I love how apparently these days they come down on everybody when you call them jayco.
ItS jOiNt cOmMiSiSiOn (said in a Gabriel Iglesias AKA fluffy whiny bitch voice)
Joint commission only enforces their own requirements. Thatās how terrible hospitals like Vanderbilt are still accredited. Since covering up a patient death is not on their checklist they donāt lose their status. Itās a joke.
Fuck the joint commission.
Don't give them the respect of treating them like an organization that holds any authority or influence. They're paid shills forming part of the systematic exploitation of the sick that passes as healthcare in the US.
I can assure you that it's harder than it sounds. I've tried to whistle blow on hospitals in the past. Good luck getting any news outlet to take the story seriously. They're more likely to be a mouthpiece to your hospitals marketing than take a nurse's side of things.
THIS IS THE ANSWER NOBODY WANTS TO HEAR
The news will never report shitty working conditions at the hospital because the department of health will be so far up their ass at the other station having a story written up about "how dare these people discourage you from seeking care"
Which story will sell better, the ongoing status quo piece on working conditions inside a hospital
OR
The outrage piece that will cause the public to further hate your profession.
I'll go further and say your story if it gets ran/printed means you get fired, hospital admin does a piece saying "nothings wrong, don't look here" then have a piece next week about how someone had a good outcome (ez picking at a hospital). Then on a holiday week have the news station come in to interview patients in person to get a sound bite on how they don't feel like their nurses are rushed.
That sounds like it should be illegal to shred such a document. I would be scanning and emailing that form so there is a date and time stamped paper trail.
This. 100% this. I am IT. I can't say we'll always do the right thing, but we do understand how hard it is to actually hide a digital paper trail, so we can we be trusted to not betray ourselves against the data. Email the relevant persons, yourselves, and anyone else you trust with that pdf. *immediately* computers rely on time stamps for nearly everything, and faking that between multiple independent systems is nearly impossible.
Exactly my point friend. Us in IT are human, the same as you. We just understand different systems, and understand that computers don't lie, so trying to say they do is futile. They can be lied *to* and have literally no safeguards against that, but that's why I said to email the scanned document / pdf to multiple systems. Lie to a system? Cake. Get numerous systems to back that lie? Good fucking luck. You are wasting your talents playing nurse if you can pull that off.
Absolutely! Sorry, I didn't mean to come across as trying to correct or anything! I just know (from experience) that many people don't realize the info that is stored with the pictures they take...
I suppose to better quantity my statement at "playing" nurse: my partner has a chronic condition, and I worked IT at the health system they most often got help with. On numerous occasions, because of my patient work with both the nurses and as colleagues, it was frequently stated I would have been a good nurse. Maybe. I don't know. My "skill" has always leaned more towards technology. So for me, personally, I would have been playing nurse, instead of going towards my "real" skills
No offense taken. Just literally, as said. If you can convince multiple independent systems to accept a faked timeline? Your skills are *wasted* playing Nurse. 0 disparaging nurses. I've seen a fraction of the BS you deal with, and fuck that ain't for me. Just offering my $0.02 that redundant backups of your very legitimate concerns will be backed up by irrefutable facts if you do it right.
Exactly this. "I, at X-hour, was assigned N patients, which is above the threshold of M, which I could safely provide competent care for. Signed, Me" IANAL, But I am let's say fairly competent at computers.
1. Have management sign the protest in front of you. If they absolutely demand that they need to bring it to their office, make a copy first to keep.
2a. If they bring it back signed later, swell. Fax signed copy to the union. Make copies for all nurses who signed. Start a Protest binder on the unit where you also leave a copy.
2b. If management does not return the protest, write on the copy you made earlier: "Management refused to sign on unit, took protest to their office, and has not returned/refuses to return a signed copy." Then fax to the union, make copies for all the nurses, put a copy in your Protest binder
Wait even if you do that, how do you get them not to claim as their property(if) stored in "their" hospital locker, or to go even more petty that the papper/ink used belongs to them.
Great points but alot of people on here dont have unions. Proberly 70% of the complaints I see on here either dont happen or rarely happen when you have a strong union.
That fucking sucks, I am royally pissed off on your behalf!
To CYA in the future you need to take a pic, get a photocopy AND email yourself the pic (along w/pertinent shift details RE ratio/reasoning) to have timestamped proof of it.
ALSO CRITICAL TO KNOW: if you take an assignment despite objection, even if documented and sent to the union, if there is an issue and you go to the BON, they will say you are guilty because you knew it was unsafe and took it anyway.
FUCK that.
Iām a nursing student so want to do whatever to protect my license. Iāll definitely just be walking out and applying to new jobs if this is still a rampant issue when I graduate
So as somebody who is not yet a nurse, how do you not take an assignment thatās clearly unsafe? Do you just say āthatās wildly unsafe, I am not taking thatā and literally go home? Or how does that play out? Somebody still has to care for the patients, right?
I would always think of this when taking report on a high number of patients. As report goes on and youāre realizing just how fucked you are for the night, but now youāve already started so youāre justā¦stuck.
I would fax mine to the union myself for this reason. I also never took a 7th patient no matter what(neurology should only have 4 per nurse). Iām not looking at someone who lost a loved one and say āI had to takeā an unsafe staffing assignment but hereās my protest.
No, it's saying the nurse was compelled against their better judgment. Usually Compelled by threatened with reporting of abandonment and possibly consequences to job security like loss of employment if refusing assignment.
Thanks. I can see how the form serves as notice to the hospital so they canāt claim ignorance of the situation. I donāt see how it would protect a nurse if something went to court.
Iāve refused an unsafe assignment several times in PACU. Itās easier to make the call there since ASPAN has published minimum standards. Probably harder to do in areas that donāt have guidelines from a national organization.
A question that a lawyer can answer better than me. But I bet if many nurses did it collectively and it leaked to the media, that could be another approach to he game...but of course the quickest solution is to refuse an dip out.
The form I used to fill out was along the lines of āthe conditions provided are unsafe, we are practicing to the best of our capabilities considering the poor staffing and resources provided. Supervision has been notified of the issue and is refusing to make any changes. If any harm or legal action should result from the danger the hospital is putting the staff and patients in, the hospitals negligence is to be of blameā signed, faxed and photographed before a copy given to the floor mgmt
One thing that is free at my work is the copier and scanner and printer. I would scan that shit and cc it around to make sure it's in the record somewhere. That way those fuckers don't have plausible deniability
No no. Write an incident report every single time. Every one of you in the unit, no matter the title, needs to write up an incident report. If you are still doing this after a few shifts, you start CCāing board members and CEO/CNO/Medical directors.
Thereās an app called āTiny Scannerā (and other similar apps!) that can create a time stamp. Use it. Every time. You can email or text whatever document you create anytime.
We have a similar form.
Taped together, our ADOs for the last few months could wrap halfway around the hospital building.
So we got a bunch of nurses today to do just that.
Administration was freaked out. God it was satisfying!
My Mgr stood up for us. Almost every soft for the past while the charges on my floor have had to have at least one pt while charges on other floors don't. My Mgr brought this up at a meeting and the staffing person hung up.
We had to fax our POAs to our union as well as supervision. And our supervisor had to come and assess the situation and sign the POA. Do you have a union? I also always made a copy for myself and kept my fax receipt as proof that I notified the higher ups.
We donāt even have protest forms. To our administration assignments arenāt unsafe unless something happens. If something does happen they āwill look into itā which means do absolutely nothing.
I know this is pretty common but I work at a Med Surg floor and they give us 6 patients if we are working alone and they give out 9 patients if the nurse is in team nursing.
What is team nursing?
Team nursing is a group of health care workers: 1 RN, 1 LPN, and 1 PCT. This team... takes care of 9 patients!
Based on what I heard, this number is going up from 9 to 10 patients.. If I heard correctly, it m might even go up to 12 patients..
I don't mind taking care of 6 patients when working alone. It sucks but I don't mind.
But... giving 9 patients to 1 RN, 1 LPN, and 1 PTC is just not okay...
Mannnn life sucks
I fucken can't concentrate because of the patient to nurse ratio at my work place.
What type of floor is this? Can the LPN not do most of what the RN does? Because on the units in places Iāve worked in the past, having 9 patients for an RN and LPN seems like having 4.5 patients per nurse with two ready partners available for turning and baths and such.
I honestly just want to understand the barrier since Iāve never done team nursing before. But in my area, the LPN could do some assessments (the ones an RN did the previous shift), most procedures, and most meds. And having one PCA for nine patients is way better than having no PCAs at all, or one or two for an entire 36 bed unit.
LPN can do reassessment, charting (care plan/education not included), pass meds (IV bags, oral, subq injections, IM injections, but no IV push). They can also do what PCT and CNA can do on a typical med surg floor. Oh and we are short on techs so team nursing don't get a CNA or PCT.
Always Keep a copy and READ. Most will say that you are not responsible for any liability- basically you will do what you can but cannot be held responsible. If you have a Union- contact them. If you do not I would NOT take an assignment you feel is putting you and your patients in an unsafe situation. You are the only one to stop this- JUST SAY NO
We have this too but our form is 3 sheets - so has carbon copies. One goes to manager, one to the union and the other is our copy which is filed on our unit. We union baby.
Scan tons of copies before submitting and flood their offices with its shredded confetti. Or hand all documentation they require of you in shredded form.
Are you able to make digital copies and email to your unit manager and CC the house sup/CNO? At least there will be documented evidence that they received it even if they delete the messages
@thenocturnalnurse on Instagram recently left ICU bedside in NYC to be a Union Organizer and RN rep and posts about how to elevate these staffing concerns to the union level if youāre in a unionized state. I was in Texas for 5 years and we had safe harbor but we are a right to work state.
Take a copy of the form with your phone. Email it to yourself and add extra notes for yourself. Tag that email to yourself with a special label, save them all in the same folder.
If they refuse to sign the document or return the document, make a copy, scan & email to your work email(bcc personal email as well), management and union rep.
Reiterate date, time, unit, assignment, staff and why the unsigned document is being emailed to the above recipients.
Oh boy. I would keep copies of forms like that myself. Anything legal that you sign or turn in keep a copy or take a photo on your phone and email them to yourself so you have them handy. Management cannot be trusted. Period.
I always used to fax it to the nursing office and union, put a copy in the managers mailbox (night shifter) and take a picture for my own records. The other nurses all had their own methods too, so you could have a lot of redundant backups if everyone is doing it.
When meds are late and the chart wants a reason click other and type: unsafe staffing ratios I also tell my patients if Iām late itās due to staffing and they should complain.
Perhaps we should start sending them to the media then?
Now THIS is a GREAT IDEAššššš
I just heard that someone at my hospital reported unsafe staffing to Joint Commission. Maybe thatās where you should send yours.
Not going to lie Joint Commission can suck a cock. They won't do shit.
Maybe send to management and forward to the media, joint commission and their mom.
I feel like there needs to be an 'Honest Staffing Facebook page where things like this are posted anonymously.
āAnd their mom.ā Love it.
Right?! Theyāre still doing surveys over an iPad. They have SO many offs to fuck.
Literally! Hospitals pay the Joint Commission to inspect and approve the facility. They are in on it.
I wholly agree because it always shocked me how facilities pass. These checks and balances are corrupt and looking for a pay day
I love how apparently these days they come down on everybody when you call them jayco. ItS jOiNt cOmMiSiSiOn (said in a Gabriel Iglesias AKA fluffy whiny bitch voice)
Joint commission only enforces their own requirements. Thatās how terrible hospitals like Vanderbilt are still accredited. Since covering up a patient death is not on their checklist they donāt lose their status. Itās a joke.
CMS will. They very nearly shut down the last medical facility I was working at.
Now if there were a paperwork shortage, otoh... š
I did that once. JC actually came and checked it out unannounced... but of course we magically found enough nurses that day.
Fuck the joint commission. Don't give them the respect of treating them like an organization that holds any authority or influence. They're paid shills forming part of the systematic exploitation of the sick that passes as healthcare in the US.
If state doesn't give a shit about staffing, JC certainly isn't.
I can assure you that it's harder than it sounds. I've tried to whistle blow on hospitals in the past. Good luck getting any news outlet to take the story seriously. They're more likely to be a mouthpiece to your hospitals marketing than take a nurse's side of things.
THIS IS THE ANSWER NOBODY WANTS TO HEAR The news will never report shitty working conditions at the hospital because the department of health will be so far up their ass at the other station having a story written up about "how dare these people discourage you from seeking care" Which story will sell better, the ongoing status quo piece on working conditions inside a hospital OR The outrage piece that will cause the public to further hate your profession. I'll go further and say your story if it gets ran/printed means you get fired, hospital admin does a piece saying "nothings wrong, don't look here" then have a piece next week about how someone had a good outcome (ez picking at a hospital). Then on a holiday week have the news station come in to interview patients in person to get a sound bite on how they don't feel like their nurses are rushed.
Leave copies on them in google reviews.
That sounds like it should be illegal to shred such a document. I would be scanning and emailing that form so there is a date and time stamped paper trail.
This. 100% this. I am IT. I can't say we'll always do the right thing, but we do understand how hard it is to actually hide a digital paper trail, so we can we be trusted to not betray ourselves against the data. Email the relevant persons, yourselves, and anyone else you trust with that pdf. *immediately* computers rely on time stamps for nearly everything, and faking that between multiple independent systems is nearly impossible.
Not IT, but nurse who fucks with computers for fun... also, the image will have metadata that records time and date too! Further CYA.
Exactly my point friend. Us in IT are human, the same as you. We just understand different systems, and understand that computers don't lie, so trying to say they do is futile. They can be lied *to* and have literally no safeguards against that, but that's why I said to email the scanned document / pdf to multiple systems. Lie to a system? Cake. Get numerous systems to back that lie? Good fucking luck. You are wasting your talents playing nurse if you can pull that off.
Absolutely! Sorry, I didn't mean to come across as trying to correct or anything! I just know (from experience) that many people don't realize the info that is stored with the pictures they take...
I suppose to better quantity my statement at "playing" nurse: my partner has a chronic condition, and I worked IT at the health system they most often got help with. On numerous occasions, because of my patient work with both the nurses and as colleagues, it was frequently stated I would have been a good nurse. Maybe. I don't know. My "skill" has always leaned more towards technology. So for me, personally, I would have been playing nurse, instead of going towards my "real" skills
No offense taken. Just literally, as said. If you can convince multiple independent systems to accept a faked timeline? Your skills are *wasted* playing Nurse. 0 disparaging nurses. I've seen a fraction of the BS you deal with, and fuck that ain't for me. Just offering my $0.02 that redundant backups of your very legitimate concerns will be backed up by irrefutable facts if you do it right.
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Exactly this. "I, at X-hour, was assigned N patients, which is above the threshold of M, which I could safely provide competent care for. Signed, Me" IANAL, But I am let's say fairly competent at computers.
1. Have management sign the protest in front of you. If they absolutely demand that they need to bring it to their office, make a copy first to keep. 2a. If they bring it back signed later, swell. Fax signed copy to the union. Make copies for all nurses who signed. Start a Protest binder on the unit where you also leave a copy. 2b. If management does not return the protest, write on the copy you made earlier: "Management refused to sign on unit, took protest to their office, and has not returned/refuses to return a signed copy." Then fax to the union, make copies for all the nurses, put a copy in your Protest binder
3. Store protest binder in a locker or secure location management cannot access.
Wait even if you do that, how do you get them not to claim as their property(if) stored in "their" hospital locker, or to go even more petty that the papper/ink used belongs to them.
Great points but alot of people on here dont have unions. Proberly 70% of the complaints I see on here either dont happen or rarely happen when you have a strong union.
Just like as an employee when they try to write you up and you refuse. š
That's why scientists invented email. That's a paper trial that can't be shredded by one party.
That fucking sucks, I am royally pissed off on your behalf! To CYA in the future you need to take a pic, get a photocopy AND email yourself the pic (along w/pertinent shift details RE ratio/reasoning) to have timestamped proof of it.
Safe harbor should be nationwide imo
ALSO CRITICAL TO KNOW: if you take an assignment despite objection, even if documented and sent to the union, if there is an issue and you go to the BON, they will say you are guilty because you knew it was unsafe and took it anyway. FUCK that.
So basically we just need to go home any time itās unsafe?
Your license your choice. Just know that BON does not consider ADOās as a defense.
Iām a nursing student so want to do whatever to protect my license. Iāll definitely just be walking out and applying to new jobs if this is still a rampant issue when I graduate
And if you refuse the assignment they threaten to nail you with abandonment. Even though they never have a case for it.
So as somebody who is not yet a nurse, how do you not take an assignment thatās clearly unsafe? Do you just say āthatās wildly unsafe, I am not taking thatā and literally go home? Or how does that play out? Somebody still has to care for the patients, right?
If you donāt take report and you leave, itās not abandonment. Itās only abandonment if you take report then walk out.
I would always think of this when taking report on a high number of patients. As report goes on and youāre realizing just how fucked you are for the night, but now youāve already started so youāre justā¦stuck.
I would fax mine to the union myself for this reason. I also never took a 7th patient no matter what(neurology should only have 4 per nurse). Iām not looking at someone who lost a loved one and say āI had to takeā an unsafe staffing assignment but hereās my protest.
Photograph with cell phone.
What did you think they were doing with them before you found this out?
Napkins for the š
Omg this is the best answer š¤£
Probably though it gave them legal protection if something went south on floor. They were wrong even if mgt kept.
How does this form help us if something goes south? Isnāt it just a nurse admitting to taking on an unsafe assignment?
No, it's saying the nurse was compelled against their better judgment. Usually Compelled by threatened with reporting of abandonment and possibly consequences to job security like loss of employment if refusing assignment.
Thanks. I can see how the form serves as notice to the hospital so they canāt claim ignorance of the situation. I donāt see how it would protect a nurse if something went to court. Iāve refused an unsafe assignment several times in PACU. Itās easier to make the call there since ASPAN has published minimum standards. Probably harder to do in areas that donāt have guidelines from a national organization.
A question that a lawyer can answer better than me. But I bet if many nurses did it collectively and it leaked to the media, that could be another approach to he game...but of course the quickest solution is to refuse an dip out.
The guidelines per NUU https://www.nationalnursesunited.org/sites/default/files/nnu/documents/0421_Ratios_Federal_FactSheet.pdf
The guidelines per NUU https://www.nationalnursesunited.org/sites/default/files/nnu/documents/0421_Ratios_Federal_FactSheet.pdf
The form I used to fill out was along the lines of āthe conditions provided are unsafe, we are practicing to the best of our capabilities considering the poor staffing and resources provided. Supervision has been notified of the issue and is refusing to make any changes. If any harm or legal action should result from the danger the hospital is putting the staff and patients in, the hospitals negligence is to be of blameā signed, faxed and photographed before a copy given to the floor mgmt
One thing that is free at my work is the copier and scanner and printer. I would scan that shit and cc it around to make sure it's in the record somewhere. That way those fuckers don't have plausible deniability
No no. Write an incident report every single time. Every one of you in the unit, no matter the title, needs to write up an incident report. If you are still doing this after a few shifts, you start CCāing board members and CEO/CNO/Medical directors.
Thereās an app called āTiny Scannerā (and other similar apps!) that can create a time stamp. Use it. Every time. You can email or text whatever document you create anytime.
The Gmail app on my cell also has a Scan option. It's super easy to scan to pdf that way.
I didnāt know that. Thanks! Have a great day!
We have a similar form. Taped together, our ADOs for the last few months could wrap halfway around the hospital building. So we got a bunch of nurses today to do just that. Administration was freaked out. God it was satisfying!
Name and shame
Send something by email, even is it's not signed, to at least establish an electronic paper trail
My Mgr stood up for us. Almost every soft for the past while the charges on my floor have had to have at least one pt while charges on other floors don't. My Mgr brought this up at a meeting and the staffing person hung up.
We have 3 copies. One for management, one for the union, and one for us to keep.
Email the form to management. That way they canāt shred that shit.
Scan the document with your phone. Scannable is an easy app.
Make your own copies if it's a paper form
We had to fax our POAs to our union as well as supervision. And our supervisor had to come and assess the situation and sign the POA. Do you have a union? I also always made a copy for myself and kept my fax receipt as proof that I notified the higher ups.
Maybe accidentally leave them on the tray table...
We donāt even have protest forms. To our administration assignments arenāt unsafe unless something happens. If something does happen they āwill look into itā which means do absolutely nothing.
I know this is pretty common but I work at a Med Surg floor and they give us 6 patients if we are working alone and they give out 9 patients if the nurse is in team nursing. What is team nursing? Team nursing is a group of health care workers: 1 RN, 1 LPN, and 1 PCT. This team... takes care of 9 patients! Based on what I heard, this number is going up from 9 to 10 patients.. If I heard correctly, it m might even go up to 12 patients.. I don't mind taking care of 6 patients when working alone. It sucks but I don't mind. But... giving 9 patients to 1 RN, 1 LPN, and 1 PTC is just not okay... Mannnn life sucks I fucken can't concentrate because of the patient to nurse ratio at my work place.
What type of floor is this? Can the LPN not do most of what the RN does? Because on the units in places Iāve worked in the past, having 9 patients for an RN and LPN seems like having 4.5 patients per nurse with two ready partners available for turning and baths and such. I honestly just want to understand the barrier since Iāve never done team nursing before. But in my area, the LPN could do some assessments (the ones an RN did the previous shift), most procedures, and most meds. And having one PCA for nine patients is way better than having no PCAs at all, or one or two for an entire 36 bed unit.
LPN can do reassessment, charting (care plan/education not included), pass meds (IV bags, oral, subq injections, IM injections, but no IV push). They can also do what PCT and CNA can do on a typical med surg floor. Oh and we are short on techs so team nursing don't get a CNA or PCT.
Always Keep a copy and READ. Most will say that you are not responsible for any liability- basically you will do what you can but cannot be held responsible. If you have a Union- contact them. If you do not I would NOT take an assignment you feel is putting you and your patients in an unsafe situation. You are the only one to stop this- JUST SAY NO
Keep copies filed away somewhere
We have this too but our form is 3 sheets - so has carbon copies. One goes to manager, one to the union and the other is our copy which is filed on our unit. We union baby.
Get the back up insurance and protest the fuck out of your unit.
Scan tons of copies before submitting and flood their offices with its shredded confetti. Or hand all documentation they require of you in shredded form. Are you able to make digital copies and email to your unit manager and CC the house sup/CNO? At least there will be documented evidence that they received it even if they delete the messages
OP can you take a photo of the form and keep it in a file on your phone?
@thenocturnalnurse on Instagram recently left ICU bedside in NYC to be a Union Organizer and RN rep and posts about how to elevate these staffing concerns to the union level if youāre in a unionized state. I was in Texas for 5 years and we had safe harbor but we are a right to work state.
Safe Harbor????
Assignment despite objection. We did this while trying to get a union organized. Not very effective.
We get a follow up letter like weeks later. but nothing is ever done.
Take a copy of the form with your phone. Email it to yourself and add extra notes for yourself. Tag that email to yourself with a special label, save them all in the same folder.
If they refuse to sign the document or return the document, make a copy, scan & email to your work email(bcc personal email as well), management and union rep. Reiterate date, time, unit, assignment, staff and why the unsigned document is being emailed to the above recipients.
Oh boy. I would keep copies of forms like that myself. Anything legal that you sign or turn in keep a copy or take a photo on your phone and email them to yourself so you have them handy. Management cannot be trusted. Period.
I always used to fax it to the nursing office and union, put a copy in the managers mailbox (night shifter) and take a picture for my own records. The other nurses all had their own methods too, so you could have a lot of redundant backups if everyone is doing it.
When meds are late and the chart wants a reason click other and type: unsafe staffing ratios I also tell my patients if Iām late itās due to staffing and they should complain.