Safe Staffing

Recently, our critical care unit (28-bed combined ICU/CCU at a major trauma center) was staffed with six floor nurses in addition to the regular critical care staff. There were ICU registry nurses available, but the staffing office canceled them. The patient acuity that day was critical. As it was, we had to take care of the floor nurses, their patients and our own, and there was no unit secretary.

What recourse do we have to make sure that our unit is safe for the patients and that our licenses are safe? I also wonder if publicity might embarrass the hospital enough to avoid a repeat of the situation.

~SUE SPENCER CANON, PH.D., RN
Corona, Calif.

Although it may sound tempting during moments of sheer frustration, the threat of media publicity should only be used as a last resort and preferably not at all, as it may backfire and hurt your reputation. Does your hospital's policy manual list the minimum criteria for ICU nurses?

If the floor nurses do not meet the stated criteria for an ICU nurse, then the hospital is not following its own policies and you should bring this up at the next staff meeting. The hospital's failure to follow policy could affect its liability insurance contract.

You also mention your concern about the safety of patients and your license. If at any time during your shift you feel patients are in danger, call your supervisor to the unit. The charge nurse and one witness should inform the supervisor that an unsafe situation exists relative to patient care and list the specifics. Also, keep a documentation notebook at home. Anytime you are uncomfortable with something that has happened at work, jot down the incident.

Nurses aides
I am a nurse in a small medical office. To save money, the doctors hire nurses aides and train them to do nursing tasks such as giving injections and catheterizing patients.

I'm wondering about the legality of this practice and the implications this might have for me. Are these other staff members working under my license?

~MARIE SCHMIDT
Anderson, Ind.

In a medical office setting where the physician hires and trains personnel to perform injections and other tasks, the personnel so trained are the responsibility of the physician.

In your example, it is the physician who has "delegated" these responsibilities to nonlicensed personnel. Therefore, they are working under the physician's license.

Terminated
Something happened to me at the beginning of this year. The patient load [at the hospital] was so bad that I decided not to reschedule myself and quit Dec. 9.

On Jan. 6, I received a phone call [from management] to ask if I was working elsewhere. I said yes.

I was told that I had been terminated for falsifying records, which I didn't. Is my career pretty much over? Am I now forced to stay where I am? Is there a way not to include a termination on employment applications without being disqualified for the position?

~G.O.
Los Angeles

As for future employment, the facts as I understand them from your question indicate that you were notified by telephone of your "termination" sometime after your last working day for that employer.

If this is correct, you left your employer voluntarily and any subsequent event was "after the fact." If you must list this employer in future applications, you should list the dates of employment from the first to the last day you worked for this employer.

Your reason for leaving this employer is the reason you decided not to schedule yourself for any more hours after Dec. 9. If you live in a state that permits access to employment files, you should determine if this employer entered erroneous information in your file. If so, you should contact a lawyer in your state for further assistance.

Mandatory overtime
Are salaried employees legally required to work mandatory overtime if a charge nurse or a CNA calls in sick?

This is not just on rare occasions; it happens weekly. We presently have no mandatory overtime policies.

~LAURIE DRISCOLL
Standish, Maine

As you have discovered, the greatest disadvantage to a salaried position is that your hours usually are not defined. Did you sign a contract of employment when you took your position? Are you a member of a union? In those situations, the terms of your contract would control your hours as long as there is no violation of federal wage and hour law or the law of your particular state.

Unemployment benefits
I was the director at a convalescent hospital for about nine months when I had the opportunity to interview [for another position]. My administrator at work found out and asked me to step out so the new director could start. They agreed to give me two weeks' paid vacation, and I was gone that Friday afternoon.

What are my rights? Can I collect unemployment now until I hear from the other job?

~SHOREH ROSTARNI
Torrance, Calif.

The right to receive unemployment benefits is governed by the laws of your state. The general rule is that you must be fired, laid off or "let go" by your employer. Your dismissal must be for reasons of the employer and not because there was cause to fire you.

If your employer asked you to "step out" for a new director and did not offer you another position, you may be eligible. By all means, promptly contact the unemployment office in your area for more information.

©NurseWeek Publishing