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. They want us to flex our hours and work other departments we are not qualified to work in, such as adult emergency 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:
As you know, as a nurse licensee, you are accountable and responsible for any patient care given. As a result, it is up to you to determine if you are competent and capable to perform nursing care, especially when it is outside your usual area of nursing practice. From your description in your question, it sounds as though there are only a few skills and expertise that you now use that can be transferred to an adult care setting.
Since your employer is taking the position to not pay you to learn the competencies you need to work in the other departments specified, you have several options. One is to take upon yourself the education and the cost so you are able to provide nursing care in these areas. The learning could take place in a well-respected CE course with clinical components or through a course offered in a nursing education setting. These options are costly and would take time to complete.
A second option is, of course, to refuse to participate in this flex-time arrangement. This option most likely will result in termination, or you may exercise your option to resign with the reason well documented.
Another option would be to ask that the employer provide an in-service about patient care and nursing responsibilities in the specific care areas in which you will be working. Hands-on exercises and a post-test would be a part of the in-service. This would be the most cost-effective for the employer and allow you to obtain the needed beginning knowledge base you would need. This approach could be coupled with nurses who currently staff the units acting as preceptors for you for a short time. Although it sounds lengthy, within a short period of time, it is most probable you would be able to provide competent care for those patients.
A fourth option is to seek advice from your risk manager. Is he aware of this mandate? Because risk management is concerned with reducing the risks, in this case, financial if a patient is injured and a lawsuit ensues, this is a mandate he may be able to help resolve.