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Due to the nursing shortage and big-business cutbacks, our hospital often has staff shortages. What is the best way to protect ourselves legally if someone's care is affected to the point of danger or a lawsuit from the patient and/or their family [is filed]?

My co-workers and I have worried about this and can't seem to find an answer. Of course, our first concern is for the patient and we let our supervisors know that, but it doesn't seem to change the result: the staffing is still way too short.

If there were a suit, would the nurse in charge be held responsible for not making someone listen and something being done? If so, what more can we do, and how? I figure we should be keeping an individual log of the circumstances on such days, but it doesn't feel like a good substitute for giving good care.

A.J.

If you feel that a patient is in danger because of a staffing shortage, the charge nurse should call the supervisor to come to the unit. Inform the supervisor in front of at least two witnesses that an unsafe situation exists and that you cannot accept responsibility for the patient without additional staff.

If the supervisor does not take some action, fill out an "incident report" and turn it in to the proper department, not the nursing supervisor. You also should be keeping your own private notes about these instances at home. Realize that short staffing is practically the norm in hospitals. There is a difference between "needing more help" and a truly dangerous situation. Don't cry wolf.

If the dangerous situations become chronic, form a committee, preferably with nurses from other units experiencing similar difficulties. Schedule a meeting with nursing administration. If that fails, work your way up the administrative ladder. Enlist the support of your doctors.

Your last stop is the board of directors. None of this is a substitute for good care, but it is something you can do to help your patients and yourself.

In-house certification

Many staff members at the hospital where I work have been contacting an outside source for recertification classes such as CPR, NRP, etc. This outside source has offered a one-on-one approach that is student-friendly, convenient and less intimidating. Everyone enjoys these classes.

I should add that the instructor is approved by the state board of nursing and is a certified instructor with the American Heart Association as well as the American Academy of Pediatrics. There are very few that continue to recertify with the hospital.

The hospital now has forbidden staff members to continue recertification courses with anyone other than hospital staff trainers. The hospital claims that these outside sources do not meet the quality it expects. Can a hospital mandate where staff members get their certifications?

J.C.

The hospital does have the right to demand in-house certification if their instructors are properly certified and there is a written policy to that effect. A California hospital cannot make you pay for the course.

Patient resuscitation

My employer announced that the new policy for our adult day health care is to perform CPR on all clients, even if they have an orange form (do not resuscitate).

I have argued that this is against patients' rights and makes us liable for assault charges. Can you tell me where I stand legally? Do my company's policy and procedures cover me legally in case of lawsuits? Is the policy legal? My company's ethics committee is reviewing this policy.

Meanwhile, if one of my DNR patients codes, should I refuse to administer CPR or perform it as per policy?

S.K.

You are almost correct. The performance of CPR on a patient who has indicated that he/she does not want to be resuscitated can make you liable for a tort called "battery."Battery, here used in the civil rather than criminal context, means an "unwanted touching."

Hopefully, your company's ethics committee has an attorney member who will set the record straight and determine the legal status of your orange forms. It may be that your company felt there was an informed consent problem with these forms and told you to resuscitate until their policy was reviewed.

Having said all this, I am not aware of any state where a legal action can be maintained for "wrongful life" in the situation of a resuscitated patient. If anyone knows otherwise, I would appreciate hearing about it. I would not perform CPR on a patient with a legitimate do not resuscitate order from a physician.