Is My Work Environment Safe and Legal?

Carolyn Buppert, NP, JD

Disclosures

February 04, 2013

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Question

I work as a registered nurse at a freestanding residential crisis unit, where the doors are not locked and the staffing levels are low at night. Is this situation legal?

Response from Carolyn Buppert, NP, JD
Attorney, Law Office of Carolyn Buppert P.C., Bethesda, Maryland

The psychiatric nurse who submitted this question supplied additional details about the work environment:

"Clients are admitted and are here for 5 days. At night, the staffing is 1 nurse and 1 aide, for 8 beds. I have concerns about the staffing and the safety of the type of patients being admitted. Some of these clients are psychotic, elderly, homicidal, or suicidal. The clinic is on the ground floor, not attached to a hospital and not locked. We have had patients who have taken medications or are psychotic, and who have walked out of the clinic into traffic. I do not feel safe and have told my supervisors my concerns. I have been a psychiatric nurse for 20 years and have seen what can happen, even in a locked unit with enough staff."

There are several issues here. One is whether staffing is adequate to ensure the safety of the clients and staff. Another is whether state law says anything about staffing requirements. A third issue is whether the facility should be locked, for safety purposes, and whether state law says anything about security requirements for crisis units. Finally, there is the issue of whether a nurse is liable if a patient is injured after he or she walks out and is hit by a vehicle.

I searched for laws governing crisis unit staffing and crisis unit security and found a few. One state (Washington) requires crisis units to be locked. Another state (Florida) has minimum staffing requirements; however, the staffing you describe would fulfill the requirements of Florida law.

Crisis units are by nature places where individuals who are unstable are cared for and protected. I think the safest place for a crisis unit is in a facility where help can be accessed, whether for security (if a patient becomes violent) or for help (with a patient who is in medical distress). Surely, administrators who decide to locate a unit off-campus, have minimal staffing, and keep doors unlocked have their reasons for doing so. Often, the decisions are based on finances. However, the decision to have an unlocked unit may be based on a desire to have clients agree to be admitted, without the necessity of going through the court system to get an involuntary commitment.

The situation you describe may be legal under state law. Nevertheless, if you believe that neither you nor the clients are safe, then I urge you to look elsewhere for employment. That will not ensure that the clients are safe or that the staff who replace you are safe, but if the company can't find people to work there because no one will work in an unsafe environment, then the company will need to do something.

This advice applies to all nurses in all sorts of work environments. The laws won't always protect you. Ensure your own safety, and don't work in an environment in which you are not safe.

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