Ummmm..are they ALLOWED to do that?

Specialties Emergency

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OK, I have worked in about 5-6 different ERS, both as staff and agency an I have never experienced this. Right now I am doing a contract in a dinky little community non-teaching hospital. The ER is understaffed and bursting at seams because they admit everyone who rolls in the freaking door. Well the other night nursing supervisor called to say that she was sending the ER a patient from med surg with a positive troponin because ICU was full. Ummm can they do that? We only had 4 nurses first of all(no secretary, no tech), with almost every bed full most of them in a holding pattern. And the patient was going to be MINE. I already had 7 patients, ALL of them holds. Its like I am not even an ER nurse anymore. But can they do that....just turf pts from the floors BACK down to ER, especially when WE are already overwhelmed? The ER nurses say it is done all the time and when they threatned to complain they were told by supervisor that " Go ahead and when we get shut down we will all be out of a job" So there are 12 ICU beds with 6 nurses and 30 ER beds, with 4 nurses? How is that fair?

Unfortunately it seems that administration just kind of wings it at times. We all have similar stories. It is extremely frustrating. It seems that what makes so much sense to us-makes absolutely no sense to them and vice versa. I can easily see one of my supervisors doing the same thing. I've never heard of sending a patient back to the ER. We have sent patients to the recovery room when the ICUs are full.

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Specializes in Emergency, Trauma.

Admitted pts NEVER come back down to ED where I'm at; ICU has to shuffle around, or if that's not possible they go to PACU, Cath Lab Recovery, or GI Unit.

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Who was presuming? You asked if they are 'ALLOWED to do that', many people answered. There was no presumption in any of this.

The real question is... what did you do about it? If you knew it wasn't safe and you or your charge nurse allowed it to happen, you are responsible for your part in it.

ummm..WHAT?! In previous post it was stated, " I doubt you would find any solution acceptable" Thats what I meant by presuming. And since you asked I conviced house physician to downgrade pt to telemetry since she was not unstable or on any drips. She ultimately went to holding. Thats not the point. The point is that it happens frequently with other more unstable pts. This is the first time it has happened to ME. And how am I or the other ED staff nurses ultimately responsible for decisions made by the administration? I didnt realize I was so powerful. All we can do is complain and hope we are heard.I fought tooth and nail to avoid getting pt sent to ED. However at the end of 13 weeks, I can walk away and never look back. I can't say same for staff nurses who need their jobs and are worried about the reprecussions of fighting back. Not everyone can walk away. I basically just wanted to know if the practice was LEGAL and I have gotten different answers form different people. So I am still not quite sure.

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Specializes in Emergency room, Flight, Pre-hospital.

I'm not sure if it is legal inside of hospitals, I know it is against EMTALA regulations between hospitals. Our ER filled a complaint against another hospital who transfered a floor pt from their hospital to our ER, because the pt was critical and that hospital doesn't have ICU. I don't know if anything came of the complaint but I know one was filled, because it is against regulation to transfer from a floor in one hospital to the ER of another, they would have to be a direct admit to the ICU or Cath Lab at the receiving hospital. I would think JCAHO would have something to say about doing that inside of a hospital?

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I work ICU at a dinkly little nonteaching hospital and sometimes I feellike ICU nurses are the only ones who know how to take care of patients. We have 6 ICU beds and alot of times run 9-12 patients. We take care of them inn Er, make ICU rooms on the floors and in PACU. We are only staffed for 6 patients. This means everyone is coming in picking up extras shifts. We will ask the doctors if a particular non critical patient can move to the floor and they say no because "They won't be watched as good as if they are here." We get ICU patients in the unit after they have been held in ER and cared for by Er nurses and the admission orders have never been taken off let alone any other tests ordered. I am sorry but every nurse should know how to provide care for a critical patient I don't care if you work ER or med surg or PACU, this is the backbone of nursing and any patient can become critical at any given point and every nurses should have the skills to maintain that patient, if needed to.

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I work ICU at a dinkly little nonteaching hospital and sometimes I feellike ICU nurses are the only ones who know how to take care of patients. We have 6 ICU beds and alot of times run 9-12 patients. We take care of them inn Er, make ICU rooms on the floors and in PACU. We are only staffed for 6 patients. This means everyone is coming in picking up extras shifts. We will ask the doctors if a particular non critical patient can move to the floor and they say no because "They won't be watched as good as if they are here." We get ICU patients in the unit after they have been held in ER and cared for by Er nurses and the admission orders have never been taken off let alone any other tests ordered. I am sorry but every nurse should know how to provide care for a critical patient I don't care if you work ER or med surg or PACU, this is the backbone of nursing and any patient can become critical at any given point and every nurses should have the skills to maintain that patient, if needed to.

And what always amazed me is that ICU nurses are on the same pay scale as the floor nurses are. It is ridiculous that I, as an experienced ICU nurse, should be making the same $$ as a floor nurse who wouldn't recognize cardiogenic/cardiac arrest, if their life depended on it, and wouldn't know how to treat it either. Explain that. I wish I had a nickel for every time a physician told me that they can't transfer a patient to the floor, because they don't know how to take care of them there.

They don't teach critical care nursing in nursing school, or, at the most, are given a brief over view to give students a "taste" of ICU. Why then, after I spent 25 years in ICU am I not entitled to earn a higher rate of pay than the floor nurses for superior nursing knowledge and expertise? Don't cardiologists charge more than a GP? Why is that? Because the cardiologists learn much more in their cardiac fellowship and residency, and do/know, much more than a GP. They also have a much greater scope of practice, and pay higher malpractice rates than GPs do (like I do as an ICU nurse). But I can't charge more for my critical care services that a floor nurse. End of story. I long for the time to come when nurses start to charge for their services, like MDs do. Then, nurses will be coming out of the woodwork to work in ICU.

I guess it goes right along with the reason that BSN, with a four year college degree shouldn't be paid more than diploma and ADN grads. Someone might have their feelings hurt because they are not making the same $$ as someone who has superior work skills/knowledge/expertise, and a higher level of education. JMHO.

Lindarn, RN, BSN, CCRN

Spokane, Washington

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Specializes in CCU 3yrs, Emergency 15yrs.

TerraRN - Your posts are so angry that I'm not sure it's worth answering you anymore. I think you just needed to vent because you can't possibly be asking if there is a LAW out there that states you can't transfer a patient from an in-patient ward to the ED. Maybe it's a moving violation???

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Specializes in ICU-Stepdown.

I guess the ICU nurses whine just as much as the medsurg ones who complain that they take on three or four times the number that the critical care ones take.

Different areas, same gripes. . I'm just happy to be in my little corner. :)

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I wish I had a nickel for every time a physician told me that they can't transfer a patient to the floor, because they don't know how to take care of them there.

Is it really necessary to turn this thread into a bash the M/S nurses thread?

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Specializes in ED, Pedi Vasc access, Paramedic serving 6 towns.

hmm for your E.D. that you describe as being a "dinky little community non-teaching hospital" you seem overwhelmed. Good thing you do not work in a non-dinky big teaching hospital E.D.

Swtooth

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Specializes in ICU-Stepdown.

gee, thats a heck of a dig. Sounds more like the dinky little non-teaching hospitals' administration is overburdoning them where a large one may not.

I know things seem to run a lot smoother in my large facility than they did in the dinky little non-teaching one that I came from. The managers cannot get away with the same things HERE that they got away with at the small one, either.

As for the medsurg vs icu -I'd MUCH rather have my higher-acute level, but only three patient load than have to have 6 or 8 on the med-surg floor. As far as >IM

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Specializes in ER.

Terra- I though it was a good question.

I would ask the sup why she was moving the pt to the ER, and then demonstrate how things were the same or worse in the ER for theat patient. Sounds like the nurse-patient ratio would have been worse, and the pt would have ended up in a hallway. With a little gentle convincing the sup may have been convinced to lean more on the ICU nurses and borrow a stretcher and a moniter from the ER.

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