Unsafe
Staffing
Nursing
staffing levels have been declining for more than a
decade. Hospitals responded to the onset of managed care
and the pressure to cut costs by driving down staffing levels,
and in some instances demanding nurses work mandatory overtime-
at the same time, patients admitted to hospitals were
increasingly more seriously ill.
Unsafe
Staffing, floating nurses into unfamiliar units, and/or
mandatory
overtime places a registered nurse in situations in which he/she
is unable
to provide safe quality care to his/her patients.
A
major study published in the May 30, 2002 New England Journal of
Medicine
shows a clear relationship between inadequate registered nurse
staffing in
America’s hospitals and the risk of deadly complications. In
hospitals with
higher nurse staffing, there were 9 percent fewer patient
complications
compared to hospitals with lower staffing.
An
understaffed unit risks patient's lives and your license!
Inadequate
nurse staffing causes needless patient deaths in hospitals.
A study, released in the October 23-30, 2002 edition of the
Journal of the
American Medical Association, finds that for each additional
patient over
four in a registered nurses' workload, the risk of death
increases by 7% for
surgical patients. In hospitals with eight patients per nurse,
patients have
a 31% greater risk of dying than those in hospitals with four
patients per
nurse.
For each additional patient the study also found a 23 percent
increase
in RN burnout and a 15 percent increase
in job dissatisfaction. ["Hospital
Nurse Staffing and Patient Mortality, Nurse Burnout, and Job
Dissatisfaction",
JAMA, October 23-30, 2002]
According
to the American
Nurses Association Code of Ethics, "The nurse
assumes responsibility and accountability for individual nursing
judgments and
actions", and "The nurse acts to safeguard the client
and the public when
health care and safety are affected by the incompetent,
unethical or illegal
practice of any person." Any time the floor or unit is
understaffed, you have a
duty to make that known. An understaffed unit is an area
of liability, a risk
that needs to be brought to the attention of the manager.
From
a liability perspective, you need documentation that each level
of the organization was aware of staffing difficulties. Don't
allow yourself to be intimidated by management into accepting an
assignment that you know
is unsafe!
Patient
Advocacy is at the heart of nurse's professional commitment.
In turn,
patients depend on nurses to ensure that they receive proper
care
Know
your state's Nurse Practice Act, find
out if your hospital, State Board
of Nursing, or Union (if you belong to one) has any sort of
Assignment Despite
Objection form! Do not accept report if you believe the patient
load you are
being assigned is unsafe- once you accept the patient load you
cannot
abandon them. Try the steps below first:
-
Tell
your supervisor or nurse manager that you feel the
assignment
is unsafe and explain why. Allow the supervisor time to make
adjustments. If no adjustments are made then....
-
Put
your objection to the assignment into writing!
Make copies for yourself.
-
Give
a copy to your manager or risk management..
-
Then
notify Nursing Administration.
This
is the only proof that you recognized and reported a potentially
dangerous situation to the hospital administrator who is
responsible for
solving it.
If
it’s not documented, it didn’t happen
Staff
Nurse Liability
-
Liability
is always shared between the staff nurse and supervisor.
-
When
working on understaffed units, you do face an increased
possibility of liability.
-
Floating
to an area with which you are unfamiliar will incur a higher
risk of liability.
-
Much
of your liability depends on whether or not you prioritize
your
tasks appropriately.
Supervisor
Liability
-
Supervisors
will share liability for patient injuries.
-
They
also share liability if they knowingly float individuals to
areas
outside their area of competence.
-
Supervisors
have a duty to help understaffed units by obtaining
additional staff, pitching in to help, and they should make
frequent
visits to understaffed units.
-
All
nurses, whether supervisory or not, need to be careful and
cognizant that they will remain liable for all tasks
attempted,
completed, and omitted.
Institutional
Liability
The
hospital remains liable for the behavior of it’s employees
Additional Information About Safe (or Unsafe) Staffing:
RN
turnover rates are at their highest mark in decades. Nurses will
not remain in unsafe hospitals! Please support safe staffing
legislation, punishment and fines for employers who put patient
safety at risk via unsafe staffing practices, bans on mandatory
overtime, and whistleblower protection laws!
While
some try to blame unsafe staffing levels on a shortage of
nurses, many
nurses point out that unsafe staffing levels are more a crisis
of hospital working
conditions than of a shortage of qualified nursing staff.
Do
you have concerns about nurse-patient staffing ratios? Are you
in a union
or not? Are you afraid to try to unionize? Have you been placed
at risk by
dangerous workplace issues? Discuss staffing and workplace
issues together in
our new Nursing
Discussion Forums and share issues and ideas for solutions!
Remember- Do not accept report if you believe the
patient load you are
being assigned is unsafe- once you accept the patient load you
cannot
abandon them!
From NSO Risk Advisor,
June 1997.
The unit where I work normally has 22 patients, 2 nurses, and 3
nursing assistants. I've repeatedly complained to my
nurse-manager about the unsafe staffing patterns, but nothing's
changed. I'm afraid I'll be held legally responsible for any
problems that may arise. Sometimes I get so frustrated I just
feel like leaving the unit. What should I do?--R.W., Fla.
No
matter how frustrated you become, don't leave your
unit--you could be charged with abandoning your patients. Your
state's nurse practice act may require you to continue working
even when you consider conditions unsafe.
Notify
your nurse-manager of dangerous understaffing. Explain your
reasons for believing the unit is understaffed and reference any
incident reports you feel are directly related to the staff
shortage. If you don't get an acceptable response from your
nurse-manager, take your complaint to the hospital
administrators.
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Nursing
Liability Related CEU Courses
($8.00/Credit Hr Unless Otherwise Noted)
A)The Staff Nurse As Risk Manager
B) Protect Yourself- Know Your Nurse
Practice Act
C) Managing Legal Risks in Home
Healthcare
Additional
Courses (some as low as $5/ceu)
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NURSING LEGAL ISSUES
