Does an empty bed justify admission?

First of all, the house supervisor also has the title capacity manager. A couple of them were questioning admissions due to the patient's conditions (for example we have no icu and sometimes the patient is better off transferred) These house supers got into trouble from admin and was told they could not refuse admissions if the doctor wants to admit. Our hospitalist will accept anything and he is definitely not on the nurses side.

Just the other day I received a patient from er with a BP of 69/36, lungs full, O2 sats in the 80' s on 40%. But he was stable according to the er doc. I spent most of my last couple of hours trying to keep him from coding. (by the way he died the next day)

The nurse manager is told she has to do what admin wants. We are told that if we have a negative attitude we can hit the door. We also recently went to pay per performance in an effort to make us keep our mouths shut.

The criteria for admission goes by Interqual so actually almost anyone can meet an observation admission at least. I have a sneaking suspicion that the floor is being kept full to make money. We get a lot of medicaid so that is guaranteed payment of some sort.

All I know is that I dread going to work and I leave with such a stress headache every day that I am sick to my stomach. What does it take for someone to be able to stand up for the nurses and the patients to protect us both? I know if anyone in my facility would take any type of action they would be promptly fired.

so as it stands right now....we could have ten empty beds a census of 15 patients and two nurses on the floor and they would still admit ten patients to those empty beds.

Just wanted to give an update on the situation at my hospital. I worked yesterday for twelve hours as a nursing assistant...I am an RN but they are constantly pulling us to work in NA capacity since they are short on NA's Horrible day. I had nine patients with two getting blood and one receiving platelets.

We had a ventilator patient and another pt. that is on an amiodorone gtt. , cardizem gtt, TPN and numerous antibiotics. There were two other patients besides the ones that I had getting blood. One was a GI bleed that the house doc decided he wanted to bowel prep before he transferred her to the "city" for her scope the next day.

Bowel prep + Lower GI bleed = increased risk for bleeding which then results in more blood being needed, falling BP, unstable patient then the need for immediate transfer.

We had a floor census of 27 patients....three nurses coming in on nights with only two NAs scheduled....Now mind you this census includes the critical "ICU" patients. (we don't have an ICU, but the doc tries to act like we do).

ER was trying to admit more patients and I blew my stack. I told the house super that she needed to call admin and let them know about the situation. WE could not safely take anymore patients. Heck, we weren't safe the way we were working now.

Her solution to the problem was talking a 12 hour nurse into working 18 hours and calling everyone that was off to try to get help. They were pulling NA from OB and the geriatric psych dept. to try to cover.

She would not call admin. for whatever reason (maybe afraid of them?) I am so frustrated I don't know what to do. I could file a complaint with JCHO but I know the hospital would find out and fire me. JCHO says that you can't be fired for filing a complaint but everyone knows they will find another reason to fire me.

There is the only hospital in my immediate area. The others are over 50 miles away. I have been at this hospital for over 12 years and I don't really want to drive long distances and I don't want to work in a Nursing home. So short of packing up and moving (which I don't have the money to do because I am the sole supporter of my family) I feel that I am stuck.

Is this really what healthcare has become? What can we as nurses do to make it better without fear of losing our jobs? I know for a fact that if the hospital gets sued they will point the finger at the nurses first. We have a doctor right now that has told the family of a recently deceased patient that it is the nurses fault.

Sorry for the long post ......just trying to vent and ask if anyone else has the same insane working conditions and if there are any solutions to the problem without fear of being fired.