1. Brooke, Penny Simpson APRN, MS, JD

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I've worked in telemetry for 15 years, but at my new job, I'm assigned to multiple patients receiving various vasoactive or antiarrhythmic infusions at one time. Titrating different meds and having to monitor several patients at frequent intervals, especially when they're receiving vasoactive drugs, is not only difficult-it's outright dangerous.


My supervisor just sighs when I bring this up. She says we're short-staffed and we have to take the patients we're given. There must be limits to how many patients one nurse can care for at a time. If something went wrong, would I be liable even though staffing was inadequate at the time?-S.F., NEV.


Short-staffing isn't a legal defense to nursing malpractice. When nurses harm patients, they're held responsible for the substandard care they provided.


Written standards of care exist to help define safe care, and nursing research has shown that lower ratios of patients to nurses in areas where patients require concentrated nursing attention lead to better patient outcomes.1 If you're consistently receiving unsafe patient assignments, protest them in writing and provide details. If nursing administration doesn't get written notification that present staffing levels are unsafe, they can't respond to your needs.


Writing to your nursing leaders also shifts some of the liability-should a patient be harmed as a result of overburdened nurses-to the administrators who received warnings, particularly if they ignored them. The Joint Commission requires hospitals to provide safe staffing levels. Nursing administration probably needs to hire more nurses, including agency nurses, or develop float plans that include education for nurses who'll be floated to your unit.


You've identified a dangerous practice setting. If nothing changes, you must decide if you can continue to work for this employer. Good luck.




1. Aiken LH, et al. Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. JAMA. 288(16):1987-1993, October 23-30, 2002. [Context Link]