understaffed and liable

[KELLY HAMILTON]

Hi again, Another question I was wondering about is when does a nurses liability end when she is under staffed (or does it even)?

[ENARN2006]

Kelly -- what a great question to ask -- i unfortunately have the same one. it seems that there are never enough nurses in my department. we have 0 techs, no triage nurse, and a nurse;patient ratio of 1:5 on a good night. It's just not safe - ive spoken with the dept manager -- told her several times how overwhelmed we are - she's done nothing... and im about to lose my license for anyone - i just dont know what to do.

[AprilRN]

I'm new to all of this..so my 2 cents might not be worth much. THe hospital I did clinicals at is going through this..and I had the opportunity to sit in a meeting with the MNA. They told them their liability ends/starts at report. When you accept report...you are liable. When someone accepts report from you....they are liable.

The only way out of this...according to them....is to band together and refuse to accept the work load. Unfortunately...each person who does is putting their job on the line. They said the only way it works..is if everyone follows through. Then..administration is stuck. If you come on to work..and say you cannot accept the assignment...but you will accept a "modified assignment" then the charge nurse HAS to call in help....approved or not....or she can't leave. If every shift follows suit...you're covered for liability.

Unforunatly the admins COULD let you all go...or if not everyone follows..they'd just let go the ones not accepting report.

This is a tough situaiton in nursing. Nurses want to give appropriate care...admins want to make money...and pay fewer nruses.

[TomB]

Hi Kelly,

I don't think the nurse's liability ever ends while a patient is under his/her care.

Once you assume the care of a patient you are liable regardless of the staffing levels.

I'm no expert, but I believe that if something goes wrong and you are sued or a complaint is filed with your BON, the staffing level is not a valid defense/excuse.

My advice (as with most situations) is document, document, document. Express your concern to your management in writing and always keep a copy.

[cassioo]

Hi Kelly,

My advice (as with most situations) is document, document, document. Express your concern to your management in writing and always keep a copy.

document document document, enact the chain of command and document (variance report) that you've notified charge nurse, unit manager, house supervisor etc of unsafe conditions, understaffing.

[NavyJim58]

The first thing you need to do is read and understand your states nurse practice act. If your state has "safe harbor", read and understand what that means. Once you take report you have responsibility for your patients. If you have an unsafe situation such as an order from a physician you believe is "wrong" and unsafe for the patient, before you follow the order question the physician. If he/she is adamant that you follow the order contact your chain of command. As a last resort you can follow "safe harbor" procedures and at least protect yourself. On understaffing you can do the same thing with "safe harbor". You can't abandon your patients because you feel you can't handle them all but you should inform your chain of command and if you feel it is necessary invoke "safe harbor" and do your best. Its not something you want to do every week but it was created as a safe guard for nurses.