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?

[withasmilelpn]

Really, nursing everywhere needs to be staffed based on acuity. I'm just a LTC nurse but they keep putting tons of skilled patients on my floors with rehab needs and PICCs etc.. because there is no room on rehab. I've worked rehab and I like it but the reason why you carry such heavy loads in LTC is because they are not supposed to require huge amounts of time to care for. Patient care suffers period. They need to listen when we say this is not safe. We are not being lazy! We are advocating for our patients!

[Diploma'82]

Wow, you have supervisors! Where I worked there was NO back up at all, we just had to deal with it 'cause they aren't going to spend the money to help the NURSING staff!

[grandee3]

I have a question for the Super's on this board. If you have the pts best interest in mind, then is it really safe to send that pt back down to the ER and turn he/she over to a nurse that already has 6 pts when the pt really needs to be a 1:1 or 2:1? How can you justify that. I have a tremendous amount of respect for Nursing Supers, I praise you for your hard work and dedication. However, I just can't believe that the pt is still #1 in this situation. Another thing, no one knows what is going to roll thru those doors next. There's got to be a better solution.

[PANurseRN1]

I always found that fascinating. ICU can't take the pt. because they're at max, but the ED can hold and hold, plus continue to take in the ambulance and walk in pts. To heck with safe ratios for those nurses. How is it safe for an ED nurse to have 2 ICU holds, 3 ED pts, plus charge? That's happened to me already.

As soon as someone can explain it to me in a way that is logical, maybe I will reconsider calling this dumping. Until then, it is dumping IMO.

[hogan4736, BSN, RN]

grandee,

i am with you...as a nurse, we should always have the pt's best interest in mind...an a house sup, we have other "variables" thrown into that equation...but the pt always remains at the top of that list...

excellent post,

thanks

[CRNI-ICU20]

doesn't the patient's physician have any say where his or her patient goes?

I would think that the supervisor is taking on a huge risk and then placing squarely on your shoulders to accommodate hospital administrators...ie more staff and more appropriate bed placement.

Seems to me, if that patien were to extend his MI, and he was turfed from hell to breakfast all over that hospital....without benefit of proper cardiac care, there could just be a hungry malpractice lawyer waiting in the wings...

Maybe the risk management people need to have a quiet conversation with the supervisor...

She could have re-assessed the ICU patients, and determined which patient from that pool could possibly transfer out....ie, a stable post op....or a two day old MI that just needs telemetry...

And put the fresh MI in that room....

Sounds to me like she was pedding backwards...which can never be a good thing for a patient...

When all else fails,the patient should be transported to higher tertiary care...

The doctor should be more aggressive in where the patient goes...

after all, his orders are all over the chart...he's ultimately responsible...

[BillEDRN]

Terra, it sounds like this is not a facility for you. I doubt any kind of solution would be acceptable.

What do you mean by that? It is not acceptable anywhere, anytime, to have a nurse be responsible for more patients than they can safely care for! Why is it the nurses "fault" when the facility creates unsafe situations and expects the nurses to "deal with it" or find another job?

What type of nurse would be "right" for this facility? One who either doesn't care about the unsafe situation, or isn't smart enough to recognize it? Either way, I do not want that nurse taking care of me or my family!

We, as nurses, need to stop making excuses for the facilities that create these unsafe situations, that devalue nurses and their contribution to the healthcare system, and stand up together for not only our rights, but the rights of our patients!

While you "doubt any kind of solution would be acceptable" I know one that would be. Safe staffing levels for every department, with reasonable written policies that would safely accomodate sudden surges in volume or acuity!

[MAISY, RN-ER, BSN, RN]

All I can say is-Thank God for teaching hospitals!! The most we will take on as an assignment is 6 patients(believe me that is stretching it!) Our area dictates that people want every test under the sun, and our doctors capitulate. We have also seen our suburban hospital change from middle class to inner city clients as hospitals close. Many of our patients are admitted-this has caused the formation of 24 hour observation units-chest obs, abd obs, and stroke obs. Our telemetry has also been broken up into low risk, med risk and high risk cp. We also have many holds in our ER. I don't think a floor should ever be able to send a patient to the ER unless a medical hold is removed. I agree that ER nurses are used to using drips and have everything and everyone they could want in the event of a code on site. However, loading up an ER nurse with critical patients is also wrong.

If ICU nurses can only have two patients due to the "critical nature of their patients" how do I have 4 patients that are going to ICU? I am so sick of hearing the issues these nurses have with everyone else! I am also sick of hearing the advanced degree nurses whine about their pay commensurate with education. THAT SHOULD BE THE LAST REASON WHY A NURSE IS CONSIDERED A GOOD NURSE! While education is worthwhile and may expand a person's horizon, being able to attend classes, lectures, write articles a paper is not helpful to a patient if the nurse is unable to bring her knowledge and action to the table when it is required! I have seen this happen many times during the past couple of years! On the other hand, I am also sick of hearing the floor nurses complain that orders have not been initiated on admitted patients. Everything I do must be entered by me-no secretary, no technicians, no assistants taking vitals, or doing BG readings or drawing blood. Meds must be sent by pharmacy at each administration-so add those phone calls as well as consults orders to my list of BS duties. We draw our own labs for everything when the patient is held in the ER(no phlebotomy here). Now imagine, having 2-4 hold patients with extensive orders and a cp roll through the door. I have one person who is possibly dying, and one who needs his ice water, or better yet bed bath(92 year old former physician last week). ER is becoming a mish mash floor that people stagnate as they wait for some type of resolution. What is becoming really ridiculous is that patients are being admitted to the hospital as patients and actually being discharged from er 2 days later. How pitiful is that?

Sorry I went off the topic, but I believe many things could be better...the first step would be to remove nurse managers who have no business experience-they are no match for hospital administration. The second answer would be to have staffing available to open area that are closed due to low pt population-and I don't mean at shift change! Physicians with backbones who aren't cowed into ordering millions of tests due to fear of patients threats. How about direct admits-what happened to them? Almost forgot about the physicians who send pt to ER when they call and say they have high fever, sob, or any other ailment that is sent to ER and turns out to be benign. What happened to physicians who actually doctored their patients? How about educated consumers-educate patients about why you need an ER, and what constitutes a "real" visit.

NOW I FEEL BETTER-good luck to all-keep plugging away!