Student Nurse Laura

Orem – "creative effort of one human being to help another human being."

Have you ever been in a situation where you didn’t feel safe, if so what was your reaction?

Posted by Laura on January 16, 2015

What did you do?

What have you done differently since?

How do mandatory staffing ratios help you?

If a patient is done with surgery, and brought to our post-anesthesia care unit (PACU), and I see the nurses on the floor are not available to receive the patient, I will go over there and receive the patient. I will leave my duties with the new patients coming in for their procedure. There is no hesitation. I react immediately when a patient’s vital signs drop and their nurse is occupied by another patient. It is obvious at this time, if do not have adequate nursing on staff to be receiving patients from the operating room (OR).
It is our policy if there is no staffing/space for a patient, they are to hold them in OR until it is safe for the patient to be brought out. In this particular situation, I wouldn’t do anything different. In my earlier days starting in PACU, I would hesitate, thinking…does the other nurse want me there…do they know there is another patient…am I abandoning my patient in pre-op? I no longer have this doubt and know where the priorities lie. I am glad California’s Board of Registered Nursing (BRN) has the staffing ratios we use. I know I can handle my patient load. We always have two nurses on the floor, even if there is only one patient left who is stable and about to be discharged. I’ve never felt it was an unsafe environment.
In California, we have safe staffing ratios. Ten years ago these ratios were implemented. They are regulated by the California Department of Public Health, effective January 1, 2004 (CDPH). In a surgical center, as where I work, our PACU is required to have a ratio of one to two, nurse-to-patients ratio. I know in our facility we do 1:1 ½ for most. Children and compromised airways are one to one.

There's been some sort of mistake ...
What I did learn from researching was Title 22 of the California Code of Regulations states charge nurses, or nurses working in the position of administrator, supervisor or manager are not included in the nurse-to-patient ratio. Only when they are providing direct patient care are they counted. This would be when they are relieving a nurse for her lunch break – but the breaking nurse is no longer part of the ratio (nurseallianceca.org). I know I have worked on the floor when I have heard the charge nurse included as part of the ratio. I will bring this up to the administration if I am in this situation again – protecting my nursing right (ANA, #6).

References:

ANA. Nurses’ bill of rights. Retrieved from: http://nursingworld.org/MainMenuCategories/WorkplaceSafety/ Healthy-Work-Environment/Work-Environment/NursesBillofRights

California Department of Public Health. Nurse-to-patient staffing ratio regulations. Retrieved from: http://www.cdph.ca.gov/services/DPOPP/regs/Documents/R-37-01_Regulation_Text.pdf

Image from: http://www.wolfescape.com/Humour/MedSurg.htm

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