Dangerous ER Admits

  1. I need advice. Our ER is dumping patients onto floors with little consideration to patient safety. My floor is medsurg with tele (which is how management can get around RN/pt ratio limits). We get fresh MI's, strokes, and all drips except nitro, with a ratio of 8:1.

    The problem is that the ER is always sending pts with no orders other then call DR for orders, and usually before the labs have resulted, so don't know how bad the pt is, or even if stable. They mostly don't even give report, but drop the papers on the desk and run (some of the older nurses do give report in fairness). I have lost count of how many pts we sent to ICU after getting them from the ER. More then once we sent 2 in one shift. Once they even sent someone after she had expired, sorry, but that's a little to stable for me. The s++t hit the fan over that one, and they were good for a while, but are now back to their old tricks.

    Most of this started when we got a new DON. In north Jersey, hospitals frequently go on bypass. In an effort to stop this, the DON canceled the 1/2 hour rule (1/2 hour from being told there is a pt in the ER to when they can send. To give us a chance to get ready). The ER called and sent at the same time, ready or not. After being swamped a few times with sometimes 3 admits in a ten minute period (with no orders), our nurse manager was able to get us a 15 min wait (even now we don't always get it). God help us if we try to go over 15 min.

    The other day I got a pt with an active occipital bleed. The ER wasn't busy, and her primary said to admit, over the phone. Neuro said not to admit, as he was sending to NY, ER to ER. They admitted anyway. Neuro hit the roof, but didn't want to transfer to ICU as she was too unstable, and wanted as few moves as posable. I had her for 5 hours before transporting. I hardly saw my other pts.

    What I need to know is what I can do to stop this. It is dangerous and life threatening. We have tried complaining, but are ignored. I'm going to write a letter of concern to management about the bleed, but if I'm the only one writing these letters, will they be listened to, or will it bite me in the back.

    Sorry it's so long, and thanks for letting me get it off my chest.
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  2. 18 Comments

  3. by   lindalee
    I would write that letter and a resignation at the same time. Notify your state board. Notify JAHCO. You will lose your license working in that environment. I would not stay. That is too dangerous. An occasional error in placement is normal, what you describe is unforgivable. You and your coworkers need to be patient advocacies and speak up. Please protect the innocent public and try to stop this unsafe policy.
  4. by   ERNurse752
    Ditto what lindalee said...
  5. by   nialloh
    Thanks, I might just do that, but for now, I'll write the letter. I'm going to get as many of my co-workers to sign it with me, so it's not just from one person. At least it will start a paper trail so they can't claim ignorance.
  6. by   bellehill
    How unfortunate that patients are being treated so unfairly. Sometimes the ER has the reputation of dumping patients, but this is extreme. Absolutely write a letter and go to other floors and get signatures on it-this probably isn't happening just to your floor. Good Luck!
  7. by   Zee_RN
    I strongly second Lindalee's advice! Get outta there fast.
  8. by   nialloh
    Originally posted by bellehill
    How unfortunate that patients are being treated so unfairly. Sometimes the ER has the reputation of dumping patients, but this is extreme. Absolutely write a letter and go to other floors and get signatures on it-this probably isn't happening just to your floor. Good Luck!


    Having tele, my floor gets most of the hard admits, although the other floors do get pts without orders as well. Part of the problem is that Drs. like our unit. We are a 40 bed unit with 5 RNs for evenings (my shift), which is an 8:1 RN to pt ratio. We get silly admits like ortho or resp, who are on our unit for a day or so before going to the correct floor. Sometimes they go the same day, which leaves us another bed to fill (they don't stay empty for long).

    We normally get from 6 - 8 admits a day, we are very good at admitting, but the worst was 15 admits and 16 discharges/transfares in one shift. Started full, ended nearly full. This happened twice in two years. As you might guess, we lose a lot of nurses.

    The thing that keeps things from falling apart is the fact that I work with the best people in the world. If you are falling behind, you will have any help that is available until you are back on track. This is the main reason I'm still here. It's a great crew.:kiss
  9. by   lindalee
    Your good crew will not save your license. You are working in a totally unsafe environment. This is NOT the accepted standard of care. You already recognize it, you need to be proactive and get help for the unit and protect yourself. Believe me, the hospital will not save you and they obviously don't care about their patients. I repeat, I would get out immediately and report to your board and to JACHO. Someone must be proactive. You are asking questions, please listen to answers/solutions. Nursing must take proactive steps to solve problems. The reason we are having the problems in the profession is because no one has had the nerve to speak up. Your patients need you to
    be proactive. You will help them far more by actively stopping this behavior than you will by staying and allowing it to continue. JMHO
  10. by   Wiper
    You need to write that letter to both the hospital management and the JACHO. I know the hospital you are refering to and know that nothing will change unless they are forced to change. A letter from a floor nurse (no matter how many signatures are on it) means nothing but it does highlight a concern, but a letter or visit from an agency like the JACHO will shake things up.
    You are a patient advocate and their safety is always your first priority. If a patient is injured due to what you consider to be a dangerous (although common) practice who do you think will be blamed. It will be you and your co-workers. So do what you must to protect your patients and yourselves and remember sh*t rolls downhill and nurses always seem to be on the bottom of the hill.
  11. by   nialloh
    Thanks for the advice guys, it is greatly appreciated. I'm working on those letters now.
  12. by   glascow
    I agree with writing those letters, but also fill out an assignment despite objection (ADO) form and have all the nurses who witnessed this sign it. Of course you'll be labeled a trouble-maker for doing this, but you need to get out of that hospital anyway!
  13. by   caroladybelle
    Originally posted by nialloh
    Having tele, my floor gets most of the hard admits, although the other floors do get pts without orders as well. Part of the problem is that Drs. like our unit.
    Well, if the MDs like your floor so much, they should be willing to abide by some rules, for the privilege of admitting there. Such as limiting the admits to what really belongs on that floor and making sure that there are adequate orders, barring major exceptions.

    Has your management gotten involved with limiting this situation? And if they have and it has done no good, well then it is time to move on. Because no matter how much the MDs like the unit and no matter how good the crew is, it will do you no good if a lawsuit comes along.
  14. by   pickledpepperRN
    An Incident report every time too. Try to hand them to the hospital attorney or risk manager.
    Thank you for advocating for your patients.!

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