[efiebke]

I JUST found this forum!

(Got to get away from the "Off Topic" forum more often!!!!)

I'll be posting here more often. (Be afraid. Be very afraid.)

Just for the books. I work for probably THEE smallest hospital in Massachusettes! We've just been designated a "Critical Care Access Facility". No one knows what the heck that means except that we get full %% in Medicare reimbursements. But because of this, we can only have 15 acute care patients in the hospital at one time. . . including the med/surg floor, the maternity floor and the ICU/CCU (where I work).

Total beds in our hospital??? Let me count in my head (which really hurts by the way!). . . . 32 beds including the E.R.

Yep! We're a small, rural, community hospital. And I'm still surprised to find that we all have a job there because. . . because. . . because. . . there are days when we have less than FIVE patients in the whole facility! One time, not too long ago, we only had one!

I love my job! Can't ship the really sick ones out fast enough!

Cheers to you all!

Ted

[renerian]

Thats awesome. I would love to work in your hospital. I worked in a huge teaching hospital that was overwhelming at times.

renerian

[efiebke]

Renerian:

You'd think more people would love to work at a place like this too! Interestingly, we've had "staffing crisises" (sp?) at times when a co-worker would leave!!! ($100.00 per night shift bonuses and all! And this is on top of the overtime!!) We're near another staffing crisis now with one full-time evening position and one full-time night position unfilled!

It just seems that people don't like to work for small hospitals! For sure, there are more interesting cases to see at the bigger, busier hospitals.

It's a great place to work, though. I'm staying here until they "lock the doors". I call it my "vacation career" and I'm enjoying it while it lasts.

But I'm telling you. . . I still check the newspapers to see what's out there in the nursing field. . . . just in case!

Cheers !

Ted

P. S. Please don't get me wrong!! Life is not like this 100% of the time here! The poop does hit the fan every now and then. I'd say, though, it's a good 40% of the time when I can say, "My one and only patient is safely sleeping with the heart a-beatin' " and do "paper-work" projects, clean & stock the unit, do self-tested inservices, re-arrange the book-work, do some QA, and surf the net.

[oraibi]

Originally posted by efiebke:

It's a great place to work, though. I'm staying here until they "lock the doors". I call it my "vacation career" and I'm enjoying it while it lasts.

But I'm telling you. . . I still check the newspapers to see what's out there in the nursing field. . . . just in case!

Hey!

i can relate . . . im sitting home fooling around on the computer and was scheduled to work tonight

i work(i think!?) in a small rural hosp in wisc. but census has been unusually low for several weeks (and i guess most of the first half of the year) . . . i have only worked here for a couple months (first job out of nursing school) and was really enjoying it, but i have been put on call and ended up getting 0 hours this week . . . tonight the HUC callled and told me there was some heavy budgeting meeting today and it sounds like staffing cuts are in the works

so wierd, just last week we had an inservice where the CEO was filling us in on the new building plan which is supposed to start soon . . . and now people are filing for unemployment . . . wierd

oh well, as doris day used to say . . . que sara sara . . .

sayonara

~O

[efiebke]

Our hospital has a union.

Under union contract, they can't force us to take call.

So, theoritically, if the cencus is down to 1 or 2 patients (which it has been), all the nurses scheduled to work can.

Of course, this rarely happens. I take call at the drop of a pin! And if I don't have time save in my "vacation bank" (we call it CLT time), I don't. Then, I'll either float to the med/surg unit, ER or do some stupid, boring paperwork.

I do wonder if or when they'll close this hospital! But it's been around for a long time with these kinds of census; it's meets the need of three neighboring states (MA, NY, and Conn); and the community WANTS this hospital open. . . almost at all costs!

So. . . . it just might stay around for a while longer.

Question. Does your hospital have a union?

Just wondering.

Ted

[oraibi]

Originally posted by efiebke:

Our hospital has a union.

Under union contract, they can't force us to take call.

So, theoritically, if the cencus is down to 1 or 2 patients (which it has been), all the nurses scheduled to work can.

Of course, this rarely happens. I take call at the drop of a pin! And if I don't have time save in my "vacation bank" (we call it CLT time), I don't. Then, I'll either float to the med/surg unit, ER or do some stupid, boring paperwork.



Question. Does your hospital have a union?

Just wondering.

hi Ted,

nope . . . no union

and my hosp sounds a lot like yours, been around a long time etc.

like i said, im very new and still trying to figger out whats up. i entered into this job with good faith and was given no inkling of financial difficulties looming

but yeah, i think a union would help and i wonder about the general lack of unions in health care around here

a few years ago nurses at the largest regional health provider tried to organize and the hosp fought it tooth and nail and the nurses lost

i figger everything happens for a reason and maybe if this falls through a better opportunity awaits

but i do like my current job, drive, etc.

ciao for now

~O

waiting for the other shoe to drop . . .

[atownsendrn]

efiebke - I am right there with you. Small rural hospital in Georgia. We, too, are a critical access hospital. 15 inpatient beds. Can have as many observation patients as we want. But only have 34 rooms. I work in the ER. We are part of a larger hospital system and have just moved into a new ER. Its beautiful. But they are predicting that our census will increase by 20% within 4 months. And, of course, they aren't willing to increase ER staff yet. Anyway, hang in there with the critical access stuff. That is what kept our little hospital open through some tough times.

I, too, came from a large hospital. 720 beds, 3 critical care units, and a 64 bed ER. I love it there. Started right out of school and felt like I had "grown up" there. But I really love my little rural hospital. And its fun to see all the great things that are happening.

[efiebke]

atownsendrn -

We've been admiting almost everyone as observation just to keep the "acute care" patient population down to less than or equal to 15.

I've heard that other "critical care access" type hospitals admits EVERYONE as "observation"!

Seems reasonable to me.

Ted

[atownsendrn]

We have a manual that helps with the decision if pts should be inpatient or observation. We hardly ever look at it in the ER, but its there if we need it. Most of our admission to the floor are observation. Every now and then administration will call over and say that there are 12-13 inpatients and that we need to tell the MD to admit any patients as obs pt. That works most of the time.

The pain is the "swing beds" We had 5 nursing homes in our county, so we very seldom have anyone in "swing beds" And luckily as the ER manager I don't get involved with that. But I hear its a pain in the @$$. But I guess if it keeps the paychecks from bouncing then its worth the trouble.

[efiebke]

Swing beds!!!

Oh yea! The paper work involved, I understand, is quite incredible! (One NEW reason why I'm happy in my little ICU/CCU.)

There are several nursing home and rehab. homes in the area. So far, I haven't heard of any patient admitted in one of our "swing beds". The med/surg nurses are dreading the use of the swing beds.

With regards to going over the "magic 15". Do you ever experience this? I guess this happend recently. There were tons of reminders about reminding the MD's to admit patients as "observation" and to keep tabs on the number of "acute care" admits in the house (I guess this is a new "task" we all seem to need to be sharing. . . . . )

Don't know what the outcome of that situation was. And no one seems to know what the ramifications are for having more than 15 designated "acute care" patients admitted at one time.

We're new to this "Critical Care Access" thingy. . . as you probably can very well tell.

Ted