Hi! I'm Tweety Your Critical Care Med Surg Nurse (Or long waits for ICU beds)

Nurses General Nursing

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We never have enough ICU beds in our hospital. They fill them up with ER admits and never have enough beds for in-house emergencies. We had a patient with sepsis low blood pressure that was low all day, well after nearly 5000 cc's of fluid bolus and a bp in the 80s they md decides to transfer to ICU for frequent bp checks and montoring. The patient had a wicked case of pneumonia and was on isolation for rule out tb.

It took 12 hours to get a bed. I took care of the patient on the floor the entire time. Taking bps q1h and running fluids at 250 cc/hr. She did o.k. and eventually I got a bed, that had been open but was unstaffed. The patient wasn't crashing and burning, and I felt confident watching her, but I neglected other duties and "my" nurses, as I was in charge, and I had another patient that was stable but vented. I also felt sure because the super. knows my skills and what a nice guy I am, she felt o.k. with making me wait. But she was a bit frustrated trying all night to figure out a way to creat a bed, the big problem being she was on r/o tb.

I filled out an incident report.

So how long do you wait for critical care beds in your hospital?

Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac.
You keep vented patients on med surg? This is exactly why I avoided medsurg like the plague once I finished school. I have never worked in a hospital that had enough ICU beds....

In order to create critical care beds and to get chronic stable vents out of critical care. Our unit has four rooms designated vent rooms. Believe it or not all persons on vents are critical (there are vents in nursing homes and even vents at home, for people like actor Christor Reeves). Anyway, they have to meet strict criteria to come to our floor. The nurses taking care of the patient has to good to a vent class, and 24 hours of precepting in the critical care unit with vented patients.

We've been doing this about six months now and it's working out well. So far we've only had two vents at a time. Our manager is very hesitant about having 3 or 4 vents on the floor. They are never more than a 3:1 assignment, so while they are stable they are not part of a full med-surg assignment.

When we are short staffed, the charge nurse is usually the one assigned the vents. We were going to get a vented patient to our unit today that's been in critical care taking up a critical care bed for the last six months.

I wish we had the budget and staff for a real step down unit. My patient really wasn't crashing and burning, or needing a vent, just hypotensive and needs q1h vital signs checks and I&Os, which can't be done on a med-surg unit. She would have been a perfect candidate for a step-down unit.

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3:1 ratio for semi-stable hospitalized vents sounds about right. Nurses in LTC vent facilities take more, but generally they are stable trachs. My new manager would like to implement this on our stepdown, we'll see if this comes to pass. Unfortunately our hospital has a problem with our doctors placing their 'favorite' patients on our stepdown because of the better ratio/better care.(not necessarily that they NEED the critical care...the doc wants it...and our CM's are trying in vain to fight the docs on this) So our stepdown and ICU are always packed, with patients waiting for critical care beds in ER and PACU forever. We NEVER are allowed to keep a bed open for codes, etc anymore and are generally playing 'musical beds' in hectic fashion to accomodate patients who really require critical care....gets tiresome doesn't it.

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3:1 ratio for semi-stable hospitalized vents sounds about right. Nurses in LTC vent facilities take more, but generally they are stable trachs. My new manager would like to implement this on our stepdown, we'll see if this comes to pass. Unfortunately our hospital has a problem with our doctors placing their 'favorite' patients on our stepdown because of the better ratio/better care.(not necessarily that they NEED the critical care...the doc wants it...and our CM's are trying in vain to fight the docs on this) So our stepdown and ICU are always packed, with patients waiting for critical care beds in ER and PACU forever. We NEVER are allowed to keep a bed open for codes, etc anymore and are generally playing 'musical beds' in hectic fashion to accomodate patients who really require critical care....gets tiresome doesn't it.

I too see this, I always thought that was what criteria were for, if the Pt does not meet the criteria to be step down or ICU/CCU then they should not be taking up valuable space, if the Docs aren't happy with ratios on other floors then maybe they should advocate change, hold it did I say Docs should help nurses, sorry I guess I kinda lost it there for a second.

Really tho if doctors aren't secure enough to send tele Pts to the Med/Surg/Tele floors then they should speak up and possibly TPTB would take notice

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Specializes in Nephrology, Cardiology, ER, ICU.

I work in a large ER and we are constantly holding patients. Heck, we even hold direct admits from the outlying hospitals when there are no beds! Yikes!

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I was just talking about that on another thread. I work rehab and we get one RN per team. Four out of five days the team has between 7 and 9 patients, however it can go as high as 13. That day it goes up to 13 is always the day I end up doing one on one nursing with a person that should be in ICU or stepdown. Last evening I a had a woman with a heart rate of 160 that was be digitalized, the doctors were also monkeying around with some other meds. The same night I had a man with a BNP of over 3000. Both of these patients should have been on monitors somewhere. And yes they think it safe to do this to the nurses they consider to be a little stronger in critical care backgrounds.

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Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac.
I work in a large ER and we are constantly holding patients. Heck, we even hold direct admits from the outlying hospitals when there are no beds! Yikes!

We have to send direct admits to the ER all the time too to wait for a bed. Here's a concept, if there are not beds, why direct admit them??? Send them somewhere else where there are beds. Oh yeah, those bean counters again. Duh.

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We have to send direct admits to the ER all the time too to wait for a bed. Here's a concept, if there are not beds, why direct admit them??? Send them somewhere else where there are bed. Oh yeah, those bean counters again. Duh.

Agree i too hate this, we can be on divert in CCU and some doc in our professional building will send someone and we have to accept them because if the doc is admiting them to CCU it is emergent, so poof produce a bed

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There have been many nights where we are sending an ICU patient to step down (after twisting the docs' arm) because the one needing to get in was sicker. Have even, on a RARE occasion, sent transvenous pacers to step down (they were the healthiest !!!) But, if there is going to be a delay, the house supervisor will stay with the patient, if they are unstable and placed on drips, if they've been vented and are stable, resperatory stays with the pt. until moved. sometimes 6-8 hours, usually two.

Yep, we're in the same boat, somedays, I don't have time to call docs, to change their level of care, let alone call report and take a sicker patient in... it's a terrible circle. Luckily, all the ICU charge nurses commuinicate and work together well in situations like this. Try putting a fresh MI in the neuro ICU, another story

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I work in the ED and if a floor patient requires and ICU/TELE bed and there are no beds in the hospital, we get the patient and HOPEFULLY we also get an ICU or TELE boarder nurse... But sometimes we don't

Becky:)

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I work in the ED and if a floor patient requires and ICU/TELE bed and there are no beds in the hospital, we get the patient and HOPEFULLY we also get an ICU or TELE boarder nurse... But sometimes we don't

Becky:)

hmmmmm What is a boarder nurse, I have never heard this term, is it like they float a nurse from ICU to your floor for the PT or they give it to a nurse that can work ICU?

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i work in paeds on a general ward. In our hospital we only have HDU for paeds, so critical care children have to go to another local hospital. Recently tho they have been full and children have to be transfered 50miles away! which is so sad. The NHS here is falling, due to many issues.

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Specializes in Neuro Critical Care.

The floor I am currently on recently closed the intermediate care area which was about 8 beds and made them general neuro beds. When we transferred a patient out from the unit we used to have the option of moving them to the Intermediate care area for further monitoring but not anymore. Now they come right out to the floor with out other 7 patient assignment and forget sending them back...that bed has been filled. It does seem like people are downgraded quicker and we end up sending patients back to ICU level more often but usually have to take a patient out to send a patient in.

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