[deespoohbear]

Don't you just love it when you get a patient for admission and no orders? We have one physician who is known for calling us and telling us he is sending in a pt for direct admit and that he will fax the orders. So the pt shows up 1/2 hour later and no orders. We call the office. They say the orders will be faxed soon. Another couple of hours go by, no orders. We call down and try to nicely explain to the office nurses that we are in a real bind and could the doctor please send us some orders? Their response is "The doctor is busy, he will send you the orders when he can." I hate to tell the doc this, but he isn't the only one who is busy!!! Anymore, I just say screw it. If the patient shows up before the orders do, I call the office once. Then I let it be. When the patient gets around to asking me why we haven't done any tests, why we haven't fed them, or why we haven't started an IV I just tell them I waiting on the orders from their doctor. My feeling is if a doctor believes a patient requires admission to the hospital, then that patient warrants timely admission orders. For crying out loud, this doc has the orders in a computer program that he just has to modify to fit the patient and click on a fax button. How hard can that be?

[tenarnc]

Hi all!
I've worked med-surg for 20 years now. Yes sometimes it seems like a dumping ground. But on the other hand, think about what Med-Surg encompasses... Everything. The one reason I've stayed in Med-Surg so long is because it is so challanging. You have to know alot about many different things. Everyone gets patients who don't really need to be there, ever the ICU. Ask them, tell will tell you. I know this because I've also worked as a House Supervisor. And because of that, I feel I can safely say that no patient is placed somewhere because nobody else wants to deal with it. You may have had the only available beds for that patient type. I lnow how you feel tho. A lot of times I've asked "does nobody else have a bed for this patient"? But you just have to grit your teeth and take it. As for the drips, our med-surg units do dopamine, dobutrex and primacor without a moniter, but we have policies in place as to how high the drip can go and procedures for the nurses to follow, like s/s to watch for and how often to do vs, ect. So that way you have guidelines to follow. We also take vent patients. My unit is mostly renal and respiratory, but we get everything. That's just part of it. Not everyone can do it, not everyone likes it. If you are truely unhappy, m/s nursing is not the only option. But if you look for something different, just remember that everyone gets those patients that shouldn't be there

[Sunstblush3]

wow... ok.. Im on a medicine unit.. we have 10 cardiac beds.. and believe me We were supposed to be considered a dialysis unit but we have suicide pts, cardiac patients, heck i had a patient that was brought to be admitted to my floor.. took one look at him and called a code.. thinking maybe he should have been sent to ICU?? :smiling: Im glad to see Im not the only one frustrated with the inadequacy of perhaps our admittin folks.. maybe they dont really know where these patients belong.. and where I work some of our patients are in a hallway for more than 24 hrs before gettin lucky enough to find a bed anywhere in the hospital.. well my hats off to all my fellow nurses that are pullin their hair out over things like this.. just think.. that is what makes us that much more special.. great to be a nurse.. better to have someone to vent of the pitfalls.. !!!!

[BBFRN]

ummm, I work on a Trauma Med/Surg floor, so the people that get dumped on us (with the exception of Burn Unit overflow) are usually way easier to manage than our usual patients, so I have no problem taking them- usually. I'm going to have a full load anyway, might as well throw in a couple of DNR's. lol

[deespoohbear]

Sometimes the DNR's are the patients who require more support emotionally. And their families can be a real trip too. I believe there is a fine line between comfort measures and heroic measures sometimes. At least if my patient is a full code, I know what to do for them if they start going south. The DNR's can be a little more tricky as for what they need. Just my .02.

[preciousnurse]

I work on a 32 bed step down unit and know that it is sometimes a dumping ground. Women's Care cannot take a patient because they are infectious ,however they may only have one patient. I have had ICU nurses however keep patients when they know that are med-surg floor is busy. It depends a lot on the type of hospital you work in. I work in a small community hospital where everybody knows everybody. The key is to working together and not so much a separate units! i know it is frustrating, but it is sometimes the reality>

[renerian]

LOL the oncology unit which did BMTs I used to work on would always get called to put a pneumonia patient in with an immunocomprised host...........always had to fight with admitting............we got alot of stuff that was not oncology but when an onc patient was in the hospital the docs would demand the patient come to the unit and others would then be sent elsewhere.........then that receiving unit felt like they were getting dumped on.......


renerian

[EmieRn]

I feel like that all the time. Just yesterday, we got three admissions from the hours of 1A.m. and 3 A.M. At the small hospital where I work we have one RN, one LPN and one aide for up to 15 pts/ We don't split the pts. up so the RN gets all the admissions, no secretary so we have to put the chart together, do the admission and take off the orders.VERY time consuming, especially with about 40 papers to an admission. All the pts. come from the ER, they do not help at all with anything! If something happens though in the ER we are also expected to go back and help. (2 RNs back there for 5 beds, but alot of nights they have no pts. back there). Its too much work fo one RN on the floor to handle, anywhere from 1-15 pts to take care, admissions to do and help in ER if they are busy. Can we say early burnout and bad management

[NiteNurseRN]

Deespoobear,

YES, YES, Yeeesssss, I feel that Med/Surg is the dumping ground. I got an admit from a NSG home that was passed on to me (hello, is it gonna be a bad night or what???) with decubs, bleeding out in his urine (f/c bag is full of kidney bean red/brown urine), H&H in the toilet, plus stroked out.

Meanwhile, the unit clerk/tele moniter is playing on the internet all nite, so the Dr's orders are full of mistakes which we nurses have to fix in our 24 hr chart checks.

I had a pt. fall because most every one on the unit was busy with a near code that was rushed to the ICU. My boss ended up mad at me because I was still there with 6 untouched-white-as-the-virgin-snow charts.

P.S. Deespoobear, Your cute, red barn looks like it has 2 bombs on top of the roof (don't get maD)

[BadBird]

As a ICU nurse I do feel that the MS nurses are dumped on, which is why I am not a MS nurse. God bless all of you, I don't know how you manage. I have found that the types of MS patients are the hardest to care for, call bells on constantly, confused, combative, constantly incontinent. Visiting hours are also longer so you have to deal with many families. Because I realize this I always make sure when I transfer a patient that the bath is done, all orders taken off, meds reordered if not in their bin so the nurse will have them. I know those are small things but I do try to help both for the patient and the nurse. I just can't believe the ratio of patients to nurses in MS, it it truly awful. Many thanks to all you MS nurses out there.