Vent: Downgrading patient from ICU status
- 4Apr 11, '13 by ukjenn231I'm a med/surg tele nurse by origin, but I also float in ER, ICU, as well as all of the floors.
One thing that irks me more than anything is being asked by management to call a physician and ask to "downgrade" a critical care status patient to a tele floor. Especially when the patient has just received admission orders for critical care. I understand the necessity of opening up unit beds when there are more patients than rooms and prioritizing, but this is how I feel.
1. If the doctor wants them on tele, they would have ordered admit to tele or transfer to tele.
2. If something happens to the patient when they are sent to the floor, then the doctor's going to be all mad at me because I called and asked.
3. There is no true step down or progressive care here so there is a huge difference between a 1:2 nurse-patient ratio and a 1:6 nurse-patient ratio.
4. Why can't management or especially the charge nurses, who have a better relationship with the docs, call instead of ol me, the float tele nurse who walks into a new shift and is pressured to call for downgrade orders?
OK that's my vent... And yes I have told management and charge nurses before I wasn't comfortable with doing this and they tell me, "Oh, just throw it off on administration making you call..." Yeah, well I still get chewed out, not administration.
- 7Apr 11, '13 by VICEDRNAs an ER nurse, the arrogance of these people just stuns me. As though the MD just doesn't really want the patient on the unit or as though their own judgment is somehow more appropriate than the person writing the orders. The MDs I see at the teaching hospital are trained to specifically not respond to outside pressures on their choice of care for the patients and this is why. Its completely unreasonable to expect "borderline" ICU/tele patients to be moved to a 1:6 unit.
- 6Apr 11, '13 by CodeteamBThe scenario you describe is unacceptable. Once a patient has been assigned a service and ordered to go to a specific unit it is the job of administration to find a bed for the patient, not to try and work around it. If they have a valid reason I downgrade the patient they had best be discussing it with the physician themselves.
It is absolutely not fair for a tele nurse who may have 5 patients to take a patient who meets ICU criteria, no matter how inconvenient it may be for bed placement.
- 4Apr 11, '13 by Aurora77, BSN, RNQuote from CodeteamBNot only is it unfair to the nurse (who will be blamed for any harm that may come to the patient due to improper placement), it's not fair to the patient. It's just asking for patients to be hurt or killed due to administrative negligence. You would think the legal department would be all over this. Of course, it may take a patient death and subsequent lawsuit for anything to be done.It is absolutely not fair for a tele nurse who may have 5 patients to take a patient who meets ICU criteria, no matter how inconvenient it may be for bed placement.
- 9Apr 11, '13 by Ashley, PICU RNI agree. I work in a 19 bed PICU. Usually we have a census between 8 and 14. But one particular day we were very busy and literally every bed was filled. We got a call from the ER for a patient needing admission and we told them that we were full. Of course, the admin supervisor for that shift came straight to the unit. Again, we explained, "We have no open beds. We are full." His reply was, "Well, let's get some of these kids to the floor." Our charge nurse's reply was, "Okay, which child's care would you like to compromise to make room for another" The supervisor said, "Well, that's not what I'm saying." She replied, "That's exactly what you're saying. These kids need to be in the ICU. They aren't going anywhere." And they didn't.
- 1Apr 11, '13 by Lil'mama, ADN, RNIf they want to send critical care patients to the floor, they should send an ICU nurse along with them.
What does happen to patients needing an icu bed when none ate open? Do they just stay in the ER.
Downgrading the level of care to me is as bad as admitting a patient to general medical floor when they need telemetry just to "save" beds.