Sal, Joey or Mikaela

RenegadeRiker

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Yeah, I can see how forcing the day shift nurses to endure an assignment AFTER THEY HAD ALREADY WORKED ALL DAY that the night shift nurses didn't want to accept when they were fresh was definitely in everyone's best interests. :rolleyes:

Do you think the staffing situation for the night shift magically improved for everyone when the night shift nurses went home? Where did this extra staffing magically come from?

Have you ever worked as a RN in a busy urban ED?
Sucks to suck. Not their fault, it’s the fault of the hospital and ED admin, who scheduled for inadequate staffing.
 
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silver

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Sucks to suck. Not their fault, it’s the fault of the hospital and ED admin, who scheduled for inadequate staffing.
What makes you so sure that people didn't call out? Or that the ED nursing admins didn't call their nursing pool and asked to cover OT shifts?
 

ffemt8978

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Sucks to suck. Not their fault, it’s the fault of the hospital and ED admin, who scheduled for inadequate staffing.
Nobody is disputing that. What is being disputed is the appropriateness of the actions of those three nurses. Their actions may or may not have contributed to the hospital increasing staffing, but they also short staffed the ED even more by not clocking in. It sounded like the hospital was already trying to get more staffing for night shift, but those 3 decided it wasn't enough.

Rather than being part of the solution, they chose to make the problem worse in an effort to resolve it. Now they will forever carry a reputation of screwing over their coworkers in the name of what they felt was right.
 

RenegadeRiker

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Nobody is disputing that. What is being disputed is the appropriateness of the actions of those three nurses. Their actions may or may not have contributed to the hospital increasing staffing, but they also short staffed the ED even more by not clocking in. It sounded like the hospital was already trying to get more staffing for night shift, but those 3 decided it wasn't enough.

Rather than being part of the solution, they chose to make the problem worse in an effort to resolve it. Now they will forever carry a reputation of screwing over their coworkers in the name of what they felt was right.
Better that than professional censure for accepting an unsafe assignment. Also, sounds like their day shift colleagues were supportive.
 

RenegadeRiker

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What makes you so sure that people didn't call out? Or that the ED nursing admins didn't call their nursing pool and asked to cover OT shifts?
Apparently none of them showed up, so I guess those RN credentials held by the ED admin are just for show.
 

ffemt8978

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Better that than professional censure for accepting an unsafe assignment. Also, sounds like their day shift colleagues were supportive.
Supportive according to those who refused to clock in. Nobody has actually talked to the day shift and asked what they thought about it as far as I'm aware.

And your point about professional censure just goes to show that they were worried about themselves and not the patients.
 

RenegadeRiker

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Supportive according to those who refused to clock in. Nobody has actually talked to the day shift and asked what they thought about it as far as I'm aware.

And your point about professional censure just goes to show that they were worried about themselves and not the patients.
Those interests can align.
 

ffemt8978

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Those interests can align.
True, but they can also be divergent.

Does anyone know for certain if there is a hard and fast patient limit per ED nurse, or are the limits more of a guideline?

I ask because I wonder what these three would have done if they started receiving several dozen or a hundred patients from a disaster such as a plane crash or earthquake. Would they have refused to clock in because they had more patients than they could "safely" take care of?
 

RenegadeRiker

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True, but they can also be divergent.

Does anyone know for certain if there is a hard and fast patient limit per ED nurse, or are the limits more of a guideline?

I ask because I wonder what these three would have done if they started receiving several dozen or a hundred patients from a disaster such as a plane crash or earthquake. Would they have refused to clock in because they had more patients than they could "safely" take care of?
I don’t know, but I also know there’s a massive difference between an acute, unforeseen traumatic emergency mass-casualty situation and a completely predictable, slow-moving public-health disaster.
 

ffemt8978

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I don’t know, but I also know there’s a massive difference between an acute, unforeseen traumatic emergency mass-casualty situation and a completely predictable, slow-moving public-health disaster.
Then it's not really about patient safety then, is it? It becomes more about how they felt and wanted the ED to be staffed.
 

RenegadeRiker

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Then it's not really about patient safety then, is it? It becomes more about how they felt and wanted the ED to be staffed.
I love how you’re deliberately obtuse. Patient/staff ratios are a pretty common predictor of outcome, particularly when there’s a lot of high acuity patients with multiple interventions. The operators of the ED sound like they were willfully flirting with disaster by staffing three nurses for 26+ patients, especially while remaining open for incoming patients.

The right way to handle this would have been to declare an internal disaster, recall off-duty employees, move all available hands to needed areas and arrange for emergency staffing. Not schedule three people for the jobs of nine and call it a day.

Would you go to work for someone who staffed at 33% and held you accountable for all of the care demanded, not just who you were able to reach?
 

ffemt8978

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I love how you’re deliberately obtuse. Patient/staff ratios are a pretty common predictor of outcome, particularly when there’s a lot of high acuity patients with multiple interventions. The operators of the ED sound like they were willfully flirting with disaster by staffing three nurses for 26+ patients, especially while remaining open for incoming patients.

The right way to handle this would have been to declare an internal disaster, recall off-duty employees, move all available hands to needed areas and arrange for emergency staffing. Not schedule three people for the jobs of nine and call it a day.

Would you go to work for someone who staffed at 33% and held you accountable for all of the care demanded, not just who you were able to reach?
That's why I asked if there was a hard and fast number. If there was, I'd be more understanding of their actions.

What we don't know from the biased article was what the hospital was actually doing to remedy the situation. We don't know if they were working on trying to recall more staff, we don't know if they were short staffed because others called in. All that was reported in the article was one self-serving side with no independent investigation or reporting.

I have no doubt the three people in the article thought what they did was the right and safe thing to do. I have serious doubts that it was the right and safe thing to do.
 

Carlos Danger

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nor are you, so there’s that.
Wrong again.

In addition to my EMS career, I've been a RN for 15 years and a CRNA for 5. So there's that.

Unlike yourself, I have also actually worked as a RN in busy, understaffed urban ED's. So there's that, too.

I can tell you that administrators can't snap their fingers and conjure qualified RN's out of thin air. I have never seen a reserve supply of ED RN's hanging out in a break room somewhere, sipping coffee and watching Netflix, just waiting to be summoned. If the ED was that short, likely the floors and units were also not overflowing with extra staff, especially those oriented and qualified to work in the ED.

There is also no such thing as "professional censure for accepting an unsafe assignment" because you show up to work and happen to be short staffed. That's absurd. In fact, I would suspect that this act could potentially be cause for action by the BON.

The ED in a busy urban center is a very hard place to work. Even harder at night, quite often. Harder still when you are short staffed. Yeah, it does suck. But taking this crappy assignment certainly didn't present any kind of "danger" to anyone. It's ok to go home from work stressed and tired sometimes. I promise. It's also OK to look for a different job.

To be clear: I am not defending the hospital for failing to find a way to address chronic understaffing issues, if that is indeed what was going on. But there is no way that any good was going to come from the unprofessional stunt that these whiny, entitled baby nurses pulled. It certainly didn't fix a chronic problem. In fact, at least for one shift, it probably made things a lot worse for everyone - including the patients.

If I were the NM of that ED, I would have fired this crew on the spot, and notified the BON immediately.
 
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OP
E tank

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I think the deal is (was) that this was an acute multi casualty incident, albeit a prolonged one...even the event in NYC dropped off precipitously, such that there was an identifiable demarcation in the ebb of the wave of casualties as would be expected in an MCI. These nurses did not recognize or appreciate the situation in which they found themselves and conflated it with lousy, normal operations staffing.

Major party fail....

(former inner city, urban jungle trauma/ER nurse here...)
 

Carlos Danger

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I think the deal is (was) that this was an acute multi casualty incident, albeit a prolonged one...even the event in NYC dropped off precipitously, such that there was an identifiable demarcation in the ebb of the wave of casualties as would be expected in an MCI. These nurses did not recognize or appreciate the situation in which they found themselves and conflated it with lousy, normal operations staffing.
I wondered if it was something along those lines, though lousy normal operations staffing certainly isn't unheard of in places like that, either.
 

Tigger

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You say “pandemic” like it’s an acute emergency.
In which part did I say that? Go ahead and use the quote feature and include it.

Unsafe staffing ratios are not really that uncommon. They happen in EMS too. As you say, the key is more staff. Good luck calling it a "safety issue" when you refuse to work, therefore making working conditions more unsafe. Sure, some changes might happen eventually, but what happens in the interim?

I don't really want to be party to a situation where I knowingly cause my coworkers to provider care in unsafe situations, so I'm out on that.
 

DrParasite

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There is also no such thing as "professional censure for accepting an unsafe assignment" because you show up to work and happen to be short staffed. That's absurd. In fact, I would suspect that this act could potentially be cause for action by the BON.
Ok, good. I was pretty sure @RenegadeRiker was full of **** when he made that claim.
If I were the NM of that ED, I would have fired this crew on the spot, and notified the BON immediately.
See, we can agree on some things.

And @Tigger I think I was the one who referred to it as a pandemic.
It’s functionally no different than a shift of paramedics refusing to go to work in an unsafe system.
Lets think about this... you want to compare it to paramedics refusing to work in an unsafe system; ok, how were the Nurses in any danger? You mentioned "professional censure" (which I didn't think existed for nurses, and @Carlos Danger confirmed), but the truth is, they can complain to their union, and do a dozen other things... but at the end of the day, they still had an obligation to their patients, and they refused to do it. Now, if you want to say they refused to work because they lacked proper PPE, I could see where the parallels are. But that's not what happened.

I've worked in overworked EMS systems, and still have former co-workers who are working in the COVID hotspots... one is now an ER nurse who tested positive for the virus. It's not fun. my former EMS agency helped out the ER after they got off shift (the entire shift, and it was likely a busy shift, because they are all busy shifts), because the ER was overwhelmed. No one refused to work because they were too busy.
The right way to handle this would have been to declare an internal disaster, recall off-duty employees, move all available hands to needed areas and arrange for emergency staffing. Not schedule three people for the jobs of nine and call it a day.
here is the other thing that you seem to not realize: what if there weren't any other options? no available nurses, no more staffing, no more rooms? You work in the ER, you can't turn critical people away if they walk in the door. You can't always recall people (especially since the people you are recalling likely have to work other shifts too, and are sleeping if they work nights), and you can't always move people; remember, just because the ER is getting slammed, doesn't mean you can move an ortho nurse to the ER and expect that he or she will not completely fail because they aren't trained for ER work. Oh, and while your statement about Administrators with RN certs is valid, when managers are working staff positions, they aren't managing. So no one is managing the "internal disaster" as you recommend, because the mangers are working as line personnel.

These three were incredibly selfish, looking out for themselves and no one else (not their coworkers, not the patients, and definitely not their employer); if the ER wasn't already short-staffed, I think they would have been terminated. their employer should file a complaint with the BON over their actions.
 

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