This came up recently. We were woefully understaffed at the hospital (I hear you out there: "NO! Say it ain't so!") It was potentially dangerous. I figured we could maintain the status quo but that any admissions would be impossible (already short a nurse and would be short 2 nurses according to the staffing grid if another person came in.)
Told supervisor we had to do something in such situations - could we block remaining beds when we were already working short? Told that management states they are never to refuse an admission as long as there are beds, regardless of staffing.
Specializes in Geriatrics/Oncology/Psych/College Health.
Is it the EMLATA thing? Would it be considered dumping or not treating to divert someone if you have a bed, even though you don't have the staff to man it?
We divert only based on the ER, not the staffing in the hosipital, and it's usually for critical care needs, not med surg. But if there is no staff on the floors, they get backed up in the ER so there is a correlation, but usually it's when the beds are full on the floors, rather than unstaffed. If the ER is holding so many patients and critical care patients that it becomes unsafe, then we go on divert. We don't accept hospital-to-hospital transfers and ambulances are encouraged to go elsewhere. Walkins still can come in. And because we're a trauma center we are open for trauma.
Our managment hates with a passion to go on divert because of financial looses with every patient that doesn't come here and goes elsewhere. And there is a lot of pressure to stay open.
I was house supervisor and went on divert once, based on the ER charge nurses assessment. Finances aside, you have to do what's best for the patients.
During our busy "season" which is winter in Florida, we frequently go on divert several times a week it seems.
I forgot to mention another thing- if the board of directors at that hospital knew how much money was being fritted away in that department would anything be done?
This is my case for staff nursing being invited to the board room --as board members.
The old boys club on these hospital boards won't make the needed changes for patient care and better working conditions if they are clueless to the daily realities of nursing. Many old board members have been in the community forever and it's time for new blood and new ideas.
A larger hospital south of me has a CEO that shadows nurses in their daily work. The pay and conditions there are quite good.
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
Nurse Ratched: I think EMTALA has a lot to do with it....
IN OB we function as a mini-ER in that we triage all OB patients over 20 weeks' gestation. So there is NO turning anyone away without at least evaluation and proper treatment.
I cannot speak for the ICU/CCU, med-surg and SNF beds in the hospital.
Our ICU diverts if there is no staffing...which seems to be happening a lot lately. We have 15 open ICU shifts on days this month and 10 on nights...so if we can get an ICU patient either shipped or stabilized for med / surg in less than 12 hours if there is coverage, we do it...otherwise they are shipped.
Otherwise, we divert of there are no beds. If we are low staffed, we just suck it up and do the best we can...
Up until the last few months when we needed to send a patient out acute from out subacute facility it was not uncommon for the doc to call three or four ERs before finding one that was not on divert. Hasn't happened much lately, though. Don't know if it is due to new regs or low census. We are located outside of Boston.
Yes we do. As nursing supervisor on Saturday, I did not have enough staff to meet our 1:6 ratio for pm's and so told the ER doc we could not admit.
OB is tricky - if birth is imminent of course it is treated as an emergency situation and we don't send those women away (they'd have to go over 70 miles in any case). We are a very small rural community and so we rarely have an occasion where there are alot of women in labor and we don't have enough staff. In an emergency, our OB nurses (including me) are really wonderful about coming in to help.
There have been several times our facility has had to divert patients to a hospital outside of town because we had reached capacity. We had several beds available, but not the nursing staff to care for them. We do not staff more than 6 patients per nurse. I love my job and I love my hospital for supporting their nursing staff in this way.
Years ago I worked L&D/Post partum and we occasionally had to try and divert people to go to other hospitals if we were full and had no beds...it was not because of a staffing situation. Basically, the security guards stood outside the entrance and told people it would be "safer" for them to deliver elsewhere because of the situation. About half of the patients would go someplace else and half would stay.
Specializes in Gerontological, cardiac, med-surg, peds.
In the major teaching hospital in which I was employed (which has since attained Magnet Status), if units were full or understaffed, patients were not accepted for transfer from the outlying hospitals. If the patients were in the ED or PACU awaiting transfer to the floor, then a "place" was generally found for the patient somewhere in the hospital (which has over 700 beds) on a "quieter" unit. If there was chronic understaffing in a unit, the hospital offered generous incentives (sometimes to the tune of $600 per 12-hour shift), for qualified nurses within the system.
Nurse Ratched, RN
2,149 Posts
Is it the EMLATA thing? Would it be considered dumping or not treating to divert someone if you have a bed, even though you don't have the staff to man it?