I work in an er that is very busy. I believe that 25% of our patients are very sick, and need to be admitted. Our hospital often gets overloaded, and we need to go on diversion of some type (critical care, medical, treat and release, etc.). We cannot refuse trauma, because we are a level two trauma center.
It seems that the hospitals goal for the er, is to see and tx and release or admit patients as quick as possible. We do a good job, and do not compromise patient safety. However, many times there seems to be a problem, moving these people when admitted. The SDU tells us that the bed assignment is inappropriate, or the patient doesn't belong there, or the patient doesn't need to come to this floor, why can't you send them here or there. or You guys are overloading us. Although I see their points on some occasions, it often seems like they just don't want the patient. The patients are what gives all of us our jobs. SDU has c/o ICU and CCU. The RNF c/o everyone, and everyone has c/o the er.
I clearly understand, that at times the job is stressful, and that everybody gets uptight. I clearly understand that not all the floors or units are staffed adequately. In the er we have the same situations at times. Often we are full, and have no beds, or monitored beds available for incoming squads, or walk in patients. This is when it is important for us to get a pt to their admitted room. We do not know what will come through the door next, or how bad it will be? Unlike the other floors and units, we cannot refuse patients, because of lack of space. If somebody is in extremes, we have to figure out a way to take care of them? It is frustrating to know that beds have been assigned in the hospital for patients, and not be able to give report or send the pt, because the room is not ready, or the nurse is busy.
In the end this causes a lot of Inter-unit controversy, instead everyone working together.
Any suggestions? or similar problems?
May 20, '99
Maybe you need to work out an arrangement where the er and floor and unit nurses can trade places for a few hours or maybe even a whole shift so everyone will have a feel of what it's like other "hot" spots in the hospital.
If Ya' Don't Love The Blues, Ya' Got A Hole In Your Soul
May 20, '99
We have a similar situation involving our ER and our IMCU/Telemetry unit. It is not that we (IMCU/Telemetry) do not want to take the patients, sometimes getting report from ER is not feasible at the moment. By that I mean, I had a patient crashing on me and needed the assistance of other nurses, and the ones NOT assisting me had problems of their own. We do not have housekeeping on midnight shifts so we and the nurse's aide (IF we have one) are responsible to clean the rooms if we need one for an admit. I get to ER as promptly as possible because we are ALL busy, not just ER and not just our unit. Staffing is usually an undermining problem with our hospital as well as many other hospitals. I call ER back as soon as I can, apologize for the delay and get my report to accept my patient. We try to work together but sometimes tension is going to arise no matter what. This problem was just addressed in our unit meeting last week! I don't think trading places/unit jobs is necessary. We all know that all units are busy and are just as important as the others. We are all parts of the puzzle and one cannot be whole without the other. Personally, I just "juggle" my responsibilities to the best of my ability to care for my patients and work with my coworkers. I never try to say that ER doesn't work hard enough or they are trying to make life difficult for us floor nurses. They are doing there job as best as they can and have to get the patients out in a timely manner.
After all of that, I sure hope I made some sense! I think I am half-awake, but wanted to give you my opinion!
May 20, '99
Yep, we had a real bad problem between our ER and ICU and PACU. I think part of the problem was the dynamics of the nurses involved. I was the DON at that time and was instructed to "fix it". I met with the employees for awareness and suggestions. We instituted a rotation policy. The three departments were incorporated under a director with a charge nurse for each shift. The charge nurse position was also rotated among the nurses. Every nurse worked in all three areas each week. The scheduling was a nightmare, at first, and bugs had to be worked out. One of these was the matter of swapping shifts and areas. Of course, we had a few individuals that were not happy with this "solution", but they were the type that would not have been happy no matter what!
May 21, '99
Thanks for the input so far :-)
However, although I have not worked in the SDU, most of the other ER nurses in our department have in the past. Much of our staff has come from the SDU, ICU, CCU so I don't think rotating would improve the situation. Besides, I know that the administration would never let it fly.
Actuaaly come to think about it, I have worked in the other areas a couple times, when they were short.
May 25, '99
I have worked in 3 different hospitals and have had the same problem in all 3. I don't know why.
After the usual polite phone call has been reduced to pleading and begging by the first or second hour, I have found that ER Charge Nurse (or Nurse Manager) to Floor/Unit Charge Nurse calls work the best. I will admit that on wild nites I have gone upstairs to investigate the "excuses" and many turn out to be just that -- "excuses." Pt "crashes" turn out to be a confused LOL taking off her O2, or a pt w/a small fever (now I'm not saying ALL situations are like this folks, it's just my OH-pinion so don't spank me). We have gone upstairs and cleaned beds ourselves when the "we can't find housekeeping" excuse is doled out. And have been greeted w/empty rooms when the "the pt's not out of the room yet" has been used. The latest has been "the nurse is taking a break". A polite callback from the ER Charge Nurse/Nurse Manager or Supe simply stating that the ER nurse taking care of the pt has not had a break in 12 hrs and has been mandated for 8 hrs more, and that it would be a good idea to take this pt now before the 3 traumas by land and 1 by air arrive, we have no beds (including the hallway and fasttrack) and the waiting room is standin' room only folks....
(I get a little cranky on this subject)
Floating has been a plus/minus, the nurses go back to their floors/units and call us "barracudas" and "witches" (use your imagination for the rest of the vocabulary). No, I am not forgetting those of you out there who take report in a timely manner -- a big hug and chocolate cookie to you, keep up the great work! There must be a solution here somewhere...hang in there
The grass isn't greener on the other side -- it's just different grass
May 25, '99
I agree with what you are saying. You hit the head right on the money.
This should not be misconstrued by those that take report, and the patient promptly, or hold off d/t a legitamite excuse.
However, the Charge nurse situation, does not always work. I am in charge frequently, and I don't think anyone in hospital could care less who calls. Unless it is their own charge person, or in house administrator, they don't always care.
We clean all our own beds in the ER, why is it that everyone always has to wait for housekeeping? I don't undersatnd that?
As much ast I also understand the staffing issue point of view by the SDU, and unti nurses, it doesn't always make sense? When they are full, they take nobody, not a one. They also have an adequate number of montiors for their beds. So the reason why this all gets me so much is this: Not all our beds are montiored, even though at times it would sure help. We often have to decide who most likely does not need a monitor, even though they should be on one.
When we are full, we cannot refuse a chest pain, CVA, or something else that could inevitably lead to death, or loss of limb. We do not have the luxery of refusing to take patients.
The other problem, is the irrate family members in the ER. Why? They are told they will be admitted, then get mad at us because they continue to sit in the ER sometimes, for as long as 1-6 hours after admission.
I am the first one to offer to hold a patient also, if we are not busy, and ER beds are not in demand. Which is probably why these issues get to me sometimes.
To all the other nurses out there, that help us out, and don't delay, or clean a bed on the floor to help get the patient up to the room, I thank you and I'm sure many others do also.
May 25, '99
We had another wild night again (no room at the inn..so to speak) and our hospital beds as well as our ER were swamped. I walked in our IMCU/Tele unit and everyone was running amok. I was in charge and was advised that we had an admit waiting for each of the 4 nurses and possibly more to come. What made it even crazier, we have a small nurses unit and they have it torn up to remodel! Anyway, ER nurses were calling and getting upset that no one was taking their patients. I decided who was admitting who and promptly, as best as possible, took report and we admitted our patients. I think the nurse I took report from was ready for a fight from me because there was an enormous (sp) amount of tension and sarcasm in her voice. Apparently they had been very busy since she came on her shift at 7p (I come in at 11P) and the evening shift wasn't as hospitable. I made a little joke and told the ER nurse to "let it rip" with the report! She bust out laughing, said thanks and started report! It sure made the night a little easier for them and for us by just accepting what must be done and toss a little humor in to break the tension. I have seen our ER "in motion" and I give them alot of credit. They are on the frontline and are the mainstay....I applaude them!
May 26, '99
Erbn Girl - That's nice of you. It's too bad more people don't have a sense of humor. If I spoke with someone with a sense of humor in report, that would
make my day :-)
May 26, '99
Joe,RN - What supervisor? Our hospital gives out a pager to one of the floor or unit charge nurses. This nurse has patients and respponsibilites, just like the rest of the nurses on the floors. So needless to say, they are not always helpfull, because they already have enough to worry about. It is not a volunteer process either. The administration says, on these days you have it, and on these days you have it, and on these days you have it.......restart cycle.
The hospital had three in house supervisors that did nothing but assign beds, keep housekeeping going and move people. However, d/t cutting costs, these positions were axed, before I even worked here. How do I know this? Because all three supervisors work in the ER with me now.
May 27, '99
Hey CEN, just a dumb thought here! What about your Overhouse Supervisor? Couldn't they act as a go between?
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