Accepting tranfer of patient not qualified to care for...

[jamesk78]

Is there any ethical/legal issues against accepting the transfer of a patient with an issue, being vented for instance, that you aren't experienced with if the hospital provides a support RN 24/7 to manage that aspect of care? In my opinion this shouldn't be an issue, but a lot of people in my class believe this goes against standards of care and so forth. Any thoughts or where I can find doumentation stating why this is acceptable or not would be greatly appreciated. Thanks!!!!!!!

[Esme12, ASN, BSN, RN]

Imagine an inter agency transfer with a unqualified hospital employee being allowed to use the county police department as the receiving party (who tried to do the right thing) without the basic information that would make the nursing supervisor who allowed this to happen upset if the situation were reversed

(Receiving a patient who was not acessed correctly with no attempt to call the PCP or The Psycharist or the Emergency Contact Number that is on the back of State ID's

or

VS Activity Level Diet Allegeries

A Nursing Diagnosis or a Medical Diagnosis

the types of medications that were directly affecting the patient

A set of vitals or F/U after the possibility of Cardiac Complications was r/o via a troponin level

The possible need for Neurologoly after inapporiate behavior continued for the next 3 days

Has anyone ever heard of someone getting arrested for going to the hospital or trying to return after the need arose?

This site is not one that gives out advice. Please see your family doctor.....

[Esme12, ASN, BSN, RN]

Thank you all who have offered the excellent feedback. I have actually seen this situation occur in person. Let's say hypothetically that a pediatric patient was brought back to the PICU post-op placement of a particular device the RN's on the floor aren't trained to handle. Due to regulations restricting the scope of practice of the practitioners in the unit capable of managing the device, the patient could only be admitted to the PICU. An RN from the other unit had to be floated over to support the PICU RN and handle caring for the device.

Is it reasonable to transfer a patient out of a unit to a unit staffed by RN's not skilled in handling their care so long as an RN is floated over to take care of the patient by themself? I'm thinking location shouldn't really be an issue with simple things like a vent, and if the proper staff is scheduled to care for the patient, this shouldn't be a problem. Thanks again for the input!!!

It is perfectly ok to allow a patient use the space on your floor (a room) as long as nurse qualified to care for the patient is caring for the patient. The patient is not in your care but the care of the nurse floated who is qualified to care for the patient. The nurse floated to "help" the PICU nurse is not responsible for the patient as she is "helping" the nurse responsible for the care of the child. The nurse floated to " help" the nurse still needs to practice within her scope of experience and competency.I think it is reasonable to transfer patients to areas not used for that specific equiptment in use but you need to be very careful that you aren't placing the patient at risk and that standard of care is maintained at all times.

Example not acceptable: A patient on a vent with cardiac drips is placed where the vent can be accomodated but there is no monitor. The patient is not safe.......the patient needs a monitor to monitor cardiac status and a monitor is not available so this is not acceptable. You also need to remember the other patients saftey won't be affected by all the attention drawn by one patient. They patient is a post op cardiac surgery (highly unlikely to happen) with multiple complications that everyone on the floor is involved in some way with the care of this patient by necessity places other patients are at risk.

Example acceptable: A patient on L/D suffers an amniotic fluid emboli during delivery and codes. An emergency C-section is performed to save the baby and finally the resuscitation efforts for the MOM are finally sucessful. The baby is flown out the MOM is in critical condition and too unstable to fly out due to hemmhorage and DIC. The MOM cannot be handled on the OB floor or kept in the OR. The MOM is transferred to the ICU (much to the horror of the ICU nurses) accompanied by the OB MD, anesthesia, CRNA, L/D RN's x2 and a couple of OR techs. This is a case of acceptable transfer to an area to keep the patient safe and supplying the staff with qualified individuals to care for the patient,........by the way......Both MOM and BABY survived.:heartbeat

[3dayRN]

At my hospital we had a floor refuse to take a patient because they did not have enough staff and a message was sent out to all nurses if You refuse an assignment you will be terminated.

[Esme12, ASN, BSN, RN]

At my hospital we had a floor refuse to take a patient because they did not have enough staff and a message was sent out to all nurses if You refuse an assignment you will be terminated.

I have alot of questions. How many nurses were there, What type of floor, How many patients per nurse were there (5 patients a piece and have to take a 6th or 10 a piece making 11), How many aides, What was the patients acuity that was denied, Has this nurse been an issue in the past, What shift, How close to shift change (where there maybe more staff commming in soon) What was down in the ED or comming to the ED. There are many reasons why a supervisor makes certain decisions. Sometimes a patient is better off on the short staffed floor than sitting in the hallway of the ED and forgotten about. Maybe there was a code comming to the ED. It has been my experience that there are certain floors and shifts that are more.......argumentative.....than others.

Administrations usually take a hard line to make the individual nurse think very hard before refusung. Your hospital has a staffing matrix that they have to provide to JACHO (who wants to be JC again). It is reportable to them for HABITUAL violations of "safe" staffing matrix. Your state board also provides you with resources as to safe staffing and procedures for dealing with unsafe conditions.

I have learned from many years n ursing there is ALWAYS more than meets the eye.....

[martymoose, BSN, RN]

You also need to remember the other patients saftey won't be affected by all the attention drawn by one patient

they did not have enough staff and a message was sent out to all nurses if You refuse an assignment you will be terminated.

this is happening more often where i am. we have pts in the hallways of the regular floors. they refuse to divert them when the ed is overflowing.

this is why i am contemplating a new field. i do not need to be sued for something I am told I can't control. sure there's insurance, but it can only go so far.