Ummmm..are they ALLOWED to do that?

[NurseJacqui]

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?

[imenid37]

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.

You know med-surg nurses, (BTW I am not one) have it really rough. I think a nurse w/ 25 years of med-surg experience is worth the same as you. Her/his experience at managing 6, 8, 10 patients is also a skill. I couldn't do med-surg or Critical care, both are really tough. I work OB, lucky for me (I can imagine what you think I am worth) and have the greatest respect for either specialty ICU or med-surg. I work at a dinky little non-teaching hospital which never goes on divert. There are ED boarders a lot lately. The floors get slammed and so does ICU. I think all nurse are worth a lot more than we are paid. When doctors whine that this type of nurse can or can't do their job, they are usually talking out of the you know what. They would not have a clue how to do our job. many can't even turn on a monitor. Does it mean they are dumb? NO!. They have lots of other smarts, it's true. They sure don't know what we do. When I worked tele the ICU nurses pulled to us had great trouble managing the "easy" patients on our floor because their skils were intensively managing 2-3 patients at a time, not the 8 that we had. Give the med-surg nurses and all nurse a break, we all have it rough.

[NurseCherlove]

You know med-surg nurses, (BTW I am not one) have it really rough. I think a nurse w/ 25 years of med-surg experience is worth the same as you. Her/his experience at managing 6, 8, 10 patients is also a skill. I couldn't do med-surg or Critical care, both are really tough. I work OB, lucky for me (I can imagine what you think I am worth) and have the greatest respect for either specialty ICU or med-surg. I work at a dinky little non-teaching hospital which never goes on divert. There are ED boarders a lot lately. The floors get slammed and so does ICU. I think all nurse are worth a lot more than we are paid. When doctors whine that this type of nurse can or can't do their job, they are usually talking out of the you know what. They would not have a clue how to do our job. many can't even turn on a monitor. Does it mean they are dumb? NO!. They have lots of other smarts, it's true. They sure don't know what we do. When I worked tele the ICU nurses pulled to us had great trouble managing the "easy" patients on our floor because their skils were intensively managing 2-3 patients at a time, not the 8 that we had. Give the med-surg nurses and all nurse a break, we all have it rough.

AMEN!

[NurseCherlove]

AMEN!

And I can only imagine what my worth would have been in my previous job as a .....PSYCH Nurse!

[moonrose2u]

sups, as acting administrators for the hospital both legally, morally, and ethically, are required to make critical decisions for the hospital and their populations taking the following into account:

-the appropriate care of the patients

-making decisions within the hospitals policies as their guidelines

-the licenses of all professionals involved, including their own

I have had to send patients back to the ED. I don't like it, but if all ICU beds were filled, PACU was not open and was policy not to open it unless a surgical case came in, and I only had M/S nurses (even with years of experience) to care for the patient on a M/S floor, I would try to downgrade an ICU to M/S to make room for the ED admit, or if not possible, then see if one if the ED admits could be admitted under M/S and sent to the floor. Some hospitals will not let you transfer, some will not let you open PACU-but I have opened SDS and brought in extra help including PACU nurses to care for the overflow.

It all depends upon the hospital. Most sups I know do not like to 'rob Peter to pay Paul' in the hospital setting, but it is done nearly every shift in some way. And most that I know, including myself, would document the situation and bring it to the proper attention that such an event occurred and steps needed to be implemented to avoid it in the future. Believe me, at the mgm staff meetings, these situations are brought up and discussed. It puts the sups license on the line too and makes us just as nervous and angry as the nurses who are put in that position.

Karen RN,C BS CMRSN

[Gromit]

And I can only imagine what my worth would have been in my previous job as a .....PSYCH Nurse!

Hey, YOU GUYS were worth PLENTY! So long as you kept the nuts away from the rest of us, and most of us strove to keep our distance from your floor, we were happy as punch! hahaha. Seriously tho, I have no idea how psych nurses can stand working in their environment.

[ERERER]

I can see both sides of this problem. I am currently working in a dinky non=teaching REDNECK hospital. If a patient goes bad, ICU is full, there have been a couple of occasions where they were brought back to the ER. SIDE1: where is the safest place for the patient? SIDE 2: in the ER we take care of non-stable pts before they go to ICU. frequently the load is quite heavy. the initial care of these patients is high: starting drips, intubating, stabilizing, etc. In the ICU, the nurses have their set limit of patients. In the ER there is NO set limit. The other night i actually had an ICU nurse say to me after hearing report "sounds like that patient is too unstable to come up here". huh? then can i send my other 5 patients to you?

[TazziRN, RN]

The other night i actually had an ICU nurse say to me after hearing report "sounds like that patient is too unstable to come up here". huh? then can i send my other 5 patients to you?

Huh???? And where would she have liked this ICU pt to go, if not to the ICU??

[canoehead, BSN, RN]

heehee, too unstable for the ICU, that's a good one. For crying out loud!

[ritarunningfeet]

Actually We have had that reply more than once from the ICU at the hospital I work at " Oh that pt is too sick", usually the response they get from the nurses is " Oh..Sorry... connect me with the SUPER ICU then". It is kind of silly really.

[MedictoRN]

Sending a pediatric patient to the ER is actually the policy for our hospital. We have a peds m/s floor but no PICU, so any ped that heads south is sent to the ER for treatment while the transfer to another facility with a PICU is arranged. It doesn't happen often but seems to work pretty well when it does need to be done.

[hogan4736, BSN, RN]

I am suprised at all of the responses here, stating that their particular hospital does this (sends an inpt to the ER)

I just attended an EMTALA conference...

This is a clear EMTALA violation...Both externally (inpt at another hospital transferring to another ER) and internally...

I am a nursing sup, and would never DREAM of doing this (in my small town hospital, or ANY hospital for that matter)

It's akin to calling physician B for orders on Physician A's pt...you wouldn't do that...

Now at night, our ER doc comes up to the floor to intubate, but that's it...

[RN4HIRE]

Did anyone think to write an incident report? If something actually happened in the ER that landed you in front of a jury, they will ask if you used the "chain of command." If no incident report was filed, then administration can pretty much say whatever they want or that you didn't fully make them aware of the dangerious situation, and you will be at fault for not notifying the proper people. Working registery, we are always told to make sure we at least document in pt's chart that the charge nurse was made aware. Then the responsibility is shared with a hosptial representaive.