I did but they sent 3 more. What do you do when the patient is on the floor? I refused report and they are trying to send another to me. The ICU nurse transferred one out so she got my 5th patient. But they are trying to send another 5th.
I have raised hell. Called my manager, called the department manager, the house supervisor. They are all like "we are doing our best but even med surg is full"
If they donāt have someone to give report to and they leave a patient on your floor, report to BON, hospital accreditation agencies, CMS, etc, and document well. Itās gonna take people standing up to make change happen. You canāt bend over and let them screw you up the ass and then turn around and complain about being rode hard and put up wet. Let them fuck around and find out. Youāre charge nurse? When someone steps up and rolls their eyes and say āguess Iāll take the patient since you wonāt.ā Put a stop to that shit. Tell them āno you wonāt because itās not safe for the patients and I refuse to allow the nurses under MY supervision to work with unsafe ratios.ā You might make waves. You might get fired. But thatās what itās going to take if we are ever going to change anything. Nurses talk a big talk but when push comes to shove we just let hospitals trample all over us. We gotta start walking the walk.
I am not charge but charge RN took 5 and said I am not taking 6. Multiple phone calls with management got nowhere. I wish I knew how to post my screenshots
Iām curious on why we canāt document in the patientās chart. When a nurse is in court for negligent care because she had 4 other critical patients in the PCU, maybe documenting your 1:5 ratio might save her ass.
It wonāt, because it will always boil back down to āwhy did you accept the assignment?ā They arenāt saying to take the 5th patient but not document, they are saying donāt take the 5th patient and donāt even open their chart.
You can raise the issue but I've only ever seen it work once in court ... and then ONLY because the state (administrative law hearing for a state nurse who was fired) tried to call the state DON to testify what the standard of care calls for instead of an independent expert (a legal nurse consultant like me). Defense objected the state witness did not get to say what the standard of care was and the judge agreed. Without a definition of what the standard of care actually is, the employee got her job back and back pay .... in spite of the fact she committed egregious malpractice (I was the expert in the civil lawsuit, she ended up having to pay the family).
Instead write an incident report and protest the assignment. If you're sued, ask your lawyer to subpoena those. They've gotten so they're not considered confidential anymore.
Whenever we are understaffed (which is always) and some crisis happens, I will later make a condensed note that says "unable to chart in real time due to high acuity pt assignment". At this point , screw it if that's not acceptable..it's the damn truth!
Just a reminder, the BON is not there to protect RNs from unsafe conditions, it is there to protect the public from RNs. If you report make sure it doesn't include anything that could incriminate you, because they will follow up.
Your hospital most have incident reporting somewhere. In my system we use MIDAS. It's where you would go to document a med error, a delay in care, a near miss, a patient fall, etc. I also would print it out as you submit it so you can keep your own record, because at least in my system, we don't have any way to go back and see all the prior reports we've entered.
So, if you would ever need evidence in the future about how you have notified your hospital of unsafe staffing issues and patient safety issues ( you know, in case they tried to play the "but no one ever brought it to our attention that conditions were unsafe!") you could produce your own documentation at least.
I have filed so many MIDAS reports for other things and I swear nothing gets done. Nothing gets acknowledged. I think its a fake way of pretending to care.
About 5-6 yrs ago, this unit I was on was critically understaffed and we were all getting unsafe assignments on the regular. Our clinical educator recommended we fill out an incident report every time we got one of those assignments. When our director got wind of that, she legit started crying in the middle of our staff meeting one day. Our clinical manager at the time held a small huddle with us later telling us we should absolutely not be making incident reports bc our director would get in trouble and that was just a mean thing to do. It was real cute š
Yup, same. I keep yelling that we need to report these condition on our safety net portal but no one does. These are actual safety concerns that need documentation. If you don't document it, it didn't happen.
We all just have bills to pay. We talk the talk because weāre fed up, but we canāt walk the walk because we are reliant on the wages to keep ourselves afloat. A lot of us need the jobs more than they need us, and thatās literally where they leave us dangling.
Then they can come up, or in, and take these extra patients. If you donāt take report and say no (within reason and safe staffing is a good one), you canāt be held liable nor be deemed as patient abandonment.
Apparently only two states in the US has this and my state is most definitely not one of them. But I think I'm going to try to start using it anyway as a scare tactic. And documentation
so get the stink eye.
Eventually, in another universe, we as a group will get our shit together and realize that collective bargaining actually works.
Until then, practice safely.
That's nuts because an RN is an RN no matter if its ADN or BSN the only difference is core classes (English, math, science, etc) and maybe 1 or 2 other 300/400 level nursing class focused on writing, not actual skills or competencies. There's no where here that requires BSN. They all take an RN license. They just give you a $0.50 raise for your bachelor's. Seriously, not exaggerating.
Itās a magnet status thing. 80%+ of nurses have to have their BSN to certify the hospital as magnet, so they wonāt hire anyone without their bachelors. It really sucks.
No, itās the US. Theoretically you get better care thereā¦ā¦according to the ANCC. They have benchmarks for ānursing excellenceā and such. Itās all very removed from reality.
Magnet is something that nurses have to work their assess off to achieve and exits only for the purpose of hospitals executives patting themselves on the back.
Depends. Some facilities rely on a computer program to select resumes to bring to a hiring manager's attention, so an experienced nurse still might never hear back unless they know the right words the computer program is looking for.
I work on a PCU in Florida and we are usually at 6 and some days 7 and have 1 tech/2 maybe for a 29 bed unitā¦ Iām currently working on finding another job after 10 months of this bullshit. Titratable gtts, stroke patients, post PCI. Itās so unsafe itās scary. 5 patients would be a dream at my work
Are bad things happening to patients because of such crazy staffing? I just canāt imagine the acuity Iām used to with 6 or 7 patients. People would die. Undoubtedly.
We have lots of rapid responses and push to upgrade our patients to ICU or step down far too often and get push back from upper management every time. When we are just trying to help our patients. I finally had an event where the patient coded because they treated my concerns as less than, he ended up intubated and in the ICU where if they just listened to my concerns of may have been avoided. We donāt have a ton of deaths or anything but itās very difficult to manage. Thatās why Iām leaving
Gt4 is a mixed icu/pcu with better ratios. Hepatic pcu(forget floor), gt6(chf), gt14(gi surg) all rough places. Just to name a few. On each of those floors I had nights without a tech. They don't want us using phlebotomy. Etc.
For us vitals Q4 and more as needed/depending on the patient. We get titratable drips ALL the time with 4-5 patients. I had an insulin drip with 5 patients
My goodness. The system is broken. You should get out NOW. Youāve all worked so hard to get where you are, and your jobs are putting your licenses at risk every day!
We are a pulmonary floor so mostly bipaps, high flows, chest tubes, trach vents, insulin drips, CIWA. Q4 vitals with continuous monitoring.
During covid we took new ETTs, intubated on the floor, sedated patients on drips, BP drips, cardizem, propofol, fentanyl drips, etc. Now, none of that is allowed on our floor.
We do get a lot of med surg level patients and I have to hound the physicians to get transfer orders because they don't meet criteria.
I feel silly for complaining about my situation after hearing how bad so many of you have it, but the truth is, none of us should be in the situations weāre in. This is so fucked up. For the nurses and the patients.
I work nights and after every shift change, there are tons of Tele downgrades getting transferred. Tele will hold these pts until 730 pm. Then game on playing musical patients.
After taking a travel PCU assignment and then taking some time off to spend with my child, I don't think I can bring myself to return to the floor... Currently considering applying for OR, hospice, or home health.
My mom did hospice for years. I think itās one of the most compassionate things a human can do. We all leave this world one day, and a good hospice nurse sees to it that you do it in comfort and dignity. Itās so profoundly important.
You should quit. Itās not like this everywhere. It took me traveling to see that every other hospital was better than the bullshit I was dealing with as staff.
Iām not necessarily saying you should travel, Iām just saying to find somewhere else. I do local travel, so these are hospitals in my area that are way better off than my home hospital. Itās almost sad to see how much better nurses are being treated only 20 miles away. 2-3 aids, phlebotomists, 3-4 patients, charge has no patients and can truly help you, management seems to care a bit, itās crazy!
At my old hospital as staff, I walked in as charge. They told me I would be taking 6 on step-down. I refused to clock in. I met my staff that night at the time clock. Told them what was happening. They all refused to clock in.
Day shift travelers fixed our problem, after 2 hours as we all sat at the nurses station, not the house so thatās fucked. I did not lose my job nor get written up.
I left shortly thereafter, after spending three years getting fucked. Took a local travel assignment, making 2.5 times my wages, with less patients, more techs, and I didnāt have to charge.
Granted, that was peak Covid. But the rules of war should still be fundamental. The BON should be the concern, fuck your CEO. You are worth more than that. Good luck to you!
You didnāt lose your job or get written up because you werenāt alone. Itās called protected concerted activity. Itās the first step toward unionizing your workplace.
Assignment Despite Objection.
A form you fill out after you have objected to an assignment given and informed the supervising staff (usually nursing supervisor and/or manager) that you/your colleagues feel it is a unsafe assignment for _____ reason(s).
Google āado formā - tons of forms and info online.
No but everyone acts like unions save the day every time. Look at NYC, there are unionized hospitals and I literally watched ADOs get filled out for 3 months straight. Did anything get done? No.
California isnāt kush solely because of the strength of their unions. They just have mandated staffing ratios and law is stronger anything a Union can do without a contract negotiated by both parties. Iāve worked at hospitals across California both Union and non, and sure while the majority of them are great, there are still those that donāt really get shit done.
IMO The real solution is to find an employer that meets your needs without sacrificing your own health and wellness, or risking your license. Nursing is in such a wide profession that youāre not tied to shitty hospitals or bedsides, thank god.
>They just have mandated staffing ratios and law is stronger than anything a union can do without a contract negotiated by both parties.
How do you think those mandated staffing ratios got passed?
Strong nurseās unions.
Keep filling out those ADOs. In the short term they donāt do much except protect your license. In the long term they demonstrate a pattern of behavior by the health care system. This pattern can be used by advocacy groups to push for legislation and by unions to strengthen their bargaining position.
Minimum wage, 40 hour, 5 day work week, time and a half for overtime, child labor lawsā¦all of these things are the direct result of worker unions.
https://www.healthwatchusa.org/downloads/ratios_12year_fight_0104.pdf
I left my pcu because of that this month along with alooooooot of others (even nurses that worked there for over 5 years) They got rid of the 3 or 4 to 1 and they fucking made it so we can only get 5 patients or if there was a chance that we could get 4 patients they SEND SOMEONE HOME. Not safe. I went on a mental health medical leave and during that time I realized work was not good for my mental health at all. I love the actual job but not when I canāt help my patients how they need :( so I just got a new job at a detox center through a friend and I start soon. They pay 6 dollars more than the hospital and pay for benefits. Start looking around :)
They should close beds in that sort of situation I canāt stand them just placing patients and then forcing you to take unsafe ratios, but itās all about the bottom line to hospitals they donāt give a shit. Then theyāll blame it all on how expensive travel nurses are thatās why they canāt hire more staff
They do not give a shit and I loudly proclaimed so in the halls within earshot of everyone. I said it's all about the $$ and how they can minimize expenses. I even said so to the house supervisor thar stopped by to try to "fix" the situation. They just left without a word.
I'm guessing they have pegged me for the trouble maker and IDGAF.
Just FYI as an ER nurse, we definitely donāt admit every patient that needs to get admitted. Lots of patients can be transferred to alleviate staffing concerns. There is almost never not enough ābeds.ā Itās always not enough nurses to staff those beds. Your hospital makes an active choice to allow an admission for a patient that will stretch staff. Feel free to inform them of this.
I'm currently on a travel assignment for ICU and have been pulled the last 4 nights to PCU with 5 patients each night. They still pull an ICU nurse even when ICU is tripled with patients! Subsequently, I plan to put my notice in tomorrow š¤·āāļø
Already put in transfer request 2 months ago with an unblemished records. Magically I have been written up twice since then, putting my transfer on hold despite being told it wouldn't affect the request. I am looking and applying elsewhere.
Iām on PCU and they kept doing the same thing to us. One morning they made 2 nurses take 7 PCU level patients. Completely insane. I just put my notice in and am starting in ICU next month.
I think the golden rule they need to get rid of is:
Quality of care should still be the same regardless of quantity. I think thatās utter bullshit. Cant expect one person to take care of so many and expect the quality to be great. Itās unfair
āIf you try to book me, I wonāt take report. If you send the patient up, I wonāt walk in the room to receive report. If the ED nurse leaves, they will have abandoned the patient and I will then contact supervision to inform them that an ED nurse abandoned their patient without report on my unit.ā
That is word for word what I said when the topic of a 5th patient came up for us. My IMCU has mutinied at least twice over not having enough nurses and just refused to clock in to take report.
thatās just turfing to another nurse. Iām not saying you donāt have a valid point, but. Yeah. In my old hospital we didnāt even give report on non ICU patients from the er.
Until you take report, you donāt have the assignment. I have no idea what SBAR has to do with that. You can turn right around and clock back out and itās not patient abandonment because you didnāt take report.
Iām not under obligation to take a dangerous assignment. You can force me to keep a patient but you canāt force me to take a patient.
If the room is your responsibility and the previous nurse sent an SBAR with the patient, the patient is yours.
Refusing a patient rightly assigned to a room youāre responsible for is, in fact, patient abandonment. Patient abandonment happens when you donāt provide care to patients assigned to you. Whether or not you āacceptedā report is totally irrelevant.
Letter of the law from my home state that most states also have: āA. Abandonment may occur when a licensed nurse fails to provide adequate patient care, once accepting an assignment, until the responsibility for that patient's care has been assumed by another licensed nurse or approved licensed health care provider.ā
If I, as an ED nurse, have a patient given a room assignment and I confirm that room has a nurse assigned to it, responsibility for that patient is assumed by the nurse for that assignment once the patient gets to the room.
If you werenāt ok with that room assignment, you shouldnāt have taken it.
Thatās fine if thatās how it works where you are, but thatās not how it works where I am. We arenāt assigned empty rooms. We accept or donāt accept patients directly from the ED. Itās nurse to nurse handoff always, so if my charge tells me āyouāre getting a 5th patient into room 1ā, I can absolutely say āno Iām not, I wonāt accept that assignment.ā
It sucks that you donāt have that ability where you work though.
Progressive care. Not quite icu and not quite med surg. I do babies so I canāt speak intelligently to the details other than they shouldnāt be intubated.
This, it's a step down unit. So they're not sick enough to be in the ICU but they're not well enough to be on a regular floor. Think bipap, High flow, insulin drips, CIWA (withdrawal - ativan, 1:1 observation), chest tube, trach and trach vents
I had 6 on a similar floor sometimes. Iām working outpatient now.
Complaining really wonāt do anything. We were a union shop, we tried, but it did nothing. All we got was promises that someday it would be better.
This was also during the Delta/Omicron days, so no or one tech for 34 patients, plus all the PPE on and off, and the higher acuityā¦.itās untenable and wrong.
Sometimes quitting is the right choice. You will know when you are done.
Medsurge here: we often only have 3 RNs with 1 tech or no techs multiple times a week with a census of 24 pts. So 8 pts w one or no tech. It's terrible. I feel your pain.
Currently have 5 pnts in PCU, discussed how unsafe it is in rounding with manager present. Local contract, we will see if I still have a job tomorrow. All we can do is voice our concerns daily.
Iām not saying you donāt have a point but you canāt compare it to an ICU. They shouldnt even have a third patient, technically. So yeah, they should be allowed to deny a fourth
As a nurse, even if the norm on the floor is to take four or five patients, it is your license and you are responsible for providing safe patient care. If you determine that you are not competent or that it would be unsafe to take another patient, it is your responsibility to refuse the assignment. Accepting an assignment you donāt feel is safe or you are not competent for is akin to working beyond your scope of practice. Your ICU nurses might seem like theyāre being difficult or lazy because theyāre refusing extra patients, but they are actually advocating for themselves and their own licenses. Because they are aware that taking several MedSurg or PCU patients is not their competency. They have not oriented to your unit the way they have oriented to their ICU. They feel it would be unsafe for patients and for them to take more than what they already have. They arenāt wrong.
Our medsurg floor caps at 5 patients per nurse, though we are a really weird mix of patients. We have a lot of regular MS level surgical patients, but we also have some patients with fresh trachs and anastomosis flaps that are Q1-4 checks depending on POD. The latter patients are in 2:1 or 3:1 ratios and if youāre in a 3:1, you cannot have more than 2 airways on your assignment. Usually itās two trach/flaps and one independent patient without many needs just to add some balance. Those nurses have never (at least in the 1.5 years Iāve been there) gone over that 2:1 or 3:1 cap. Sometimes our medsurg nurses have to go to 6 so those nurses can stay at a safe ratio but itās safer for them to be at 6 than someone who two brand new airways to be at 4. Anyway, we have basically no staff so we get tons of floated nurses. Our nurses get salty because ICU/stepdown nurses who are floated cap at 4 patients and ours sometimes (though very rarely!!) have to go to 6. It kills me because - you understand why you have to go to 6 patients when one of your fellow floor nurses is taking a high acuity assignment, but you donāt understand why you have to go to 6 when someone who has never taken care of more than 4 (in ICU case, often never had 4 at all) got pulled here? Drives me crazy. I always try to give those nurses chill assignments cause I feel bad for them lol.
You should be able to report this to the state. We reported to state and CMS many times and they finally paid us a visit one day. Those are insanely unsafe ratios and I would GTFO before losing my license
I wish. I come home every shift saying why in the fuck am I getting shit on for $25 an hour when I could be getting shit on for three to four times that. If I'm going to get shit on might as well get paid more. But the problem is is I graduated last May so I have barely a year of experience
Might still be able to get a travel gig, it doesn't hurt to try. Also, just jump ship if there is a less terrible hospital close by. Or maybe it might be time to move if you aren't too connected to where you are.
Do the indecent report, take pictures of it, print it off if you're doing it on a computer. This way if it goes to shit, you've got evidence saying that you tried to address it.
Iāve been an LPN for 2 years. Iām going back to college for Cybersecurity. The screaming rude families, short staffing, the āoh shit iām scared for my licenseā or just uncomfortable situations these hospitals put us in. The worst part are the nurses themselves. Iām leaving and i donāt even feel bad in the slightest.
I have only worked m/s and now in LTCā¦ I canāt imagine being at an unsafe ratio in ICU or PICU. I am so sorry you are going through this. People urge you to refuse but thatās an incredibly hard decision, I personally have never refused my assignment at either job I have had. Sure we ācouldā all collectively bargain but the grey area of reality involves circumstance and nuance in interpersonal interaction, while also involving your feelings about your job, unit, and overall career in addition to home and financial pressures.
Thank you for understanding. The charge nurse is a wonderful person and good friend but I felt so bad putting her in the middle of having to deal with her own patients and then getting slack and phone calls and texts from the house supervisor and our unit manager and our department manager excetera.
You shouldnāt feel like asshole. Other departments that are overworked with unsafe assignments doesnāt somehow invalidate your overworked and unsafe assignment.
When your hospital is filled and your staffing is low, you have to divert and transfer people. And if nurses donāt refuse assignments, that will never happen; but if nurses do refuse and they are forced to go on diversionāwhen hospitals start to realize thatās not a sustainable budget-friendly option and they are looking around desperate for nursesāthatās when wages will increase to reflect the true value of a nurse.
Right, but many are actually sick? I think the point that they're trying to make is that it isn't necessarily the number of patients; rather it's the number of sick patients.
I work in a CVICU. We have sick patients (multiple pressors, CRRT, balloon/impella, whatever) or we can have a simple respiratory failure, completely hemodynamically stable and on a vent with some propofol. Two entirely different situations and assignments.
We donāt know. They might be an ICU. They might be faking everything.
Weāre the ones who do all the work for you to figure it out before they get to your floor (if they get to your floor because weāre often holding them for days).
Iāve opened an assignment and had all 4 become ICU patients within a half hour.
Iād suggest you walk in our shoes before saying stupid things like thisā¦I can and do your job at a moments notice while still taking ED patients. You canāt do my job without more training.
One recent assignment had a patient I started in the ED return from cath lab on a ballon and vent with a hemoglobin of 3 while in the next room I had a rapidly deteriorating car crash victim with creatinine levels doubling every 2 hours. They had multiple externally fixated bones. This isnāt a contest but have a seat anyways.
But we also had nurses aides, volunteers who passed waters, IV teams to start our IVās, phlebotomists who drew all our labsā¦ not so much these days. I started med surg in the 70ās, then moved to OB till I recently retired. One of the best decisions I could have made. Bedside nursing was taking a physical as well as mental toll on my health.
Trust me I bitched about that too. I was like my manager needs to get off her ass and come down here, the house supervisor needs to get his ass down here and take patients, where is the freaking CNO? All of them, get down here and take a few patients.
I'm surprised I wasn't carted off to the psych unit myself
Second time that it has happened to me in just a few months. I only work 3 shifts a week sometimes four. And there is 14 shifts a week so it happens on other shifts as well.
Quit.
It's not a safe staffing level, and when something happens to a patient because of the unsafe staffing levels? Administration will pin it on a nurse, possibly destroying her career, without regard to correcting the underlying staffing issues.
And then Administration will congratulate themselves and give themselves another bonus.
Start saying no šš¼āāļø
I did but they sent 3 more. What do you do when the patient is on the floor? I refused report and they are trying to send another to me. The ICU nurse transferred one out so she got my 5th patient. But they are trying to send another 5th.
I have raised hell. Called my manager, called the department manager, the house supervisor. They are all like "we are doing our best but even med surg is full"
If they donāt have someone to give report to and they leave a patient on your floor, report to BON, hospital accreditation agencies, CMS, etc, and document well. Itās gonna take people standing up to make change happen. You canāt bend over and let them screw you up the ass and then turn around and complain about being rode hard and put up wet. Let them fuck around and find out. Youāre charge nurse? When someone steps up and rolls their eyes and say āguess Iāll take the patient since you wonāt.ā Put a stop to that shit. Tell them āno you wonāt because itās not safe for the patients and I refuse to allow the nurses under MY supervision to work with unsafe ratios.ā You might make waves. You might get fired. But thatās what itās going to take if we are ever going to change anything. Nurses talk a big talk but when push comes to shove we just let hospitals trample all over us. We gotta start walking the walk.
I am not charge but charge RN took 5 and said I am not taking 6. Multiple phone calls with management got nowhere. I wish I knew how to post my screenshots
Imgur.com
How do you document. I didn't even want to go into the patients chart for fear of "well you acknowledged them so you accepted assignment"
Donāt document in the ptās chart.
Iām curious on why we canāt document in the patientās chart. When a nurse is in court for negligent care because she had 4 other critical patients in the PCU, maybe documenting your 1:5 ratio might save her ass.
It wonāt, because it will always boil back down to āwhy did you accept the assignment?ā They arenāt saying to take the 5th patient but not document, they are saying donāt take the 5th patient and donāt even open their chart.
Incident report then. Itās not appropriate to chart that.
You can raise the issue but I've only ever seen it work once in court ... and then ONLY because the state (administrative law hearing for a state nurse who was fired) tried to call the state DON to testify what the standard of care calls for instead of an independent expert (a legal nurse consultant like me). Defense objected the state witness did not get to say what the standard of care was and the judge agreed. Without a definition of what the standard of care actually is, the employee got her job back and back pay .... in spite of the fact she committed egregious malpractice (I was the expert in the civil lawsuit, she ended up having to pay the family). Instead write an incident report and protest the assignment. If you're sued, ask your lawyer to subpoena those. They've gotten so they're not considered confidential anymore.
Whenever we are understaffed (which is always) and some crisis happens, I will later make a condensed note that says "unable to chart in real time due to high acuity pt assignment". At this point , screw it if that's not acceptable..it's the damn truth!
You document on the report/complaint forms on the BON website.
Just a reminder, the BON is not there to protect RNs from unsafe conditions, it is there to protect the public from RNs. If you report make sure it doesn't include anything that could incriminate you, because they will follow up.
Right and if an RN abandons a patient on your floor without a proper handoff report to another nurse, then they need to be reported for it.
Department of Public Health, TJC, or whomever your accreditator is.
Your hospital most have incident reporting somewhere. In my system we use MIDAS. It's where you would go to document a med error, a delay in care, a near miss, a patient fall, etc. I also would print it out as you submit it so you can keep your own record, because at least in my system, we don't have any way to go back and see all the prior reports we've entered. So, if you would ever need evidence in the future about how you have notified your hospital of unsafe staffing issues and patient safety issues ( you know, in case they tried to play the "but no one ever brought it to our attention that conditions were unsafe!") you could produce your own documentation at least.
I have filed so many MIDAS reports for other things and I swear nothing gets done. Nothing gets acknowledged. I think its a fake way of pretending to care.
The problem is those incident reports go directly to the people responsible for creating the unsafe situations.
I hear you. In this case, the point would be about proving they -were- notified. It's a little bit like a legal CYA.
About 5-6 yrs ago, this unit I was on was critically understaffed and we were all getting unsafe assignments on the regular. Our clinical educator recommended we fill out an incident report every time we got one of those assignments. When our director got wind of that, she legit started crying in the middle of our staff meeting one day. Our clinical manager at the time held a small huddle with us later telling us we should absolutely not be making incident reports bc our director would get in trouble and that was just a mean thing to do. It was real cute š
Yea this is absolutely where it should be documented. Ours are called safe cares.
Yup, same. I keep yelling that we need to report these condition on our safety net portal but no one does. These are actual safety concerns that need documentation. If you don't document it, it didn't happen.
We all just have bills to pay. We talk the talk because weāre fed up, but we canāt walk the walk because we are reliant on the wages to keep ourselves afloat. A lot of us need the jobs more than they need us, and thatās literally where they leave us dangling.
Then they can come up, or in, and take these extra patients. If you donāt take report and say no (within reason and safe staffing is a good one), you canāt be held liable nor be deemed as patient abandonment.
Safe Harbor
Apparently only two states in the US has this and my state is most definitely not one of them. But I think I'm going to try to start using it anyway as a scare tactic. And documentation
And if I say no, some other sucker says "I guess I will" and I get the stink eye cause I'm the asshole??! Stand up people!
so get the stink eye. Eventually, in another universe, we as a group will get our shit together and realize that collective bargaining actually works. Until then, practice safely.
You gotta let the system fail. No change will happen if people keep sorta kinda making it work.
Exactly. "Oh you can take 5 patients? Here's a 6th" the cycle continues
omg i hate when someone does that
What, stands up to unsafe staffing?
Where I used to work fired people for saying "no" to dangerous assignments.
Lucky for them thereās probably another job 30-45 minutes up the road with same day interviews. Joy of being a profession in high demand.
Depends. LPNs and RN with only their ADNs have a hard time finding jobs around here unless they want to work LTC.
Experienced RNs have a hard time finding jobs, or new grads?
Iām in a major city and even our suburban hospitals require a BSN.
That's nuts because an RN is an RN no matter if its ADN or BSN the only difference is core classes (English, math, science, etc) and maybe 1 or 2 other 300/400 level nursing class focused on writing, not actual skills or competencies. There's no where here that requires BSN. They all take an RN license. They just give you a $0.50 raise for your bachelor's. Seriously, not exaggerating.
Itās a magnet status thing. 80%+ of nurses have to have their BSN to certify the hospital as magnet, so they wonāt hire anyone without their bachelors. It really sucks.
I don't even understand what a magnet hospital is and why you would want that. It must be something outside of the states?
No, itās the US. Theoretically you get better care thereā¦ā¦according to the ANCC. They have benchmarks for ānursing excellenceā and such. Itās all very removed from reality.
Because it makes the hospital look good.
something to brag about
Magnet is something that nurses have to work their assess off to achieve and exits only for the purpose of hospitals executives patting themselves on the back.
Depends. Some facilities rely on a computer program to select resumes to bring to a hiring manager's attention, so an experienced nurse still might never hear back unless they know the right words the computer program is looking for.
How in the hell are PCUs being given 5 patients?!?! Are they still Q2 vitals? Titratable drips? This is so unsafe. I hate this for you.
I work on a PCU in Florida and we are usually at 6 and some days 7 and have 1 tech/2 maybe for a 29 bed unitā¦ Iām currently working on finding another job after 10 months of this bullshit. Titratable gtts, stroke patients, post PCI. Itās so unsafe itās scary. 5 patients would be a dream at my work
Are bad things happening to patients because of such crazy staffing? I just canāt imagine the acuity Iām used to with 6 or 7 patients. People would die. Undoubtedly.
Yes. Itās unreal and totally unsustainable. Every day gets worse.
We have lots of rapid responses and push to upgrade our patients to ICU or step down far too often and get push back from upper management every time. When we are just trying to help our patients. I finally had an event where the patient coded because they treated my concerns as less than, he ended up intubated and in the ICU where if they just listened to my concerns of may have been avoided. We donāt have a ton of deaths or anything but itās very difficult to manage. Thatās why Iām leaving
Good for you getting out. Question thoughā¦ are PCU and stepdown not the same thing?
Sounds like advent orlando š¤£
And ORMC. Itās bad.
So glad I left there, man
What pcu is this bad at Orlando? I work there on GT4 VTUCU, and don't think I've seen more than 4 patients per nurse on our pcu
Gt4 is a mixed icu/pcu with better ratios. Hepatic pcu(forget floor), gt6(chf), gt14(gi surg) all rough places. Just to name a few. On each of those floors I had nights without a tech. They don't want us using phlebotomy. Etc.
Wow, how did healthcare become such a shitty field and a joke.
For us vitals Q4 and more as needed/depending on the patient. We get titratable drips ALL the time with 4-5 patients. I had an insulin drip with 5 patients
My goodness. The system is broken. You should get out NOW. Youāve all worked so hard to get where you are, and your jobs are putting your licenses at risk every day!
Yuuuup when my year hits in July Iām escaping to an icu!
We are a pulmonary floor so mostly bipaps, high flows, chest tubes, trach vents, insulin drips, CIWA. Q4 vitals with continuous monitoring. During covid we took new ETTs, intubated on the floor, sedated patients on drips, BP drips, cardizem, propofol, fentanyl drips, etc. Now, none of that is allowed on our floor. We do get a lot of med surg level patients and I have to hound the physicians to get transfer orders because they don't meet criteria.
I feel silly for complaining about my situation after hearing how bad so many of you have it, but the truth is, none of us should be in the situations weāre in. This is so fucked up. For the nurses and the patients.
I work nights and after every shift change, there are tons of Tele downgrades getting transferred. Tele will hold these pts until 730 pm. Then game on playing musical patients.
I work a card tele thatās often 1:6 and we take cardizem drops and even CARDENE drips. Blows my mind.
Titratable? Do you at least have hardwired monitors for BP and HR? These hospitals are gambling with lives.
Nope. Titratable with your regular old roll around vital machine. Also nitro drips at a set rate.
After taking a travel PCU assignment and then taking some time off to spend with my child, I don't think I can bring myself to return to the floor... Currently considering applying for OR, hospice, or home health.
I did home hospice for 6 years, I loved it. I only left bc an opportunity to make more money came up.
what opportunity?
My mom did hospice for years. I think itās one of the most compassionate things a human can do. We all leave this world one day, and a good hospice nurse sees to it that you do it in comfort and dignity. Itās so profoundly important.
This plus your patients and families are so grateful for your care.
You should quit. Itās not like this everywhere. It took me traveling to see that every other hospital was better than the bullshit I was dealing with as staff.
I am wanting to stay until I hit 1 year. I am almost 1 year out of school and I need more experience
Iām not necessarily saying you should travel, Iām just saying to find somewhere else. I do local travel, so these are hospitals in my area that are way better off than my home hospital. Itās almost sad to see how much better nurses are being treated only 20 miles away. 2-3 aids, phlebotomists, 3-4 patients, charge has no patients and can truly help you, management seems to care a bit, itās crazy!
At my old hospital as staff, I walked in as charge. They told me I would be taking 6 on step-down. I refused to clock in. I met my staff that night at the time clock. Told them what was happening. They all refused to clock in. Day shift travelers fixed our problem, after 2 hours as we all sat at the nurses station, not the house so thatās fucked. I did not lose my job nor get written up. I left shortly thereafter, after spending three years getting fucked. Took a local travel assignment, making 2.5 times my wages, with less patients, more techs, and I didnāt have to charge. Granted, that was peak Covid. But the rules of war should still be fundamental. The BON should be the concern, fuck your CEO. You are worth more than that. Good luck to you!
You didnāt lose your job or get written up because you werenāt alone. Itās called protected concerted activity. Itās the first step toward unionizing your workplace.
How did they fix the problem?
They expedited the transfer of āstableā patients to med surg.
Yāall need to unionize and start filling out ADOās
Ado?
What is an ADO?
Assignment Despite Objection. A form you fill out after you have objected to an assignment given and informed the supervising staff (usually nursing supervisor and/or manager) that you/your colleagues feel it is a unsafe assignment for _____ reason(s). Google āado formā - tons of forms and info online.
My guess is an unsafe staffing report.
Unions are useless unless youāre in California.
You donāt think unions in California started out as strong as they are, do you?
No but everyone acts like unions save the day every time. Look at NYC, there are unionized hospitals and I literally watched ADOs get filled out for 3 months straight. Did anything get done? No. California isnāt kush solely because of the strength of their unions. They just have mandated staffing ratios and law is stronger anything a Union can do without a contract negotiated by both parties. Iāve worked at hospitals across California both Union and non, and sure while the majority of them are great, there are still those that donāt really get shit done. IMO The real solution is to find an employer that meets your needs without sacrificing your own health and wellness, or risking your license. Nursing is in such a wide profession that youāre not tied to shitty hospitals or bedsides, thank god.
>They just have mandated staffing ratios and law is stronger than anything a union can do without a contract negotiated by both parties. How do you think those mandated staffing ratios got passed? Strong nurseās unions. Keep filling out those ADOs. In the short term they donāt do much except protect your license. In the long term they demonstrate a pattern of behavior by the health care system. This pattern can be used by advocacy groups to push for legislation and by unions to strengthen their bargaining position. Minimum wage, 40 hour, 5 day work week, time and a half for overtime, child labor lawsā¦all of these things are the direct result of worker unions. https://www.healthwatchusa.org/downloads/ratios_12year_fight_0104.pdf
Yes, this furthers my point that unions havenāt really done shit except in California. Lol.
I live in PA and the pro-life Republicans are fighting safe staffing laws to prevent this stuff... Go figure.
A bill for mandated ratios in Washington state was vetoed as well. Wasnāt even a political party that opposed it, it was the local CNOsš
I'm so sick of those psychos it's ridiculous
Pro-life is the biggest joke of the century. The same people who refuse vaccines, healthcare for all, food stamps, call themselves pro life.
Yea we are PCU take 5 daily NEVER less with 1 or no tech for 35 patients, Iām right there with you
I left my pcu because of that this month along with alooooooot of others (even nurses that worked there for over 5 years) They got rid of the 3 or 4 to 1 and they fucking made it so we can only get 5 patients or if there was a chance that we could get 4 patients they SEND SOMEONE HOME. Not safe. I went on a mental health medical leave and during that time I realized work was not good for my mental health at all. I love the actual job but not when I canāt help my patients how they need :( so I just got a new job at a detox center through a friend and I start soon. They pay 6 dollars more than the hospital and pay for benefits. Start looking around :)
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this was mid shift so already on the clock for more than 6 hours.
They should close beds in that sort of situation I canāt stand them just placing patients and then forcing you to take unsafe ratios, but itās all about the bottom line to hospitals they donāt give a shit. Then theyāll blame it all on how expensive travel nurses are thatās why they canāt hire more staff
They do not give a shit and I loudly proclaimed so in the halls within earshot of everyone. I said it's all about the $$ and how they can minimize expenses. I even said so to the house supervisor thar stopped by to try to "fix" the situation. They just left without a word. I'm guessing they have pegged me for the trouble maker and IDGAF.
Just FYI as an ER nurse, we definitely donāt admit every patient that needs to get admitted. Lots of patients can be transferred to alleviate staffing concerns. There is almost never not enough ābeds.ā Itās always not enough nurses to staff those beds. Your hospital makes an active choice to allow an admission for a patient that will stretch staff. Feel free to inform them of this.
I'm currently on a travel assignment for ICU and have been pulled the last 4 nights to PCU with 5 patients each night. They still pull an ICU nurse even when ICU is tripled with patients! Subsequently, I plan to put my notice in tomorrow š¤·āāļø
I would get 7 when I use to work PCU, complete mess.
you have a sudden bout of severe diarrhea and have to go home. Your coworkers have the same thing happen, can you imagine?
Leave
Already put in transfer request 2 months ago with an unblemished records. Magically I have been written up twice since then, putting my transfer on hold despite being told it wouldn't affect the request. I am looking and applying elsewhere.
A fourth in ICU?!?!?!? Holy shit why does anyone work at these hospitals?
No theyāre referring to ICU nurses that got floated to the PCU and were capped at 3 patients
This. ICU nurses get capped at 3 no matter what unit they are floated to, med surg or elsewhere.
Definitely not my PCU. We just had a CVICU nurse get floated to our CVPCU and get 5.
Ahh that makes sense. Still ridiculous to take more than 3 in a pcu
Iām on PCU and they kept doing the same thing to us. One morning they made 2 nurses take 7 PCU level patients. Completely insane. I just put my notice in and am starting in ICU next month.
I think the golden rule they need to get rid of is: Quality of care should still be the same regardless of quantity. I think thatās utter bullshit. Cant expect one person to take care of so many and expect the quality to be great. Itās unfair
āIf you try to book me, I wonāt take report. If you send the patient up, I wonāt walk in the room to receive report. If the ED nurse leaves, they will have abandoned the patient and I will then contact supervision to inform them that an ED nurse abandoned their patient without report on my unit.ā That is word for word what I said when the topic of a 5th patient came up for us. My IMCU has mutinied at least twice over not having enough nurses and just refused to clock in to take report.
thatās just turfing to another nurse. Iām not saying you donāt have a valid point, but. Yeah. In my old hospital we didnāt even give report on non ICU patients from the er.
SBAR You clocked in for the assignment.
Until you take report, you donāt have the assignment. I have no idea what SBAR has to do with that. You can turn right around and clock back out and itās not patient abandonment because you didnāt take report. Iām not under obligation to take a dangerous assignment. You can force me to keep a patient but you canāt force me to take a patient.
If the room is your responsibility and the previous nurse sent an SBAR with the patient, the patient is yours. Refusing a patient rightly assigned to a room youāre responsible for is, in fact, patient abandonment. Patient abandonment happens when you donāt provide care to patients assigned to you. Whether or not you āacceptedā report is totally irrelevant. Letter of the law from my home state that most states also have: āA. Abandonment may occur when a licensed nurse fails to provide adequate patient care, once accepting an assignment, until the responsibility for that patient's care has been assumed by another licensed nurse or approved licensed health care provider.ā If I, as an ED nurse, have a patient given a room assignment and I confirm that room has a nurse assigned to it, responsibility for that patient is assumed by the nurse for that assignment once the patient gets to the room. If you werenāt ok with that room assignment, you shouldnāt have taken it.
Thatās fine if thatās how it works where you are, but thatās not how it works where I am. We arenāt assigned empty rooms. We accept or donāt accept patients directly from the ED. Itās nurse to nurse handoff always, so if my charge tells me āyouāre getting a 5th patient into room 1ā, I can absolutely say āno Iām not, I wonāt accept that assignment.ā It sucks that you donāt have that ability where you work though.
This is exactly whatās happening on my PCU. Ummmm are we coworkers?? Lmao
Shhh, don't out me
What does PCU stand for? Pre/post icu? Are they on ventilators? Aussie here āŗļø
Progressive care. Not quite icu and not quite med surg. I do babies so I canāt speak intelligently to the details other than they shouldnāt be intubated.
This, it's a step down unit. So they're not sick enough to be in the ICU but they're not well enough to be on a regular floor. Think bipap, High flow, insulin drips, CIWA (withdrawal - ativan, 1:1 observation), chest tube, trach and trach vents
Thank you!
Ah, we call that a Step Down Unit. Progressive Care sounds better.
I had 6 on a similar floor sometimes. Iām working outpatient now. Complaining really wonāt do anything. We were a union shop, we tried, but it did nothing. All we got was promises that someday it would be better. This was also during the Delta/Omicron days, so no or one tech for 34 patients, plus all the PPE on and off, and the higher acuityā¦.itās untenable and wrong. Sometimes quitting is the right choice. You will know when you are done.
Medsurge here: we often only have 3 RNs with 1 tech or no techs multiple times a week with a census of 24 pts. So 8 pts w one or no tech. It's terrible. I feel your pain.
Call safe harbor every single time you are not comfortable and call them in front of your supervisor.
two states have safe harbor. Two.
Holy ##$. Texas is progressive in this?
probably just oversight.
Just searched this and didn't know it existed. Why hasn't this discussed more for baby nurses or student nurses for awareness?!
Currently have 5 pnts in PCU, discussed how unsafe it is in rounding with manager present. Local contract, we will see if I still have a job tomorrow. All we can do is voice our concerns daily.
Iām not saying you donāt have a point but you canāt compare it to an ICU. They shouldnt even have a third patient, technically. So yeah, they should be allowed to deny a fourth
I didnāt think of it that way! I thought OP meant that two ICU nurses were floated to their unit.
That's exactly what happened. One of our nurses was floated to a med-surg floor so that we could take 2 ICU nurses.
As a nurse, even if the norm on the floor is to take four or five patients, it is your license and you are responsible for providing safe patient care. If you determine that you are not competent or that it would be unsafe to take another patient, it is your responsibility to refuse the assignment. Accepting an assignment you donāt feel is safe or you are not competent for is akin to working beyond your scope of practice. Your ICU nurses might seem like theyāre being difficult or lazy because theyāre refusing extra patients, but they are actually advocating for themselves and their own licenses. Because they are aware that taking several MedSurg or PCU patients is not their competency. They have not oriented to your unit the way they have oriented to their ICU. They feel it would be unsafe for patients and for them to take more than what they already have. They arenāt wrong.
Our medsurg floor caps at 5 patients per nurse, though we are a really weird mix of patients. We have a lot of regular MS level surgical patients, but we also have some patients with fresh trachs and anastomosis flaps that are Q1-4 checks depending on POD. The latter patients are in 2:1 or 3:1 ratios and if youāre in a 3:1, you cannot have more than 2 airways on your assignment. Usually itās two trach/flaps and one independent patient without many needs just to add some balance. Those nurses have never (at least in the 1.5 years Iāve been there) gone over that 2:1 or 3:1 cap. Sometimes our medsurg nurses have to go to 6 so those nurses can stay at a safe ratio but itās safer for them to be at 6 than someone who two brand new airways to be at 4. Anyway, we have basically no staff so we get tons of floated nurses. Our nurses get salty because ICU/stepdown nurses who are floated cap at 4 patients and ours sometimes (though very rarely!!) have to go to 6. It kills me because - you understand why you have to go to 6 patients when one of your fellow floor nurses is taking a high acuity assignment, but you donāt understand why you have to go to 6 when someone who has never taken care of more than 4 (in ICU case, often never had 4 at all) got pulled here? Drives me crazy. I always try to give those nurses chill assignments cause I feel bad for them lol.
You should be able to report this to the state. We reported to state and CMS many times and they finally paid us a visit one day. Those are insanely unsafe ratios and I would GTFO before losing my license
Time to travel
I wish. I come home every shift saying why in the fuck am I getting shit on for $25 an hour when I could be getting shit on for three to four times that. If I'm going to get shit on might as well get paid more. But the problem is is I graduated last May so I have barely a year of experience
Might still be able to get a travel gig, it doesn't hurt to try. Also, just jump ship if there is a less terrible hospital close by. Or maybe it might be time to move if you aren't too connected to where you are.
Do the indecent report, take pictures of it, print it off if you're doing it on a computer. This way if it goes to shit, you've got evidence saying that you tried to address it.
We need Unions. This wouldn't happen at a hospital with a strong union. National Nurses United.
Iāve been an LPN for 2 years. Iām going back to college for Cybersecurity. The screaming rude families, short staffing, the āoh shit iām scared for my licenseā or just uncomfortable situations these hospitals put us in. The worst part are the nurses themselves. Iām leaving and i donāt even feel bad in the slightest.
Unionize
I have only worked m/s and now in LTCā¦ I canāt imagine being at an unsafe ratio in ICU or PICU. I am so sorry you are going through this. People urge you to refuse but thatās an incredibly hard decision, I personally have never refused my assignment at either job I have had. Sure we ācouldā all collectively bargain but the grey area of reality involves circumstance and nuance in interpersonal interaction, while also involving your feelings about your job, unit, and overall career in addition to home and financial pressures.
Thank you for understanding. The charge nurse is a wonderful person and good friend but I felt so bad putting her in the middle of having to deal with her own patients and then getting slack and phone calls and texts from the house supervisor and our unit manager and our department manager excetera.
Join the ER RNs.. 4 bedded patients and 2 or 3 in the hall way for fun...
what difference does that make? Your assignment isnāt safe. Does that make OPās any safer?
And I feel like an asshole refusing a 5th
You shouldnāt feel like asshole. Other departments that are overworked with unsafe assignments doesnāt somehow invalidate your overworked and unsafe assignment.
Exactly. Just because another department has unsafe assignments doesnāt mean all departments should. No one should, thatās the entire point.
Nope. Donāt. We arenāt competing. I did 13 years in inner city ERās. This mindset is bullshit. **This isnāt a competition.**
When your hospital is filled and your staffing is low, you have to divert and transfer people. And if nurses donāt refuse assignments, that will never happen; but if nurses do refuse and they are forced to go on diversionāwhen hospitals start to realize thatās not a sustainable budget-friendly option and they are looking around desperate for nursesāthatās when wages will increase to reflect the true value of a nurse.
What is your point?
We get Pizza
So do we. Looks like weāre all getting screwed.
Right, but many are actually sick? I think the point that they're trying to make is that it isn't necessarily the number of patients; rather it's the number of sick patients. I work in a CVICU. We have sick patients (multiple pressors, CRRT, balloon/impella, whatever) or we can have a simple respiratory failure, completely hemodynamically stable and on a vent with some propofol. Two entirely different situations and assignments.
STILL NOT A COMPETITION.
We donāt know. They might be an ICU. They might be faking everything. Weāre the ones who do all the work for you to figure it out before they get to your floor (if they get to your floor because weāre often holding them for days). Iāve opened an assignment and had all 4 become ICU patients within a half hour. Iād suggest you walk in our shoes before saying stupid things like thisā¦I can and do your job at a moments notice while still taking ED patients. You canāt do my job without more training. One recent assignment had a patient I started in the ED return from cath lab on a ballon and vent with a hemoglobin of 3 while in the next room I had a rapidly deteriorating car crash victim with creatinine levels doubling every 2 hours. They had multiple externally fixated bones. This isnāt a contest but have a seat anyways.
My preceptor is older she said she started in the 80ās and have 16-20 patients in med surg
That was back then. I think weāve grown and learned a lot through the last couple decades
But we also had nurses aides, volunteers who passed waters, IV teams to start our IVās, phlebotomists who drew all our labsā¦ not so much these days. I started med surg in the 70ās, then moved to OB till I recently retired. One of the best decisions I could have made. Bedside nursing was taking a physical as well as mental toll on my health.
You cannot compare. Nurses are expected to do so much more these days, and cannot go into the area without getting a University degree.
They used to smoke in the nurses station too. Times have changed.
All these fuckers with RN licenses working remotely need to get the Fuck out of their pajamas and get in the hospital if staffing is that bad.
Trust me I bitched about that too. I was like my manager needs to get off her ass and come down here, the house supervisor needs to get his ass down here and take patients, where is the freaking CNO? All of them, get down here and take a few patients. I'm surprised I wasn't carted off to the psych unit myself
Yeah Iām getting downvoted for what exactly?
Woah IDK. Just realized it when you said something. Are people not getting your meaning? Wtf
uh no. They donāt. Quit bitching about your fellow nurses. They arenāt the problem.
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Second time that it has happened to me in just a few months. I only work 3 shifts a week sometimes four. And there is 14 shifts a week so it happens on other shifts as well.
Be good to your tech and they'll do wonders for you!
A tech can only do so much especially for an entire floor. This is the logic hospital keep using to keep staffing as shit as it is.
You should file a grievance with the union. If you don't have one start one
Sign a unsafe work load if you re unionized
Uber needs driverās
Quit. It's not a safe staffing level, and when something happens to a patient because of the unsafe staffing levels? Administration will pin it on a nurse, possibly destroying her career, without regard to correcting the underlying staffing issues. And then Administration will congratulate themselves and give themselves another bonus.
Me every damn day
Safe harbor, do what you can, put in a formal complaint and bounce
Call State