Problem
You are a nurse working in a state that has no law for patient: nurse ratio. You have just arrived at work to receive the handoff on your shift. Although the normal patient load is four patients, your assignment today is to provide for seven patients. The unit is short staffed, and everyone's workload has increased accordingly. Six of the seven patients are new to you even though this is the 4th day of a 5-day work stretch and most of the patients you cared for are still on the unit. Five of the seven patients have the highest acuity possible. In addition, your patients are scattered geographically on the unit which makes coordinating work in a time efficient manner even more difficult. Your charge nurse tells you she has requested additional staffing but that no one has been found yet. She also says she refused to admit any new patients to the unit, but the current patients' needs to be cared for and she needs to work with staffing she has been given. Your original thought is to refuse the assignment because you feel it may be potentially unsafe and threaten to go home. Upon reflection, you decide instead.