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Are there any laws or guidelines stating there should be at least two nurses on a unit to care for patients?

Friday January 10, 2014
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Question:

I work in a small six-bed, intermediate ICU. Most of the time there are only two nurses on at a time to manage the patients during evening and
night shifts.

On our unit, we give a lot of blood products. Our hospital transport services recently was discontinued so management now expects nurses to retrieve the blood products we need to transfuse. This means one of two RNs will be off the unit for up to 20 minutes, leaving the other nurse to care for up to six patients alone (exceeding our pre-determined nurse patient ratio).

I'm concerned about the safety of our patients. What if a patient codes? I'm also concerned that this might be viewed in the eyes of the law as patient abandonment. Furthermore, I'm concerned about nurses being expected to perform non-nursing duties.

Are there any laws or guidelines that state there should be at least two nurses on a unit to care for patients? If there was an event, would the nurse who ran to get the blood products be held liable for patient abandonment? Do you have any insight regarding the erosion of nurses performing nursing duties versus non-nursing tasks?

Rosemary



Dear Nancy replies:

Dear Rosemary,

Your concerns are understandable and you are wise to seek resources for them. One resource you should take advantage of is the American Association of Critical-Care Nurses' website (www.aacn.org) . You will find a wealth of information to help you with the issues you face at your small ICU. Look in the drop-down menu under Clinical Practice, click on Staffing and Standards. The Healthy Work Environments statement ó also on the drop-down menu ó contains pertinent information about how ICU staff nurses need to be involved in making such decisions.

You also should check, either with or without the help of a nurse attorney or other attorney, state staffing requirements for ICUs in your state.

In addition, although not always as helpful as they may sound, your state may have a mandatory nurse-patient ratio that the ICU where you work may or may not adhere. An attorney could help you determine if such ratios exist. So, too, could your state nurses' association.

You are not alone about your concerns that nurses are doing more non-nursing duties. Nurses in Canada are observing the same change in nurses performing more non-nursing duties.

One article to review is "Non-Nursing Duties" by Melanie Leckovic, BCNU, on the thinknursing!ca website: http://www.thinknursing.ca/research/non-nursing-duties. The article is very pertinent for nurses everywhere and it reviews articles and situations in U.S. workplaces as well.

Cordially,
Nancy




Nancy J. Brent, RN, MS, JD, is an attorney in private practice in Wilmette, Ill. This information is for educational purposes only and is not intended as legal or any other advice. The reader is encouraged to seek the advice of an attorney or other professional when an opinion is needed.