Unsafe staffing forms—a tool to improve patient care and protect your practice

By Cece Buckley

Forms :: Hospital Setting :: Community Setting

Maintaining and enforcing staffing guidelines continues to be one of the most challenging and frustrating issues we face as RNs. Our safe staffing legislation to mandate safe patient ratios was refiled this year and will hopefully become law in this next legislative session, but until it does we will need to continue to utilize all our contractual and professional resources as we maintain our efforts to guarantee safe registered nurse staffing levels at all times.

No unsafe staffing assignment should go undocumented. A critical element in documenting unsafe situations is the completion and submission of unsafe staffing forms. Below we have tried to provide answers to some of the most commonly asked questions and concerns posed by nurses in regards to our unsafe staffing forms.

• Why should I fill out unsafe staffing forms?
  1. It is the best means of documenting unsafe working conditions for management.
  2. It may be the single piece of evidence that could save your license to practice, if something was to happen to one of your patients on the shift you worked where staffing was unsafe.
  
  
• How will documenting on these forms protect my license?
  
  The Board of Registration of Nursing (BORN), and the civil court hold individual nurses accountable for the safety of their patients. In the event a patient is harmed due to the care on your shift and you are sued or brought before the Nursing Board in relation to your care, an unsafe staffing form provides documented evidence that you were working under duress, that you took responsibility to notify your supervisor of your objection to these conditions and what actions if any were taken to support you. This evidence might prove extremely valuable in the defense of your license. When you consider the benefits, unsafe staffing reports are not a senseless chore, they are your most powerful tool and your best defense.
  
  
• What is an unsafe assignment? At our hospital, we have staffing grids that say how many patients to RNs we should have on each shift. Does that mean our assignments are always safe when we have the number of patients allotted on the grid?
  
  As registered nurses we are obligated to protect the safety of our patients and are legally responsible in the eyes of the BORN. An unsafe assignment is anything that you, the assigned RN, judge to be unsafe. It is your license. When in doubt, talk to your most senior experienced colleagues and solicit their help in evaluating your situation.
  
  In response to the second question related to the number of patients per nurse, patient acuity must be taken into account in making out patient assignments. For example, if the grid says you should have five patients on the day shift but one of your surgical patients requires dressing changes every two hours, it may not be safe for you to have five patients. The assignment should be adjusted to reflect the recognition of the time required to afford that the nurse can provide adequately for the needs of her/his patients. In any unsafe assignment situation you should approach your supervisor/manager and insist that she adjust your assignment.
  
  
• If I fill out the unsafe staffing forms is it something bad against my manager?
  
  No. Filling out unsafe staffing forms is an objection to an unsafe situation that puts both the patients and the nurse at risk. As a registered nurse you have the responsibility to give the best possible care to your patients and can legally be held accountable for your actions in providing that care. Your manager is responsible and accountable for providing safe staffing on all shifts. Again, your submitting an unsafe staffing form in a given situation is your best legal protection, even in situations where you believe that the circumstances are beyond the control of your manager.
  
  
• I am afraid that my manager will be angry if I file a staffing objection and make my life at work difficult, perhaps denying my time off requests or giving me less-desirable assignments and shifts.
  
  Such actions by a manager are inappropriate as well as violations of both our contract and the National Labor Relations Act. Your actions are "protected activities," that is they are protected under labor law. Be assured that your union is firmly behind you in aggressively protecting your rights. If you feel that your manager is trying to intimidate or dissuade you in any way please contact an MNA committee leader; you do not have take this on alone.
  
  
• I never have time to fill out the forms; do I have to fill it out that shift?
  
  You want to do it when it's fresh in your memory. If you do not fill out the form that shift take notes on who you spoke to and what was done to improve your unsafe assignment.
  
  
• What happens to the completed unsafe staffing forms?
  
  There have been numerous occasions over the last few years when these forms have identified a problem and when brought to management's attention by us the problem was fixed. At St. Elizabeth's Medical Center we are engaged in a six-month trial, where these forms will be an integral part of how we hold CSEMC accountable to address and remedy unsafe staffing situations. Managers will be required to provide a detailed explanation of all efforts they made to remediate your objection. And the objections and management responses will be discussed monthly at our regular labor/management meetings. At all MNA bargaining units a copy of the form is sent to the MNA staff rep, who, along with your union representatives, share these forms with management at regular labor management meetings. A copy also goes to management.
  
  
• What do I do with the forms after I fill them out?
  
  Always keep a copy for yourself and put it in a safe place. (These forms have been known to disappear.) Give your manager a copy and a copy should go to MNA at 781.821.4445. Together we can make sure our patients and our licenses are always safe.

Forms :: Hospital Setting :: Community Setting

Cece Buckley is co-chair of the MNA local bargaining unit at Caritas St. Elizabeth's Medical Center.