I have been a critical care nurse for 10 years, and until recently I never felt unsafe in my practice ("Failure to Rescue," January).

One night I arrived for a 12-hour ICU shift and learned that we were short three nurses. All 16 beds were full, so I was forced to take an assignment of three patients. At midnight, I was told to transfer my most stable patient to the floor to make room for an ED admission, a patient (Mr. S.) who had had a grand mal seizure. I conducted an initial neurologic exam and tried to stay afloat while checking on my other patients, who had had MIs. Mr. S. had stable vital signs and a good airway and was starting to rouse, although he was confused. What more could I ask for under the circumstances? I tended to a patient who had had an angioplasty and was having chest pain, but I occasionally checked on Mr. S., looking for any obvious changes in his condition. As my shift ended at 7 am I checked on him one last time, and he had another grand mal. His heart stopped, and we attempted resuscitation for an hour before he died.

Had I received the standard two-patient assignment, I might have been able to notice the subtle changes in Mr. S. In the future, I will refuse to take a third patient. Nurses must decline to take additional patients, forcing the administration to defer them to another hospital. Our patients deserve better care.

Name withheld upon request