ER Admission Holds

[LegzRN]

Hello all ER girls and boys,

I work nights at a level 2 trauma center that sees around 75k patients annually. A problem we have is that by the time night shift rolls around at 11pm, we begin to hold admissions down in the ER because of no beds upstairs/ not enough nurses to staff the patients upstairs. It's a problem we face every night, holding anywhere from 5 to 10 admitted patients. When this happens, one of the ER nurses takes the assignment of all the admissions. Do any of my fellow ER nurses on this site also have the same problem, and if so, has your facility proposed any solutions? Thanks in advance!

[Blue Crab Lover]

This is the exact reason why I left ER nursing. If I wanted to work the floor, that is where I would seek out employment. One hospital I worked would hire agency people or pool people to take care of the ER holds. Other times, they get sourced out to the regular ER staff. The ER holds get neglected if you have patients coming and going in your other room assignments. The sickest patient will consume most of your time. The ER pace is not for in patients.

[dthfytr, ADN, LPN, RN, EMT-B, EMT-I]

The fix is simple, but first YOU need to recognize it's a financial and political move by the hospital. ER staffing is fixed. Rarely do ER nurses float. Rather than hire more staff for the multiple floors that the ER patients might need, and chance having the floor over or under staffed depending on admits, just warehouse the admits in the ER. Also, there are usually rules saying admits must be seen by the admitting doc within a certain amount of time from hitting the floors. Admitting docs pressure administration to warehouse admits so the docs can get their beauty sleep.

[Anna Flaxis, BSN, RN]

We very rarely have holds, even if inpatient beds are tight. On the rare occasion, one of our ED nurses will be assigned to the critical patient, or a float pool nurse to the noncriticals.

[All4NursingRN]

You have it good, where I work we frequently run out of beds and have ER holds often. And get this, you keep your ER holds for as long as they are there, no signing them off to a float nurse or anyone being assigned the holds, you manage your holds plus new patients coming in non-stop. If you have a patient that becomes unstable/critical we can send them to the trauma bay, but mostly our trauma bay is full to overmaximum capacity (4 bay trauma with 7 pt's in it sometimes), so you basically have to keep your sick pt, let your charge know, and work on that patient until a spot in trauma opens.