Asking for Opinion/Advice from TEXAS

1 I work on a 31 bed telemetry unit. we are currently at a ration of 7:1 with a charge nurse who take 3 pts. We have drips on our floor/post cabg/dialysis, and whenever there is no room in ICU we take them when the Dr. downgrades them also if a pt on any other floor except for icu who is started on drip is sent to us, of course unless the drip involves titration or if the pt is intubated.

Normal Day to Day Scenario, I might have all 7 on tele 1 to 2 might be post cabg, and i most likely have a couple on drips. I have 7 assessments, 7 different charts to check, etc etc,
Problem:
they want to change the ratio to 8:1 with a free charge... I like the free charge thing BUT.... if we are running around looking like a blur to our patients now i can only imagine who this is going to work... and for get it if a pt goes bad.
We have all expressed our concerns to our manager and he said "you can tell me whatever you want Im not going to change my mind you are wasting your time"... we feel dismissed and are very scared of the consequences if anything were go down with a pt. We have not had anyone from administration come and talk to us or make us aware of these changes let alone get our feedback... My fellow nurses are meeting tomorrow at someones house to see what our next move should be, I feel we need to stick together and stand up for ourselves and protect our pts, and our licenses.

Please can some of you all tell me you thoughts I would love to know what others think
sorry i had already posted this on another thread but I wasnt getting any hit and iam impatient at the moment about this situation

Sounds dangerous to me. Something happens and the hospital will usually blame a nurse. I hope you're able to improve things, maybe get the press involved. Unfortunately the "troublemakers" who want safe staffing ratios often have trouble afterwards. Since it's always about money, can you suggest to your sepervisors some other ways to save money other than cutting staff? Good luck and best wishes.

Thank you for your support, yes I think it is a dangerous situation too, we are gonna try to talk to admin. and bring them ideas, but we also well aware that those who are willing to stand for themselves usually get shafted... we hope this doesnt happen but what else can we do, we are trying to be pt advocates and we are advocating for their safety at the moment by decreasing ratio... we just dont know how to go about it yet

Any other state and a union would be there banging on their heads.:P

You can quote the recent article from the New England Journal of Medicine that states unsafe nurse to patient ratio will lead to increased patient mortality. The staffing ratio's you quote seem very unsafe to me. I would hate to ask what the night time ratios are.

I think you should keep going up your chain of command because this is not safe pt care. In the end it will be your butt/license.

You should all invoke safe harbor, seriously. That's ridiculous.http://www.bne.state.tx.us/practice/safe.html

You basically work in an ICU step down unit. I've only heard of ratios 3:1 or 4:1 NEVER 7:1 or 8:1!!!This is dangerous! If you can't change it, get out. That is unbelievable.

Seriously you should all invoke safe harbor. Safe harbor protects your license from sanction during the time the issue is undergoing peer review, but it does not protect you from civil liability. When you invoke safe harbor it must be done before accepting the assignment you are concerned about. You may then continue with the assignment or refuse the assignment based on the the provisions for refusing outlined in the Nursing Practice Act.Please read all pertinent information regarding this legal alternative to unsafe care. Your patients and your license are definitely at risk. The link is noted above in Orange Tree's response. You must follow the directions exactly, and there is protection for you and others to prevent retaliation. I don't think many nurses understand this provision in the Nursing Practice Act. There is also information under the Nursing Practice section on the home page at the website. Please read your NPA!Is administration aware of this? Is your manager following mandates "from above" or is he trying to make his numbers look good? I have to say that I would not put my license on the line for this. This is the kind of situation that makes nurses look to collective bargaining groups for change.Good luck, and protect your patients and your license!

Of course its all about the numbers and making himself look good administration... just the other day we had a patient with hepatic encephalopathy on top of an underlying dementia, he was boxing with the staff we were trying everything to redirect and reorient him I was as charge helping my fellow nurse with this patient, we called the doctors got orders for restraints and meds, I call my manager to let him know of the situation, he was very frustrated that we had someone on restraints, he had told us from the beginning "NO ONE ON RESTRAINTS, ON ONE ON one to one", I told him we had no choice this guy was out of control... and he was a hazard to himself and others. His solution well tell the nurse to go sit in the room with his notes and watch him... I was shocked I said what about his other six patients he cant sit there. OK so that day was a horrible day to begin with, and during all that that same nurse had someone that we rapid responsed who we intubated and stablized who went PEA while waiting for an ICU bed to open, we coded him and well he didnt make it. But my crew, we awesome we helped each other through and through, can you imagine what it would have been like if we werent so together!!!! Well I made sure that all the right protocol was legit and kept the other patient on restraints anyway. I come back a few days later the combative pt is still there with no restraints no meds to calm him NOTHING, still combative, still wandering, I could just feel that this guy is going to fall and its going to be the best day ever. Well he did fall after grabbing his tray and throwing it at us in hallway he fell while throwing punches at us. The best incident report EVER!!!! well what can I tell you, we are going to get together tonight and discuss our situation we are hoping that if we all stick together we just might be heard even its at least stays 7:1.... any other thoughts.... or anyone know how to contact anyone who can help us, we live a city where people are scared to fight back because its all about who you know here and if you whistleblow you are going to get retaliation and we cant afford to get fired.... thats the mentality here and with my group of nurses, we r young want to chnge that...

I agree with the chain of command recommendation as the BON likes to know it was attempted at least. You need to confer with the CNO. Perhaps ask him/her to meet with all of you in staff meeting. Could be your manager is getting directives from above. You can call JC but they will want facts. You can claim safe harbor (see BON website for details). Remember the Board exists to safeguard the public, not the nurse. They cannot prevent you from being fired. Last, if anyone is a member of TNA you can contact the Director of Nursing Practice for advice. Good luck. This sounds like too many patients for one nurse.

I'm sorry that's awful, I agree you should go up the chain, but maybe you could enlist the help of some of the medical staff who agree and are sympathetic? This happened on a unit I worked on. We were ignored until our intensivist got involved. He basically involved the Medical Director who told admin that they wouldn't admit patients to the hospital if the ratio was dangerous. BTW we didn't actually approach him, he noticed how crazy the unit was and overheard some of the nurses talking about how scary it was....I am sorry.