I was working ICU yesterday (I floated from the cath lab). In a 16-bed unit, we had 12 pts (8 on vents) and 6 RNs, no care partner or USP. I did not get to the unit until 0930 so the charge RN did not assign me any patients; I was the "helper." The patients were all pretty critical, with 3 very unstable, so I was kept hoppin' running for supplies, suctioning, giving meds, checking beeping pumps, etc.
Around 1100, the charge RN asked if I would admit a transfer from the cardiac floor. No problem; I was glad to help. So what's the problem? This is the report I received from the transferring nurse: The patient was an elderly lady who was admitted that morning at 0600 because her hemoglobin was low and her doc wanted her to have 2 units of PRBCs and watched as an observation patient overnight. The reason she was being transferred to the ICU was because the RN giving me report stated she had 3 other patients and had not even seen this lady yet and the doc told her to transfer the woman to ICU because he knew she would get her blood there in a timely manner. I asked, "You mean this woman is being transferred to ICU because you have 3 other patients and do not have time to take care of her?" Her response was whiney and pitiful. I told her I could come over there and help her with the patient because they were pretty busy over here in ICU, but she said the doc had already written transfer orders and she was bringing her over in the next few minutes.
Upon arrival, the patient did not have an IV yet, had not been T&C'd, nor was any of her admission history started. Within a few minutes, I had an IV in her, the lab was called re the T&C, plus I got her something to eat (since she had not eaten since the night before.) She told me she arrived on the floor at 6am, was put in a bed and did not see anyone until her MD showed up at 1030. She was from a ECF and none of her family had arrived yet.
As I was leaving her room, I happened to run into the Med Director of ICU. I explained to him what had happened. He replied that I should tell the cardiac floor's nurse manager and let her take care of this. My response was that I was no one to this manager and it would have more effect if HE called and complained to the nurse manager. He then proceeded to tell me that this was a nursing issue and to leave him out of it. My response to that was that a nurse cannot transfer a patient to the ICU, only a MD can do that so that makes it an MD issue too. I told him I did not think it was right for an MD to send a non-critical patient to the ICU just because that doc felt his patient would receive better treatment there than on the floors. About that time the ICU's nurse mgr got involved and I returned to my patient. I do not know the outcome of this.
I do not know what the night nurse's excuse for not seeing this patient was, but I did find out that the transferring RN went into her taped report at 0730 and came out at 0830 (an entire hour for report on 4 patients? -- puh-leeze! Honestly - when was the last time you had only 4 patients!) then spent the next 30 min looking at her Kardexes and MAR, so it was 0900 before she started assessing her patients. This is a nurse that is always unorganized. Whenever I work with her, it seems to me she stands around complaining about all the work she has to do instead of doing it! The floor she works on has a really good group of experienced nurses and I guess they were tired of picking up her slack yesterday morning. I really don't want to turn this into an issue about this one nurse (isn't there one of these on just about every unit?)
I guess what I want to know is is this a problem in other hospitals about non-critical patients getting admitted to ICU? Is this a nursing issue, a MD issue, or both? This patient was charged an ICU bed just to receive 2U of PRBCs. When I worked ICU full-time, we would get admissions for DNR patients because the docs did not believe their patients would get good end-of-life care on the floors. I know DNR does not stand for "do not treat", but I am talking about those patient's who just need a bed, privacy, and their loved ones surrounding them as they take their last breath. Not bells and whistles and "codes" being called in the next room.
