Prior to taking on any assignment under their license, a nurse must verify they have the knowledge, ability, skills, competencies, and resources to deliver safe client care.
Number of clients and geography of clients are not a guarantee of client safety. The nurse must individually determine if the assignment is safe based on their assessment of the client. “Unsafe” is from the perspective of the client: are you able to mitigate the risks these clients are facing based on your comprehensive assessment?
If the answer is “NO”, escalate your concerns up the chain of command. Be specific about your concerns and provide a solution if possible.
Example: “I want to be clear that I am alerting you that I cannot accept another patient because I have a full assignment and am currently struggling to manage it and operate within the policies and protocols of the institution. Accepting another patient will impede my ability to provide comprehensive, competent, and safe care. My recommendation is: that you call a manager and have them come in to help, call an agency nurse to come in, offer incentive to get a nurse to come in, etc. Can you provide me with a timeline for resolution from those in the chain of command with the authority and responsibility to do so?”
Nurses with roles in the chain of command have an obligation to assess your escalation.
If there is no response, or the response is inadequate and this impacts patient care, you may consider using the OSBN complaint evaluation tool to determine if you are required to submit an OSBN complaint against a licensee.
Direct care nurses are not the primary problem solvers when it comes to workforce shortages and system staffing issues. The assignment a nurse manager has accepted under their license encompasses the care environment of the unit(s) they oversee. They too must ensure safe client care in this environment.
If your concerns are not addressed because resources are limited and there are no other options per your chain of command, ask what other tasks and documentation may be eliminated so you can focus on providing the safest care possible, given the circumstances.
Examples: Not charting for reimbursement but based on client care needs, eliminating non-critical tasks, using ancillary staff support for non-nursing tasks, etc.
