Best refused transfer ever!!!

  1. In the middle of nurse to nurse, I had to stop a transfer to my unit today because pt was unable to ambulate independently. I was so impressed with the ICU nurse on the other end who listened to my reasons for shutting it down and said, "That's okay. I just want this kid to be safe." Me too, which is why I had to stop the admission. A kid who can't ambulate won't be safe on my unit.

    I think that's the first time a discharging nurse hasn't thrown a fit or demanded that I take an inappropriate patient. It was a real highlight of my day.
    •  
  2. 8 Comments

  3. by   PeakRN
    Meanwhile some kid who is suicidal or psychotic is stuck in an ICU where his mental health is just getting worse. I have worked with psych nurses to figure out some very creative solutions so that my patients could both get the medical and psychiatric help that they needed. I know that this will be an unpopular opinion but I don't think that shutting down a transfer is necessarily a reason to celebrate.
  4. by   GeneralJinjur
    Quote from PeakRN
    Meanwhile some kid who is suicidal or psychotic is stuck in an ICU where his mental health is just getting worse.
    Doubtful in this case, since they have been unconscious for most of their ICU stay, but I agree that balancing mental and physical health is always a concern.

    Quote from PeakRN
    I have worked with psych nurses to figure out some very creative solutions so that my patients could both get the medical and psychiatric help that they needed.
    As have I. My go-to response is to find a way to make something work. There was no safe workaround for this patient. I remain impressed with the ICU nurse for acknowledging that we share a common goal for this patient and not being hostile about it. It was an unusual response and I am allowed to celebrate 2 nurses successfully advocating for the best interests of this patient.

    My expectation is that this patient will be safe to transfer within a day or three. I will accept them and they will get the mental health treatment they clearly need. They will be more alert and able to focus when they join my unit, which means they will be better able to absorb what is happening in groups and therapy. This was the right move for this patient.
  5. by   Ruby Vee
    ICUs are pushed to get patients transferred out so that the ER or the OR can fill our beds. As a charge nurse, it's frustrating to get a transfer all arranged, have a new patient slated for that bed and then have to call a halt to the transfer. It can back up the OR or the ER, and surgeons have been known to throw fits. A charge nurse who is subjected to a surgeon's tantrum (or the tantrums of multiple surgeons) is a stressed out, unhappy charge nurse. But that doesn't mean it's OK to throw a fit or to demand that you take a patient who would not be safe on your unit.

    I think it's great to celebrate good nurse to nurse communication and a patient disposition that works out in the patient's best interest.
  6. by   dchicurn
    I could give two sh*ts who throws a fit...I'm there for the patient who is already in ICU, no matter what...So glad I work at a facility where doctors tantrums are no longer tolerated. Maybe get admin involved if that continues...no one should have to be subjected to that. Best of luck to you!
  7. by   pixierose
    Quote from PeakRN
    Meanwhile some kid who is suicidal or psychotic is stuck in an ICU where his mental health is just getting worse. I have worked with psych nurses to figure out some very creative solutions so that my patients could both get the medical and psychiatric help that they needed. I know that this will be an unpopular opinion but I don't think that shutting down a transfer is necessarily a reason to celebrate.
    Yes, but you need to ensure that the patient is safe on ALL counts.

    I've had to make tough calls with the physician on call and the charge nurse several times with impending transfers. We're a mental health facility first. When a patient has a sodium lab value of 154 and hasn't had an efficient urine output etc etc or when their BP is 234/135 over several consecutive readings with a slamming headache ... their physiological needs are more critical to address first. We don't have the ability to address them as effectively as the main hospital.

    It's frustrating that more often than not, the main players at our hospital don't see it that way. Thus, you have several rounds of "whose going to take this patient?" I would certainly see the victory when someone actually sees safety first.
  8. by   KarenMS
    Quote from PeakRN
    Meanwhile some kid who is suicidal or psychotic is stuck in an ICU where his mental health is just getting worse. I have worked with psych nurses to figure out some very creative solutions so that my patients could both get the medical and psychiatric help that they needed. I know that this will be an unpopular opinion but I don't think that shutting down a transfer is necessarily a reason to celebrate.
    So you think NO transfers are ever inappropriate?
  9. by   Flo.
    A psych floor is a dangerous place for a patient that is not medically stable and far too often in my hospital, the physicans want to transfer patients to psych before it it clinically appropriate because they don't want to deal with the patient. There is such a stigma about mental illness and it really affects patient care.
  10. by   PeakRN
    I have no input on whether it was appropriate to refuse the transfer and that is not what my comment was about. Of course there are inappropriate transfers all of the time.

    I feel that celebrating a refusal is distasteful, and placing it under the guise of 'celebrating nursing communication' doesnn't change it.

close