A few years ago I worked at a hospital as a CNA. There was an incident where one of our RNs worked a double, (7am -11pm). By the time 11 rolled around, the RNs who were to relieve her had called in, and the DON at the time wouldn't come in either. (The DON who replaced them always put themselves on the on-call schedule to prevent that from happening again) So she was faced with the choice of working a 24 hour shift or leaving and abandoning the patients. She stayed and worked the 24 hours. I'm about to start nursing school, and I know it's a possibility that I could be in this situation at some point. What are my options? I know it's unsafe to work that long because I could make mistakes and harm someone because I'm exhausted, but patient abandonment is a serious issue as well.
Jennifer
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February 2nd, 2009 at 4:09 pm
Any skilled nursing facility you work in should have the name and number of one or more temp agencies in case of staffing emergencies. When someone calls out and no one can make it, just call a temp. It costs more, but that’s what it’s there for, staffing emergencies.
I’m not sure if it’s the same in every state, but around here it’s illegal for a facility to keep an RN on the clock more than 16 hours. It would be unethical to abandon the patients, but the employer should have some serious questions to answer afterward.
February 3rd, 2009 at 1:20 am
It is illegal here too, and that’s where the dilemma was. I’m sure she felt that it was kind of damned if you do, damned if you don’t. I’m not actually sure if she tried a temp agency, but thanks for mentioning it because that option hadn’t crossed my mind.
February 4th, 2009 at 12:29 am
I would give report to charge nurse, or the house supervisor and clock out. If there were any probem with that, I’d clock out anyway and notify the Labor Board.
February 4th, 2009 at 2:46 am
I don’t think anyone could leave a shift when there is literally no one there to look after your patients. The solution is to call the hospital duty shift manager. All hospitals I’ve had have these, and they’re usually nurses in charge of all nursing activities for the shift. Many nurses don’t know these people exist, or more likely, don’t know you can contact them anytime they’re on call. This is often because they’re seen as big management types and not involved on the floor.
This is wrong. Lack of staff is a huge issue, so call them when in a bind. They would much rather come in than see their hospital in the newspapers.
February 4th, 2009 at 4:57 am
Well here in Australia people arent really allowed to work 24hrs, but you do regularly hear about doctors doing like 18hr plus shifts just coz of lack of staff.
Ive done a double before and it was ok. But it would be VERY hard to do a double and then do a night duty..thats not fair on the nurse or the patients coz the nurse is greatly affected by fatigue. We were told that eg if you do a night duty, depending on how you cope etc, you can be worse off than a drunk driver over the limit by heaps! Now thats scary
My housemate used to drive home (a short 5min drive or so) from a night, and one morning she had a very close call. Since then she refuses to drive to/from nights.
February 4th, 2009 at 7:56 am
I think it’s ridiculous that the DON wouldn’t come in to resolve the situation. I’m active duty Air Force and have had situations where our contract counterparts call in leaving my tele unit dangerously short staffed. Our shiftleader then has to call our unit commander who will either come in to relieve staffing or call in another contract nurse not originally on the schedule. If it were me, I’d work the 24, but make dern sure I got comp’d at least one day ricky tick.
February 4th, 2009 at 12:58 pm
I’m in Michigan, and working a 24 hour shift is illegal here, too. After exhausting all my options, I would have stayed to work the 24, but in the morning I would have been in touch with the hospital CEO, medical director, state labor board, and state board of nursing. Then, I would have been looking for another job. As for your fear that you may someday find yourself in this situation, I’ve been a nurse for 14 years and have never encountered this–every place I’ve worked has taken the “can’t work longer than 16 hours” rule VERY seriously.
February 5th, 2009 at 6:00 pm
This should have been reported to any higher ups that you can – like the chief nursing officer (if there is one there). At the very least the dept manager should know and put something in place so it doesn’t happen again!
February 6th, 2009 at 7:50 am
Do the 24 hour shift for immediate need if you can.
Report the whole event with what time you were notified of staff absence/sickness who; was phoned to relieve and when and what was said; and the time you started and finished.
Write the conversation with the on-call senior nurse (DON) as close to accurate as possible – take notes as you write.
As you are discussing with the DON tell thme you are taking notes and will be obliged to report your 24 hour shift to: administration, BON and union. Send a copy to DON.
Then leave it with them to sort out.
If you can’t do the 24 hour shift (family need or other commitments – or you believe you are “unsafe to practice” until you’ve rested) ring the facility manager and tell them you are not prepared to work any longer and insist they replace you. If they refuse then advise them of Heath & Safety law.
If they do not replace you – tell the senior you are going to call a nursing agency yourself and get a replacement at their cost.
It is THEIR job to staff the unit – not yours.
February 8th, 2009 at 2:50 am
Thanks for the great advice everyone! I really appreciate it!
February 11th, 2009 at 12:04 am
You would need to do the 24 hour shift if there is literally no one else to care/oversee professional care. You certainly need to document your concern after that IN WRITING to the CEO, BON, Accredidation agencies (JCAHO takes these complaints seriously and you can do so anonymously), state health facilities licensing board and anyone else you can think of. What a heck of a dilemma but in 30 years ofnursing it has never happend to me-I would report the DON who refused to com in to the BON too, by the way-the DON is required to assure safe nursing and the BON would certainly have found this unacceptable standard of care for a DON
February 11th, 2009 at 6:51 am
What an awful dilemma to be in. The problem is as nurses we work on and everyone knows that. Legally it is against the law here in UK but does not stop it happening. Ethically it is a dilemma, one that does not have an answer. Professionally it put both you and the patients at risk and could cost you your registration. At the end of the (24 hour) day we still have a duty of care to our patients and are still accountable for any acts or omissions. We cannot be all things to all people.
The difficulty with working out of hours is that there is, in reality, no contingency when someone phone in sick at short notice. Planning can help to a point; escalation points, policy on phoning in as soon as possible, agency contact details, reciprocal arrangements with other wards. But this is all useless when at 11pm you are sitting there waiting for your relief and they do not show.
To protect your registration you have to be seen to be doing something about it. Here are some options for you to consider. Talk to your colleagues and see if there are some local arrangements you could make between yourselves. Raise an incident report, this has put the patient’s at risk and needs to be investigated as part of a process review. Also it forces management to recognise the problem and act upon it. Make it a local policy that your next immediate shifts are cancelled for the extra hours you did. Although the money is handy it is important you rest and recover and it also shows the management, again, that there are consequences when their processes fail. If all else fails, it may be time to move on.
February 11th, 2009 at 9:34 am
When the hurricanes were hitting us back to back a few years ago, the security guard warned a few nurses that the hospital was going to “lock us in”. I IMMEDIATELY started to write report to give to my charge nurse. We were not locked in and thankfully, I did not have to hand over written report and leave. Another time, I was working step-down, I work 7p-7a, at 11p, charge nurse and house supervisor realized we were short-staffed, go figure. They wanted to give me FOUR additional patients (double load). That is the first time I had to refuse report. I took the yellow pages and handed them to the CNO and said “start calling”. None of the agencies had “available nurses”. I was on the code team also that night, how sweet, they took me off (gee thanks, 2 of my own coded) I took on the additional patients who were very unstable, documented accordingly and ended up with the first year residents up on the floor most of the night. I was SO behind in meds, etc. Again, document, document, document. Triaged all patients during that shift, etc. It seems to me that the nurse was “stuck” as I was. JCAHO was alerted……..document, document, document…..