Why are unstable ICU/CCU pts on our med/surg floor?!

Specialties Med-Surg

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Specializes in ACNP-BC.

I'm a new RN-have been working on my med/surg/tele floor for 8 months now & today I had crazy complicated pts. One of them had a trach, TF going, TPN going, a PICC, several antibiotics going, a PEG tube, etc, etc. I was overwhelmed when I took the pt two hours into my shift (he was a CCU transfer that at first the LPN I was working with was going to get but when we saw how complicated his care was going to be, I got him) but I was already going crazy with another pt who didn't speak english-her daughter who spoke english could not convince her to take her meds (!!!!! how frustrating) and she was very sick too, wheezing, got her duoneb treatments, then she had a scary high fever, I got that down finally, she had a PICC as well, docs just wrote orders for her to get TPN too, and she got typed and crossed for blood, was on antibiotics, other meds, etc. etc. SHe came from the CCU today too. THEN we got yet another lovely pt who was a COPDer who retains CO2, and we had him on just 0.5 L O2 and he JUST came to our floor and went from 95 % down to 56 %!!!!! So I called the doc who came up and got resp. up there too, he was gasping for breath, we got him on his Bi PAP machine (which we very rarely get on our floor, so I have NO clue how to work it-luckily resp helps us with that) And he was so confused and in restraints and was shaking all over and to make a long story short, they decided to send him back to the unit as soon as a bed opened up. So we had to monitor him in the meantime. How scary is that!! We had all these pts ith all these crazy issues, and we are a med/surg unit, not an ICU. We nurses were all running around like nuts today trying to get everything done, check everyone, etc. It can be so overwhelming! Anyone else feel like pts from the unit really, really need to stay there longer? I know I do! I felt like I was a med/surg nurse today with 3 ICU pts and one med/surg pt, PLUS I was helping the LPN I was with, with her other pts. My Lord!

Totally know how you feel...

Ratio on our floor on a good day is 1:6. If we're short (which I dont need to tell you how often that is...) it's 1:7 or 1:8. And one NA per RN. Yes, once in a while, I'll have a nice load of stable pts. Unfortunately, thats not very often. I'll always have one or two vents (and sometimes three) in the mix, that comes along with PEG/NG, foley, mulitple antibiotics, etc. And yes, often enough, some of my pts will be critical, very critical, either going from or going to ICU. (Like I mentioned on a previous post, I have many times been titrating dopamine...) Days like these I'm so thankful for ancillary staff. We dont do have to do any blood draws (either phleb or NA does scheduled ones, and docs draw their own stats), RT will be called for any resp issues and they do all scheduled nebs... And whichever NA you have, makes all the difference in the world! Fun stuff medsurg is (:uhoh21:)... but I wish staffing would be better.

Though I do have to say that older nurses on my floor tell me staffing now is *good* b/c it used to be 1:8 norm on a good day!

Specializes in Surgical.

Ok, if you have a ventilated patient and are titrating dopamine then how is that different from ICU? You are taking a big risk having five other patients too. I don't care how good your NA is, they don't have the license to lose...you do.

Specializes in Surgical.

....AND YOU ARE A NEW GRAD:selfbonk: ???????????????

Specializes in Med-Surg, Geriatric, Behavioral Health.

I remember the days when I first started....1:10 WAS the ratio. At that time, LPNs at my hospital did NOT pass any meds or chart, but functioned much like aides do now. As an RN, you could potentially have 10 discharges and 10 admits. Thank goodness, those days are over. Not saying it is any better...not at all. Acuity is MUCH worse now than it ever was. 4-5 patients nowadays could feel like the 10 patients long ago. Numbers mean nothing...it is the acuity!

Specializes in Trauma,ER,CCU/OHU/Nsg Ed/Nsg Research.

I can understand Trachs, Bi Paps, TPN, etc. being on Med/Surg as long as they are stable...but titrating Dopamine? I would have huge issues with that one.

Specializes in med/surg, hospice.

I have done clinical rotations in three different hospitals; two of them had the type of pts you are discussing, really ICU pts..Not as an everyday occurence but, I did hear several of the nurses saying that their pts needed to be sent back to the unit. One of the nurses told me (regarding vents) "you had better learn how to work one of these things and learn how to work every one where you work...respiratory might not always be handy and you are going to need to know what to do" (great advice!). On one of the cardiac rotations, the CCU was just down another hall...and I saw them doing transfers off and on throughout the day. One of the nurses their told me that they did everything on the floor except give amiodarone :uhoh21: .

Plus, this floor was getting overflow from other med/surg floors. The nurses were hopping. :o

Specializes in Trauma,ER,CCU/OHU/Nsg Ed/Nsg Research.

Wow. Do these hospitals not have stepdowns or PCUs/TCUs?

Specializes in Med/Surg, Ortho.

I think you found your answer in "when a bed opened up". Some of these units only have so many beds and have to move patients out that have been there and are a bit more stable than new ones they are getting before they are really ready.

My med/surg floor sees all of what you are talking about. Drips(yes weve had amnioderone too), trachs, TPN, subcalvian lines, thankfully they havent tried to send a vent patient to us yet. Our patients are sicker than ever before but then most all patients in a hospital are sicker than ever before too. They go home sicker than they used to too.

I agree with Thunderwolf it shouldnt be about the numbers but about acuity. I just wish the people who make the staffing decisions understood the same thing, unfortunately they dont and dont want to hear about it.

Specializes in Med-Surg, Geriatric, Behavioral Health.
I think you found your answer in "when a bed opened up".

Current truth in a nutshell.

Specializes in med/surg, hospice.

YIPES!!!

I meant to say "adenosine" NOT "amiodarone". :smackingf

Specializes in Med/Surg, Ortho.

I understand that, but I DID MEAN to say amnioderone!! Weve had it on our med/surg with the patient on scatterbed tele. Totally nuts huh?

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