the responsibility on the nurses. Such as scheduling and finding another nurse if non are present. But now we are reaching critical levels of shortage, and these are uncharted territories. The dwindling staff is burned out to a crisp, yet they continue to bring patients in as if nothing is happening. I think I'll leave SNF work because it is no longer safe and I'm risking my license. I thinking about hospice.

[Guest219794]

1 hour ago, Leonardo Del Toro said:

Thanks. They have always pinned the responsibility on the nurses. Such as scheduling and finding another nurse if non are present. But now we are reaching critical levels of shortage, and these are uncharted territories. The dwindling staff is burned out to a crisp, yet they continue to bring patients in as if nothing is happening. I think I'll leave SNF work because it is no longer safe and I'm risking my license. I thinking about hospice.

That pretty much says it.  And, unfortunately, staff nurses have historically taken on these management issues because of concern for patient safety.  Just like the millions of hours of unpaid lunch breaks every year.  The result has been that management has never learned to, well, manage.

It is coming to a head, and health care will be different in the future.

Nurses are toast right now.  People are ready to leave.  Management has zero leverage.  Honestly, the patient safety lever isn't even that effective anymore, as, in many places, patients aren't safe no matter what you do.

[Been there,done that, ASN, RN]

Please clarify. So you would be responsible for 20 patients? Are there nursing assistants? How could you get a break? ( I know, breaks are a joke) but would they pay you?

[JBMmom, MSN, NP]

21 hours ago, Leonardo Del Toro said:

Thanks. They have always pinned the responsibility on the nurses. Such as scheduling and finding another nurse if non are present.

That's ridiculous. I know that at our hospital, you can request a week vacation and they will cover your weekend during the week, but if you want a weekend shift off for any other reason you are responsible for finding your own replacement. They give the excuse that when nurses are assigned every other weekend, they can't make anyone cover an open weekend shift. And of course NO ONE is staffed enough to absorb an absence. Even though almost every shift is supposed to be staffed enough to have a charge out of count, which we haven't had for years. 

I understand your feelings, my time in the long term care facility where I worked was challenging enough before COVID. The high patient to nurse ratios and potential for acute events with little support makes it difficult even in ideal times. Best wishes to you and your coworkers who are truly facing some hard times. Your patients are lucky to have you. 

[Leonardo Del Toro, RN]

On 12/24/2021 at 1:53 PM, hherrn said:

That pretty much says it.  And, unfortunately, staff nurses have historically taken on these management issues because of concern for patient safety.  Just like the millions of hours of unpaid lunch breaks every year.  The result has been that management has never learned to, well, manage.

It is coming to a head, and health care will be different in the future.

Nurses are toast right now.  People are ready to leave.  Management has zero leverage.  Honestly, the patient safety lever isn't even that effective anymore, as, in many places, patients aren't safe no matter what you do.

For the longest time, they have been saying "we have sufficient staff" but they never add, sick days, vacation, and people leaving into the equation. These three neglected items are always covered by the staff. Then came Covid and things started to get out of hand, more sick calls and people leaving.

And once more, nurses filled the holes sacrificing and pouring their sweat blood, and tears for the patients. But now this is getting too old and again they pull it off in the hopes they will at least compensate us with some bonus or a reasonable raise. But none of that came in. I know of so many nurses who are about to leave. Not sure how they will be able to stay open with so few nurses. This place is becoming so unsafe and I'm trying to figure out what to do. Any suggestions? 

[DavidFR, BSN, MSN, RN]

You need to turn this around on the nurses on the preceeding shift. If they stay on, THEY have to make their complaints.

I once did an agency night and my morning relief didn't arrrive. Very small gastric surgery unit, just me and a care assistant. Care assistant left at the appointed time on the grounds of "they'll be here soon". Nobody arrived.

The nurse on the unit next door refused to take my handover knowing she'd be lumbered with opening the double doors and taking the two units. I don't blame her.

I rang the on-call administrator - not on site as Sunday morning but reachable by phone. I underlined that I had a handicapped husband at home depending on me and it was out of the question that I be late. THAT got his attention and he moved things. My relief (another agency nurse) arrived an hour and a half after I was due off, with the promise of care assitants to follow.

Being agency I made sure I got paid for the extra hour and a half I worked. I made a formal complaint to the agency and the hospital. Had I been on the staff I'd have filled out all the internal untoward incident reports etc. possible. Had the on call administrator not acted I'd have complained to the local health board.  

Morally you shouldn't just walk out on the patients, but you can complain and make all the fuss possible so that it doesn't happen again. If you do find you're alone for a shift where you should have had colleagues with you  (and that has happened to me too) you ring the on call manager or administrator, you file an incident report, you complain in writing, and if you're unionised you bring them in going to the local health board if it should happen again. I realise this may be harder in the US where you're essentially working for a"business" that may not appreciate "troublemakers"  - however it is your moral duty to speak out.

You say this hasn't happened yet but you anticipate it coming soon. Isn't NOW the time to confront the management with your concerns?

 

[Zippy83]

This conversation came up on a night shift where a fellow registry nurse shared an experience from last year during our regional Covid surge. They only had two nurses, one RN and one LVN, show up at a 120 bed facility. No CNAs. Multiple covid positive and whole facility was supposed to be iso/full PPE for each patient. They stayed and did what they could on that shift.

A new grad LVN was part of the convo and she asked what would happen if you leave, and what happens if no one shows up for the next shift.

We advised in this case, either don’t take the assignment, meaning when you arrive hopefully before the actual start of shift you call off and don’t take any endorsement or keys etc due to hazardous working conditions. Or if you choose to take the assignment, either way call the Ombudsman, your licensing board, your staffing agency, your malpractice insurance provider, and probably the health dept as well, and report upfront the working conditions, number of staff and patients, everything. That way you won’t get accused of abandonment for not taking the assignment, and protect yourself from liability if you do take the shift. This would be the facility failing the patients but of course they want to shift the blame everywhere they can, so protect yourself and your license first. Then by notifying the proper agencies such as ombudsman and health dept you are also advocating for the patients in the best way you can. 

[kbrn2002, ADN, RN]

This is where the mandate comes in. Nobody likes it but it is what it is. Somebody from the previous shift has to stay until somebody comes in to relieve them. Whoever it is that gets stuck likely won't be at their best but they are at least there. 

I worked in a SNF for 25 years and it certainly has it's good points and bad points. Staffing is definitely one of the bad points.  I left LTC a few months before COVID hit so I didn't have to deal with that in the LTC setting but I do still have friends there. Oddly enough a few of them actually liked working under COVID lockdown because they felt they could devote more time to the residents without providers rounding and without families visiting. Fortunately the facility I was in wasn't hit hard with the virus. 

The lack of hoped for and even somewhat expected bonus money, a decent raise or both  isn't isolated to nursing homes. I don't know a single nurse in my area at least that actually received a bonus or any kind of a decent raise. Some places had "hazard pay" for awhile but that also went away. Apparently working with COVID patients without adequate PPE was only hazardous for a relatively short period of time.  I'd dearly love to see the breakdown of where the bailout money that so many health care facilities received went. I guarantee you that the upper brass still got their huge salaries and obscene bonuses while the nurses working the front lines got nothing.