Accept or refuse an assignment

I Last edit by Level2Trauma on Feb 12, '02
I have never worked psych, but that sounds very unsafe.Where I work, in acute care, our suicide precautions patients have one on one sitters. You are saying you have only 2 licensed staff for 20 patients with one tech (not counting the admit nurse who is not providing patient care)? The nurse patient ratio is 1:20 for the RN? That is insane! I look at it this way: would you rather refuse an assignment & possibly lose your job, or take the unsafe assignment & possibly lose your license? I would refuse that assignment.

I have never worked at an Acute Psychiatric Unit. But once I saw the patients at the Psychiatric Unit. At that time, I felt very dreadful. I think I would not work there.

REFUSE THE ASSIGNMENT, AND GO HOME! PROTECT THY LICENSE!

This is always a tough call. I'm not a psych nurse but I have been in unsafe staffing situations. Only once did I walk out and not go back, and this was after zero response to my demands for more staff. I refused to accept report from the offgoing charge nurse and quit on the spot. You must be careful if you do this, to avoid abandonment charges.DO NOT ACCEPT REPORT or you may face charges!! I feel I may have helped the nurses who stayed on, as they were staffed better after I did this, but it is a hard thing to do.(and of course I had a lousy job reference..LOL!) Follow your heart. Know your nurse practice act. Do you have a safe harbor provision or some means to file a grievance within your facility? Use your union if you're lucky enough to have one.Keep trying to educate administrators about safe care. I know sometimes it feels like we are just spittin' in the wind but we have to keep pluggin'! I am seeing more attention paid to nurses today than I have in my 25 year career, so we are making progress. Best wishes!

Since you already showed up to work and took report, wouldn't you be abandoning the patients if you walked out???

I don't work psych. but those nursing ratios sound terrible.When I'm in charge and they want me to work over matrix...I always say I'll take more patient's if you give me more nurses. I've even done that for the midnight shift. It'll be 6 P.M. and they want to give me a bunch of admissions which is alright with our matrix but not MN. matrix. I'll call staffing make sure they can get another nurse for mn. before accept additional patients.Usually what will happen is... I'll call staffing and they'll say nope MN. is not getting another nurse. Then I tell them I will not take anymore patients until mn. gets another nurse. And everytime I get a phone call 10 minutes later...stating MN. WILL get the extra nurse. I like when I'm in charge staffing seems to be better for the upcoming shift. Now other nurses hear I'm refusing patient's they sit there and say you can't refuse patients even if we go over matrix. But I do it...and I always end up with the extra nurse. Now when the "other" nurse is in charge (that let's us go over matrix) MN. NEVER gets the extra nurse.

In 1993, I was working at a hospital on a twenty bed Cardiac Stepdown Unit. I worked four 8 hour 11-7 night shifts per week making 20.00/hour. I enjoyed working the unit until staffing no longer met the needs of the patients. On night shift, they usually had two to three RNs with one or two CNA's. We managed, but could have used another RN as all 20 beds were filled; half with serious fresh cardiac patients, some of which had multiple issues wrong with them including a few mental problems that got out of hand each night. As that particular week went on, our third nurse called in sick, leaving 2 RNs and 1 CNA on duty for twenty patients. As the night went on, alarms were going off constantly, more than five patients were complaining of chest pain that had to be monitored frequently while giving the NTG tabs, etc, taking vital signs every five minutes, and so forth. One combative patient pulled loose from his restraints, pulled off his tele monitor, patches and all, and we found him stumbling down the hall towards the nurses station with blood splattering everywhere since he dislodged his IV. His NGT was dangling from his nose/taped by a thread, foley bag dragging on the floor.... need I go on??? The entire floor was in chaos! I called for the supervisor who told me "We just had to do the best we could because there weren't any nurses in the house that she could send to help us out." WELL, EXCUSE ME, but that wasn't good enough for me. I asked her to come to the floor to help out, and she declined stating "That wasn't her job to help us out." COME AGAIN??? I told her she had better find us a nurse, and find her/him fast or I was going to call the police for backup.... OKAY, I was PISSED, okay????:roll She sent us a pediatric LPN agency nurse who had never taken care of an adult patient in her life! God bless her for trying her best to help us out, but it just wasn't enough for the kind of patients we had to deal with. The other RN and I were pulling out our hair, to put it mildly. I called the Nurse Manager (Head Nurse) and the main Charge/Preceptor Nurse at home and asked them to come in. They refused. The supervisor eventually sent us someone from ER to put in the old man's IV again, and help us get the floor settled down as much as humanly possible. At the end of that shift, I made it known that I would NOT be returning that night UNLESS they had sufficient staffing on that floor, or transfer some patients back to CCU or to a unit that could help us deal with the serious cases. I went home, got a few hours sleep, woke up and called the Dayshift Nursing Supervisor and asked her how things looked for the nightshift, and she said she was afraid they weren't going to get any better. I said, "I hate to leave you hanging tonight, but if you don't staff that floor, or move patients around so that they are "safely" cared for, I will not be reporting to duty because I knew I would be held accountable for any patient assignment I came to work and took report on. She said, they would call me back if things changed. By nine thirty that evening, I called them back, and nothing had changed; not even an agency nurse. So, I told them with much regret, I would not return because it was putting the patients lives at risk as well as my nursing license. The following morning, I went to the hospital and handed them my resignation letter, apologizing for not giving them the two week notice, but under the circumstances in which they expected their nurses to work, they left me with no other alternative but to resign. The hospital gave me an excellent evaluation to my next employer, but when asked if they would ever rehire me they said "No, because the employee did not give her two week notice." They at least acknowledged that I was an excellent nurse, but stuck to their policy of needing a two week notice when an employee resigns. Can you imagine what those two weeks would have been like for me? I wasn't stupid! At least the evaluation left nothing negative against my nursing skills, just my timing of leaving their facility. I would never abandon a patient assignment that I had already accepted, but I would not accept an assignment if I knew beforehand that the patients would be inadequately staffed. I learned to call in two shifts before my next assigned shift to find out how the staffing versus patient ratio was for the nightshift. If it sounded too unsafe, this gal let them know not to expect her. If the entire shift refused to do this when there are unsafe conditions, I bet they would find some nurses in a heart beat.

Okay, I never worked Psych, but I did just sit on a panel for a CE class on Patient Abandonment so that is the area I'm answering your question from. Level2Trauma, you don't say whether psych is your home station, and I think that would also make a difference here (I'm assuming from your name that it is NOT your home station, but I may be wrong). The other thing you don't mention is the state, province, or country you practice in - and THAT will make a BIG difference also. First of all, I would NOT accept that assignment-- here in Mn., suicide precautions requires that the patient is either 1:1, or at the least, every 15 minute patient checks. A recent case here received much publicity when a suicide patient who was supposedly being checked Q15 minutes through the night, and the staff would look in the room and see the patients' feet but weren't checking further. In the morning, it was found that he'd managed to strangle himself during the night.I looked at many state Nurse Practice Acts while researching for the C.E. class on patient abandonment, and found that once you receive report, all states consider that as the point at which you have accepted the assignment. So now you're stuck, right? Not Necessarily! Several state Nurse Practice Acts don't address the term "patient abandonment", but several include it under unethical or unprofessional conduct. And there are many states that will not consider quitting on the spot (as mattsmom81 did) as a reason for discipline! It seems that it is safer to quit when faced with an impossible assignment than it is to work it! A number of states differentiate between patient abandonment and employment abandonment; and there are some states that seem to place the onus of the burden (of unsafe staffing) on the supervisors, managers, and facilities instead of the nurse! If you feel it is an unsafe assignment, do not work it. You may be disciplined by your facility in these states (and even lose your job), but you will not lose your license!Most states do not consider refusing to do mandatory overtime as patient abandonment! IF you have worked your shift; you can not be forced to work extra, ESPECIALLY IF YOU FEEL THAT YOU ARE TOO TIRED TO DO SO! However, once you agree to work overtime, YOU WILL BE HELD ACCOUNTABLE to the same level of care as if it was not overtime!AND DOCUMENT, DOCUMENT, DOCUMENT TO CYA!

Renee, GOOD FOR YOU! I hadn't read your post (I'm a slow typer when the TV is on!) before, so we overlapped here. The supervisor was definitely in the wrong in that situation, it seems to me that the supervisors' duty is to staff a facility adequately and also "stomp out fires" along the way. That shift from hell jeopardized your license. Too bad it wasn't her license on the line also.

What a great thread and Renee, I especially loved your story!! Good for you for stickin' to yer guns and I'm glad you were able to overcome the 'no rehire' ref---I did too with an explanation attached to my Group One. I strongly feel if RNs would stick together and take our duty to the public more seriously,we could use our power to make things better for our patients and ourselves. I love these bulletin boards where we can share and learn from each other.! My hat's off to you Renee!

Thanks gals! Supporting one another in nursing is what it's all about, heh? "It's easy to get good players. Getting them to play together (cohesively as a team)...that's the hard part." -- CASEY STENGEL {I added the 'cohesively as a team' part to Casey's wonderful quote. Hope she doesn't mind -- whoever Casey is...}

Renee your an inspiration