I work in a pediatric ED attached to an adult hospital. We are certified nurses with specific competencies and qualifications. The administration dropped two nursing positions and they want us to work flex hours and work other departments we are not qualified to work in such as adult ED with stroke alert, cardiac code heart patients and psych intake. They will not pay for us to gain these competencies. What are our options here?
Dear Nancy replies:
Although no specific advice can be given to you, some general comments can be made about this situation you face. As you know, there are sometimes no easy answers to work situations such as this one. Even so, a consultation with a nurse attorney or other attorney in your state might help identify specific options to this specific situation.
Initially, it is important to emphasize that since you and your colleagues are licensed health professionals, you are accountable and responsible for your own decisions, conduct and the care you provide. Accepting a patient assignment or assignments for which you are not at least minimally competent is risky, and any patient injury that might occur as a result of your own professional negligence will be yours to bear. The same is true with any disciplinary proceedings initiated against you by the state board of nursing. You cannot easily, if at all, try to shift the liability to another (e.g., the employer made me do this).
If the employer’s position is firm in not compensating you to learn the skills you need in these new patient care settings, you can gain them at your own expense through a CE hands-on program that focuses on the areas and skills you will be required to provide in these new settings. This would be at a cost to you, both financially and timewise, but you would be prepared to take on the patient care needed and, at the same time, fulfill your legal and ethical obligations to your patients.
In this regard, you may want to try to negotiate with your employer what specific care you will provide. Learning all of the nursing care required you mentioned may be impossible. So, for instance, you might want to try and negotiate a plan where you would only do psych intake while another colleague would only do stroke alert.
Of course, your last option is to seek employment elsewhere, if it is a realistic option for you and your colleagues. This is not an easy one to consider, especially if you enjoy the work you do at this facility. Your employer may consider a change in its position if all of you decide you cannot work at the facility with this mandate.
Also, don’t forget to try to negotiate the employer mandate one more time. Perhaps a change by the employer, such as bringing in someone to do an in-service on some of the aspects needed in these new patient care areas, may take place.