LIKE MANY NURSES, you're probably all too familiar with understaffing. You begin your shift and suddenly find yourself assigned more patients than is reasonable or safe. What can you do to protect your patients and yourself?

First, make every effort to discuss the situation with the charge nurse and request help. Do your best to care for your patients and meet their essential needs. Ask your charge nurse or nurse manager for additional staffing. If they can't provide extra resources, go up the chain of command to the nursing supervisor or to hospital administration. If the situation still isn't corrected, write a memorandum detailing exactly whom you spoke to, what you did and said, and the answers you received. Keep a copy of this memo for your records. Don't walk off the job, or you could be fired or charged with patient abandonment. Just do the best you can, prioritizing patient care.

After your shift is over, immediately prepare an event report, following facility policy and procedure. Never document or even mention a staffing issue in a patient's medical record.

Keep in mind that filing a written report isn't guaranteed to absolve you from liability if a patient is injured during your shift. You may still be found liable, especially if you could have foreseen and prevented the patient's injury. However, a written report will provide validation to a jury that you made a sincere attempt to protect your patients. The report could also offer you a measure of defense if the patient injury involves something you couldn't do because of understaffing.

When completing your event report, make sure to:

* record the names of the nursing leaders with whom you spoke, the time of the conversation, exactly what you told them, and the response you received.

* include the names of any other managers or administrators you notified, the times they were notified, and their responses.

* record any significant events that happened during the shift, noting any care issues related to understaffing.

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