No beds available? - page 3
I was admitted to a major hospital here in Houston. I layed in the E.R. for 7 hours waiting for a bed. When I was finally settled in comfortably in my room, the lady in the bed next to me told my... Read More
Apr 30, '02This is not an issue that nursing can fix. The patients do not belong in the ER or on a floor with inadequate staffing. Hire more nurses, pay permanent nurses what travelers are paid...(i wonder how much of the shortage is attributable to nurses who are now travelers). If all else fails divert..If more patients were diverted ...less hospital income...increased incentive to hire more nurses. The more we are willing to suck up and roll over, the less likely change will ever occur.
Apr 30, '02Emergency rooms have core staffing. Floors do not in general---we are staffed by numbers of patients and limited by what level of 'shortage' exists in the facility. Acuity systems are out the window, and most of our patients will be as sick as they can be; AMI's, CHF ....many need ICU care but there are 'no beds'.
If hospital policy states 5:1 patient nurse ratio max on stepdown, it would be ridiculous for me to exceed it if it is against policy and unsafe. If I break hospital policy, there will be NO representation for me should an adverse outcome occur. I'm on my own and hopefully I have good cuz the hospital will NOT represent me. Let's be real here. Two wrongs don't make a right, and just because 'ER nurses can't refuse patients' does NOT mean MY practice should be unsafe. I WILL refuse what is unsafe and I've told the ER doc this many times, much to his chagrin.
Apr 30, '02The answer to this problem is simple, have enough nurses available to care for your patients. If you don't have enough Nurses then first divert to another facility and secondly truly and honestly assess why you don't have enough nurses. The problem can only be solved by nurses uniting and controling their profession and their practise.
If left to the bean counters nurses would be able to care for an infinite number of patients.
May 1, '02The government is telling us to cut back, we are spending too much on health care. Okay, so we decide to reduce overtime. Oh yeah, and there's a shortage of nurses. So we close beds. Now we have medical patients and patients awaiting extended care placement on the surgical floors to the point where we cannot even accomodate our own OR slate! I work on an Ortho Surgical floor. Surgical nursing is my area. That means patient care is maximized when I get the surgical patient and the palliative unit gets the palliative patient on our floor. I think that you have to consider patient safety from the perspective of staff training. Many nurses are reluctant to care for off-service patients not because they are lazy or unco-operative, but because they feel uncomfortable when patient care exceeds their knowledge base. If you are a nurse on a medical floor and you have just received a patient from ER with a tib-fib #, are you going to know whether or not the patient is at risk for compartment syndrome and how to assess for it? Likely not. This could have implications for care, couldn't it?
Right now on my floor there are 30 physical spaces for patients. 22 beds are open - we admit up to a max of 22 patients; we will go 1 over census only for an ortho. The slates are packed, the surgical wait lists are long. But 14 out of 22 patients are either extended care or medical patients with no discharge plans in the foreseeable future. Grrr. This does not make sense!
There is no such thing as an empty bed. It's not as simple as that. The bed may be physically empty, but that doesn't mean anything. It could be that the bed was designated as closed until ward had a discharge, so their census could accomodate another admission. It is also true that during the week when the ORs are fully operational, a certain number of beds are designated to accomodate that day's slate. That means, Ortho's first priority would be ensuring enough beds for the Ortho's on the slate, etc.
May 1, '02Hey all you ER people out there,
If safety is that much of an issue in any particular ER (unsafe nurseatient ratio) then what's to stop the hospital from closing the ER dept? Up here in Canada it happens routinely. ERs have sometimes closed for an entire weekend. At our hospital when there is more that 16 patients in emerg, they call a 'code gridlock.' That means every unit MUST accept one patient to relieve the pressure on emerg. My point is, there are things that ER can do if staffing compliments are not sufficient to handle the patient demand.
Just providing a little balance
May 1, '02RoxiRN,
ER's can technically be on code red (divert) to ambulances yes. Unfortunately people can still walk in and be just as sick. Also code red means nothing if an ambulance has a critical enough pt they have to go to the closest ER, on diversion or not. So in reality we have no real control. They just keep coming!
May 1, '02wow...is just about all i can say right now!
i work on a med-surg floor. we often have a problem with finding housekeeping to stat clean rooms for direct admits. since when does a stat clean take 2 hours?! yes, i know that there may be another room on a different wing that requires a stat clean...but please tell me there are more than 2 housekeepers working on a 3p-11p shift.
sometimes it is the fact that we are just plain out of room. our hospital doesn't close it's doors. we have 2 campuses and the one campus is located in a not so nice area and is the only hospital around...i heard a story of one patient waiting 20 hours for a bed.
we used to be an mainly surg floor until management ticked off the docs and they started doing only required cases in our or. so to fill the beds, we were taking med patients, which is fine with me...but they ran out of places to place fresh surgicals. one would think that they might cancel a few of the electives but no...so our 33 bed unit is full with maybe 4 discharges and 16 surgicals that we can't place. i don't understand...but maybe that is why i am not management. eventually a same day surg floor was opened and they tend to house patients for us. which has been very helpful...but stinks for patients. they don't feel well and are getting transfered from floor to floor. oh well. i think the whole situation is sad.
May 1, '02This 'ER vs the Floors' battle is just another stressor in our already overstressed workplace, IMO. So why get caught up in all the drama? Why can't folks problem solve instead of the 'us vs them' mentality of blame?
I will not be pushed to go way past my safe care limit. Administration pushes us as far as they can, we're the ones with licenses to protect, not them. I am 'on the line' constantly these days; it's like a battlefield mentality most shifts. When ER starts pushing me, I know how to push back and I do. If ER nurses feel they are working in unsafe conditions this is the ER's problem, not mine...and I've more than got my hands full.....so ER nurses, address YOUR problems. Thankyouverymuch.
May 1, '02I wish I had a dollar for every time I have been involved in looking at the problems of beds, patient flow, ancillary and support services--I could retire!
The problems are very common from one place to another--no beds, more elective admissions than available beds, ERs backing up and having to divert, inefficiencies in getting patients discharged in a timely manner and then getting the beds cleaned and ready for the next patient. I think the days of 75% occupancy are over--hospitals can't afford to run at those levels anymore. Unfortunately, that also takes away the buffer of having empty beds to place waiting patients in. It's become a real catch-22 trying to juggle patient flow anymore, and I don't know that there are any hard and fast answers to solving the problem. Add to the lack of beds the lack of good support services, and you have a recipe for disaster--I'm sure many of us have been in the position of calling housekeeping and having to harass them to get one bed cleaned.
May 1, '02Hey PRN that was my hospital that you posted that nursing was controlling bed placement.
Shocked to see that our little hospital was a "trendsetter". Actually the process works extremely well. What we have is a shift coordinator in which all bed placements are made. Then each floor has a "color board" in which data is entered and then a color is selected based on the amount of staffing and acuity of the patients. Patients in my opinion don't sit down in ER waiting for a bed. ER patients are placed generally as a priority, if you have a bed (such as a transfer) stays in that bed until a bed becomes available. Units have green, yellow, orange and red status. The shift coordinator sees the color and knows that a floor can handle more or less patients during a shift. The board is updated all the time. Sometimes you end up getting a patient that is not in your speciality but for the most part the system works really well. I love it and would never go back.
When the hospital is full then patients are rerouted to other hospitals or planned discharges are expedited. :kiss
http://www.metrowestdailynews.com/ne...al04112002.htmLast edit by moonshadeau on May 1, '02
May 2, '02Please know that I am not trying to place blame OR open a can of worms, and I am not especially not trying to get in an argment, but there is no "you" or "I" in TEAM. Frankly, I think attitudes like those expressed by mattsmom are exactly what keeps the "us vs. you" problem continue to be a problem. I am the one to offer to hold patients and do so if possible when the floors are buried! If you want to get technical, the same could be said in reverse; if you are busy and the bed is staffed and empty then maybe it's the floor's problem and THEY need to get additional staff, but I defy anyone to find me stating that in a post, as I AM aware of both sides, thankyouverymuch!
May 2, '02An exerpt from RN magazine Sept '01 written by Valerie Lyttle: Before I movd to the emergenc dept. in 1995, I'd worked on a variety of different units over the course of my nearly 16 yr. career. So to me, this latest ove wasn't especially noteworthy. A collegue of mine, however, viewed things a bit differently. "I suppose you'll develope that ED attitude," she remarked on my last night in my old unit. "That ED attitude," I have come to learn, means having a reputation for being aggressive, assertive, loud, demanding, tenacious, and bossy. ED nurses are frequently called chronic complainers and are also accused of not understanding the floors, the pts, or their families. At times, ED nurses certainly are guilty of all of those things. While I don't excuse offensive behavior, I would like to share withyou some very good reasons why those of us who work in the ED behave the way we do. "The challenge of being a jack-of-all-trades" If on some days we seem to have an attitude, try to understand how many different nursing tasks we're called upon to do. Although we're best known for our ability to treat emergency trauma, we also have to be part labor/delivery nurse, part pediatric nurse, and part geriatric nurse. We must move among all of our duties quickly and easily, turning from a critically injured child to a pt with a sprained ankle to a cardiac pt without skipping a beat. We take on the role of clinic nurse, caring for pts who return for daily antibiotics and staying up-to-date on those diseases that are reportable to public health agencies. We are oncology nurses who have to help cancer pts through an oncological emergency or support them as they exit this world. But it doesn't stop there. For some pts, we are renal nurses; for others, we are orthopedic nurses, applying all kids of splints-and sometimes even making our own. We are pulmonary nurses, helping asthmatics and pts with COPD, and we are neuro nurses, rushing a stroke pt to the radiology dept for a CT scan to determine which treatment protocol he'll need. We are cardiac nurses when we must work feverishly to get enough IV's in place to administer thrombolytics to a pt suffering an MI. We are intensive care nurses when we are looking after a pt who's septic and going into multisystem organ failure. Then we may have to turn to a burn pt and know the priorities of care for someone with severe burns to 70% or more of his body. In addition, we must know what to do for a pt involved in a hazardous material incident. We are forensic nurses when we assist with the exam of a sexual assault victim, or attempt to collect and preserve evidence on gunshot victims. We dabble in psychiatry when we keep a pt experiencing an acute manic or paranoid episode from harming himself, or encourage a severely depressed woman to hang on. We are also educators, teaching pts how to walk on crutches or manage their asthma at home, or explaining to a new mother what to do when her baby develops a fever. We promote safety by reminding pts about the correct use of seatbelts and helmets. We're also the "SWAT team," responding to codes and crises throughout the hospital. "The added stresses of emergency care" In the ED, we have to be able to respond at a moment's notice, no matter what else is going on. The ED doesn't have the luxury of closing, can't turn away pts, and always has to make room. When a sick pt comes in, we can't say, "Sorry, we're full," or "Sorry, that nurse is on break." We have to pu ou feelings aside-in fact, we're TOO good at negating our own feelings, and as a result, we're at high risk for PTSD, an occupational hazard for all emergency care providers. In the ED, we also see humanity's worst. We deal with murderers and rapists. We look after victims of abuse. We care for innocent victims of alcohol-related car crashes. We see people during the worst tmes of their lives. We are there when a critically injured pt pleads withus not to let him die. We are there when a family tries to achieve a sense of purpose for the loss of someone they loved as we explain organ donation. "Why we are the way we are" If we seem aggressive, perhaps it's because drunk or distraught individuals verbally abuse us. We try not to take it personally, but it's hard to duck every arrow when you are in the line of fire. We also face the risk of physical assault and threats to our safety as part of the job. If we seem too assertive, it's because assertiveness is an essential quality in any nurse-especially those in the ED. We have to speak up for pts and their families in situations that are often chaotic. In addition, assertiveness is essential when we triage pts. We need this quality when explaining to the pt who feels miserable with the flu why she must wait for hours while another pt gets treated immediately. If we seem loud, it's because we sometimes have to shout to make our feelings heard in a busy trauma or resuscitation situation. If we appear demanding, it's often because we need to get admitted pts to their rooms to free up beds for another who's waiting-and there's ALWAYS someone waiting. We're also demanding when we have a full unit, plus six or eight pts in the halls on monitors, and we're running out of both beds and equipment. If we are tenacious, it's because we know that sometimes you have to prove your point with attending physicians or residents who may want to discharge a pt you believe shoud be admitted. ometimes tenacity is required for airway management, to do everything possible to avoid having to intubate someone in an acute asthmatic episode. Are we bossy at times? Absolutely. But that's because we have to be able to respond appropriately when a major trauma rolls in-whether or not a physcian is available at that moment. So if at times we seem curt or irritable, please bear with us. We realize these qualities can be exasperating. While it's true we chose the ED-and most of the time we love it-this nursing specialty can be physically, mentally, and spiritually draining. Please try to understand us when we get that ED attitude.
That about sums it up--Amy