Monday, December 8, 2008


I want to put out a question to see if I can get any feedback or information. I work in a small rural hospital that has a 6 bed ICU. Actual ICU cases are few and far between, so they aren't well-staffed. As a trained ICU nurse, I work in another department, but I am being pressured to float to the ICU as the SOLE PRACTITIONER in the unit. No secretary, no aide, no other nurse but myself. The DON's rationale is that the M/S nursing station is only steps away. I am used to working in large ICU's with complex patients, but there's always been other nurses around and ancillary personnel. I feel very uncomfortable and have stated that this is not a safe environment for a solo practitioner, to no avail. I've looked at the AACN standards of practice but have been unable to find anything specific to address the issue.

I have told the DON that I would be happy to float to the ICU anytime as part of a team, with another nurse there-not alone. I frequently float to the ER, so floating isn't the issue. Staffing is, and I feel trapped. Any suggestions?

Now, this is the story behind the story:

This is the question I put out to various nursing forums. It basically explains the situation I've found myself lately. I had a sit-down conference with my DON today. Basically I was told to "shut up and stop saying I felt it was unsafe situation". NO WAY! No amount of walking the political line will EVER make me do something that jeopardizes my license. Especially when someone makes little veiled threats (no, let's call it an OVERT THREAT) about contacting the state board of nursing AND IPN (the impaired nurses intervention program) regarding the little incident from Thanksgiving (you know-my little overnight stay in the slammer courtesy of the TeenQueen).

The Florida Nurse Practice Act actually reads that the reportable offense is "Having been found GUILTY of, regardless of adjudication, or entered a plea of nolo contendere or guilty to, any offense
prohibited under Section 435.03, F.S., or under any similar statute of another jurisdiction; or having committed an act
which constitutes domestic violence as defined in Section 741.28, F.S. " (Don't fuck with me, I can research and read too!)


I've tried to access AACN's website regarding staffing standards in the ICU, to no avail. I can't seem to find ANYTHING that says you can't be the only nurse in ICU. At the same time, I can't seem to find anything that says it's OK, either. Any help would be appreciated, if you happen to have any of these references handy. I'm well versed in ASPAN's standards of practice, but I'm hitting a wall with this.

This just makes work SUCK. We're in the middle of a regime change-the hospital is being bought out and going nonprofit. The atmosphere is tense, and the present management knows they are pretty much on borrowed time. Add to that the current crappy economic situation, and everybody's on the verge of going postal. They've changed our hours from 4 ten-hour shifts to 5 8-hour shifts to save money (......where?), they count the minutes to make sure you're productive until you check out, and of course, NO OVERTIME and MUCHO FLOATING.

Thank God for the ER! I can work 3 12 hour shifts, do my hours in 3 days, then DISAPPEAR! I love the ER. My docs are great, the staff is nice, and no DRAMA, except the clinical variety.

As I said, any help on the information highway is greatly appreciated!



jeepgirl said...

Try the RN Safe Staffing Act. I found the info on the AACN website, but the origin was the ANA. There is a whistleblower protection clause also. I will keep looking though.

Don't do anything ou think is unsafe. Being an ICU there is always the potential for badness, plus, what are you supposed to do if you have to check insulin, blood or someone gets combative?

Anonymous said...

My hospital has a 5 bed ICU and used the same rationale--ie med/surg was just "steps away". Here in Oregon the state must grant a waiver in order to have just one staff member in a unit. Our hosp. was applying for this when an ICU RN was cornered by a patient and beaten. She was not alone at the time but if she had been, she could have been killed or seriously injured. After this incident--no more mention was made of the waiver!!!

Nurse Practitioners Save Lives said...

That's total BS! Yes, Med/Surg is only steps away but what if a patient has managed to pull an arterial line and you are holding pressure and can't reach a call bell for example? There are 100's of different scenarios that can be unsafe in that kind of situation. Keep researching and keep pushing for your rights.