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Saturday, January 30, 2010

Poor planning results in busy nurses

She was an RN. Her boss sat next to her as she was finishing her charting and asked her if she would work tonight. The RN said she was unable. The boss lectured her that "we are all in this together, and part of being a team means we all need to do our part."

The RN said, "I am doing my part. I work my one day a week and that's all I want to work. If I wanted to work more I would schedule myself for more."

The boss was dumbfounded. She picked her ear with one hand, and with the back of her other hand wiped away the drool swirling around the corner of her lower lip as it dropped almost to her jaw.

I thought for a moment she might cry. I, for a brief moment, felt empathy for this boss. Finally she said, "We need you. We're in a crisis here and we really need you."

"Look, I don't mean to be disrespectful," the RN said, "But poor planning on your part doesn't constitute an emergency on mine."

That ended the discussion. I won't go on about how it ended. I won't explain how I so happened to be there to hear the discussion, for neither of those facts matter.

Tonight I was sitting in the ER. I noticed that the charge nurse was sitting at the unit secretaries desk putting in all the orders. From time to time she'd get up, run to a patients room, do some chore there, and return to finish typing away, and flitting through sheets of paper.

"Why are you doing all this work?" I asked, knowing she didn't have time to talk with me.

She leaned back in her chair and smiled, "The unit secretary went home at 2:00 in the morning. The rest of the night we have to go without her and without any nurses assistants or techs to help us out. Plus Janet is going home at 3:00 and so is Jim. So basically it will be just me and Susan."

"So basically the powers that be want you guys to work at unsafe levels."

"Wow! That words it about right."

That was the end of that discussion.

A few years ago another nurse named Peggy was sitting in the nurses report room about 40 minutes after her shift was supposed to start. I said, "Why are you sitting in here when all the nurses out there appear to be overworked."

She said, "I'm refusing to take report because they want me to take 14 patients, and I think that is unsafe. I'm not going to put my license on the line because of their poor planning on their part." She was referring to the RN boss.

Due to her persistence another nurse arrived a half hour later and Peggy finally took report on seven patients, a load that she said was safe.

With respect to hospital bosses it is not possible to know when business is going to be swarming and when it's going to be slow. But still, poor planning on their part does not constitute an emergency on the part of the nurse.

RT Cave Rule #41: Poor planning on the part of administrators, bosses and supervisors does not constitute an emergency on the part of the staff.

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