Reporting a facility for staff ratio issues?

I've exhausted my google resources.

I work at a facility that has been ignoring staffing ratios for the last few months in all the units. Us nurses have been getting ran through a meat grinder the entire time. We've been missing meals and breaks (we work in CA with a union) and now management is threatening punishment for missing meals and breaks when we're out of ratio. The Director of Nursing said "nothing can go wrong in 30 minutes" and encouraged us ICU nurses to go to lunch despite leaving a charge nurse with 3-5 ICU patients. The other night when I had a 1:1 patient, they sent me a 2nd patient regardless of my objection and my 1:1 pulled their central line out. Crisis was averted, but narrowly.

Anyway, sorry for all of the ancillary information. I'm wondering if any CA nurses specifically have any experience with reporting an employer for this behavior (to the state?). Reporting a facility to the CA Dept. of Health entails including patient information rather than it being related to a staffing ratio problem.

The final straw came when a member of management brought up "time management" problems on the end of staff nurses due to recent overtime and missed meals/breaks. They're actually blaming the staff nurses for time management problems when we're out of ratio or have an encumbered charge with no one to relieve us. Any insight would be appreciated. I'm at my wits end Last edit by ICUEDMursenary on Mar 25 : Reason: additional comment
I'm sorry this is happening to you. At the start of each shift that is not safe document in writing exactly what the situation is and give a copy to your manager or shift supervisor. If your union provides an "Assignment Despite Objection" (ADO) or "Disclaimer" use that and keep a copy. If you don't have a form use paper. Write, "In our professional judgment this assignment is unsafe because the facility failed to provide sufficient staff. As a result the facility is responsible for any adverse effects on patient care.Write details on the one given to management. Here is an ADO from the Washington State Nurses Association. California does not have it on line:http://www.wsna.org/labor/ado/documents/ADO.pdf It is not a HIPAA violation to provide information to hospital management or to a regulatory agency.Write an exact quote of what you were told and the name of the manager or supervisor. The date, time, location, number of nurses, number of patients, and room numbers of patients should be written on the form or paper.If something happens remember the name of the patient and the room number. Don't write it anywhere and don't look at the chart when you are not assigned to that patient.That form can be used in court or a disciplinary hearing. It is best for all nurses on the shift to sign it, but do it alone if they won't.It can save your license, your job, and protect you in the event of a malpractice lawsuit.I'll type the text of a flyer on reporting to the state:HOW TO COMPLAIN TO THE DEPARTMENT OF PUBLIC HEALTHINTRODUCTION:

find out what law firm represents the hospital in liability issues, have the union start with them. Of course, it should have been reported the first time that it happened..... I know, easier said than done.

If ordered to go to lunch I would ask, "Who will take over my patient(s) while I'm at lunch?"If there is no one I would say, "I would if I could, but I cannot abandon my patient.'If ordered to i would ask with other staff to witness, "Are you ordering me to leave my patients without an assigned nurse?"Sometimes they then understand that they are ordering you to violate the Nursing Practice Act and the law.Here is an examples of a hospital fined after a patient was harmed due to ratio violations:Palomar Medical Center (PDF)555 E. Valley Parkway, Escondino, CA 820211, San Diego County - The hospital failed to ensure the health and safety of a patient when it did not follow its patient care policies and procedures. This is the first administrative penalty issued to this hospital. The penalty is assessed at $50,000.The statement of Deficiency is in the column on the left. The right side has the required Plan of Correction. Generally unless a patient is harmed there is no fine. The hospital must provide an acceptable Plan of Correction.

Quote from mortefind out what law firm represents the hospital in liability issues, have the union start with them. Of course, it should have been reported the first time that it happened..... I know, easier said than done.

Forgive my ignorance because I've never worked with union protections, but isn't this what your Union is there for?Why aren't these conditions being monitored by or at least reported to your Union representative?

Quote from roser13Forgive my ignorance because I've never worked with union protections, but isn't this what your Union is there for?Why aren't these conditions being monitored by or at least reported to your Union representative?

This is a terrible and unacceptable situation. herring_RN has given you the best advice regarding ADOs and filing complaints with the state. Some nurses have a difficult time "making waves", but it is our responsibility as patient advocates to speak-up for safety. If your management is not responding by providing additional staff, then they have given you no recourse but to ask the state to investigate. You should specifically mention the incident of your patient pulling out the CL. Kudos to you for caring! Side Note/Soap Box: In California, barring an ongoing emergency/disaster situation, no nurse should ever accept a patient or assignment that violates the patient safety ratios. Just say no. And keep saying no. And mention Title 22. And refuse to take report.

Yes. Give the date and other information to the state. I'm not sure it is a good idea to refuse the assignment unless there is a plan with all your colleagues.I heard in a class about a group of nurses who sat in the break room refusing to take report until sufficient staff was provided. They had already planned so the previous shift nurses continued caring for patients. When handing the ADO to management you have put them on notice that if there is a fall, late medication administration, or failure to rescue it is their responsibility. you then do the best you can under the circumstances because if you leasve it will be worse.BUT don't stop there.Nurses at this hospital testified before the city council:RNs at Watsonville Community Hospital to Testify at City Council on Unsafe Patient Care Conditions | National Nurses United

Here is a Nurse Alert explaining a lot about how to advocate for your patients and the profession of nursing:http://www.nationalnursesunited.org/...nsemar2309.pdf

Is there an admission criteria or nurse/pt ratio listed in your nursing requirements/job descriptions? If so, then the facility can be held liable for this---do a little digging, maybe see what they advertise on line etc.

Quote from firstinfamilyIs there an admission criteria or nurse/pt ratio listed in your nursing requirements/job descriptions? If so, then the facility can be held liable for this---do a little digging, maybe see what they advertise on line etc.