If you want to prevent this from happening again, then you need to think of an alternative when the hospital is short-staffed. Does your unit have a call system? That can be unpopular, but it does give you someone to call in if staffing is an issue. Have you invited people to cross-train to your unit? Have you offered to cross-train to their unit? Has your unit considered being a closed unit? Can you think of ways to re-organize assignments so that a less-qualified nurse could cope with it?

Just my $.02, but working short is a part of nursing. Sometimes, even with the best of plans, it can't be prevented, and you have to live with it. That's what makes the job so hard.

Our problem is that we are the only unit that is halfway staffed in the hospital. We worked a long time to get that way and to train our staff. The floor's managers are rotten and treat their staff poorly. My managerstaffs when needed and all of the others just leave it short. Today because we were short staffed my manger took patients and missed her daughter's birthday party. We are in a crunch and our administration doesn't care. I am all for refusing to take the third patient in ICU as it's unsafe. But, I want to know if I can actually do that and not get fired. By the way I am also a supervisor in the unit. I don't think that my staff should have to do this.

I don't know the way things work in your hospital, but if you refuse this patient, where else in the hospital will the patient go? Another ICU? Will the patient be held in the ER? And if so, will this cause problems for them (where I live, this might mean that incoming patients will have to be diverted from one hospital's ER to another). Does that mean that an unstable, high acuity patient will be kept on the floor, where the staffing may be 6, 7 or 8 to one?

Bottom line is that you can refuse the patient as long as your manager is willing to stand her ground and support your decision. It's an issue you need to discuss with her.