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.
We have closed our NICU due to having 50 some kids and not enough staff to take anymore. Our OB had to ship people out or divert. We rarely close and this was really a bad summer! We had to take the unforseen ones, but when hospitals called to send moms they had to decline. Our PICU has closed due to high census.
I dont know that my hospital would close beds for low staff. They would pull nurses from management and slip them into staff positions as long as the bodies matched up with the numbers. They may not do to much but it only says that we have to have X number of RN's on the unit, doesnt say they have to actually DO anything. I'm pretty sure very few of them would either(do anything i mean).
On one particularly bad day in our ER we pulled administration onto the floor..... It was the worst choice we could have made. They have been out of direct care for long enough that basically all they could do was be in the way, we had multiple traumas coming in ..... no diversion for us, we are THE TRAUMA CENTER, and our ER was full of critical care pts "awaiting placement" in the units due to under staffing in the units no beds were "available". I never followed up with the outcomes for the pts I had a hand in that day. I don't want to know the long term repercussions suffered from the care put out that day. One person can only do so much..... I understand the need for ratios on the floors, but there must be consideration made for census in the ED as well, ED is a very flexible environment but even we are only human and can only do one thing at the time, at least floor pts are "Stable" I had upwards of 6-12 pts all day the day with most being level 2 or "very unstable" all day. I had at one time an MI, a PE, an alt bp of 50/30, and two traumas, all of whom needed 1:1 care, as well as a couple others... a spontaneous abortion, 2 GI, one puking and one bleeding and others I don't even remember....:o:o:o:owhile my "helpful" administrator was passing out blankets to pts with fevers and water to pts who were npo:angryfire:angryfire:angryfire. Administration on the floor.... yeah, good idea. I don't even want to know what the waiting room looked like....
I DON'T WANT TO SOUND OVERLY CRITICAL......
Most of the time I work in a great place, just it is the ONLY place for many, many miles and we have a lot of indigent care that uses our facility as their pmd office, this blocks up our ed for emergency pts and ties up staff trained for critical emergency care, we often admit pts because "they have no where else to go" tying up the floors with BS, so when the crap hits the fan, its too late..... I hope and pray everyday that a loved one or myself never have to be cared for in our facilty.... can't close the doors of the ER! I
I remember my previous employer having an issue. I worked tele but floated to all med/surg type units. Oncology was in dire straits then and had tried everything to bring more folks in to no avail. They had huge sign-on bonuses. Finally they locked out their census at 18 when there were something like 30-35 beds on the unit (many times semi-privates were used as privates due to immunosuppresion). This went on for many months and really helped things. Then one day we came in and they were struggling again, and their census was soaring. Apparently "the state" (whatever or whomever that refers to) had gotten wind of them locking up all those beds and came down on the hospital saying there were 30+ oncology beds "certified" and they had to make them available to the community.
Now to my current job. We recently have had severe staffing issues (I now work NICU at another hospital). Nothing they did was helping, they were paying bonuses on top of on-call pay (time and a half for your whole shift whether or not 40 hrs achieved). They still couldn't staff us properly, and we have higher infant to nurse ratios than any other unit I've heard of in this area. Conditions were tough and the nurses were starting to break down in tears all the time at the bedside, were calling in sick way above the norm, management finally got the message (plus they wre tired of paying those bonuses, it was affecting their bottom line). They locked out our census at 49 when we have had as many as 62-63 infants in our unit before. Any higher and automatic divert takes place. It's not a huge deal because we have a children's hospital next door that takes neonates. I don't think we've heard the last of that situation. I think it's going to end up like the previous one I described. . . the state will get wind of this and we will be forced to open to our number of certified beds. I don't know how many that is but I don't think it's 62-63 but definately above 49. As for the locking out the census it really has helped the workload and we are enjoying it while it lasts.
we also have ceilings. It can change based on patient acuity but if I was maxed our either due to number or acuity I refuse another patinet. I can get another job but not another licencse. :smokin:
The hospital I work for will NOT EVER allow us to block beds for staffing. They will MAX out the nurses with the highest number of patients that the nurses will allow. (It is 7:1 on Med/Surg, and the supervisor will beg for us just to "this one time", take that 8th pt!) Of course, after the "free charge" has her/his own 7. They will find the patient a bed. It might be an inappropriate bed, like a cardiac patient on the postpartum floor, but they will find a place. Don't wanna loose any $$$$$$$$$$.... :angryfire
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.
Does anyone practice this?
I work in the ED at a Hospital in Columbus, OH. We have closed/diverted the ER d/t no staff/low staff. Our Trauma sureon was PI*SED but what were we to do. It is dangerous to have ICU/CCU nurses tripled or even X4 Pt's. I get taxed with 6 Pt in the ED.
I work ICU and we never divert. Sometimes it means that each ICU nurse has 5 or 6 patients. Way more than what should be allowed, but hospital adminstration tries to find us some help. We usually end up getting an aide.
Our area has 2 main hospitals, and another about 20 miles north. They do regularly "close" ER to ambulances at both, but then they go to a rotation. They have increased beds and staff, but it still seems to fill up. Not the same as a "unit", but the ones I worked on never ever closed until they were full. They just shuffled staff around, and work at trying to discharge/down grade pts to home, or say from ICU to stepdown, or med/surg. ( that's why I do what I do now :)
I have about 650 "potential" pts, and I'm usually busy. I see an average of 30-35 per shift. I might just remove a sliver, and I may have an amputation, or a chest pain....
On my unit the NM is allowed to place beds on hold. For example if we have several discharges during the day, and we are short a nurse or two at night, then we place some of the discharge beds on hold. All of the units at my facility are allowed to do this to maintain safe staffing numbers.
I worked in a facility that doesn't care about the safety of patients. we're dangerously short staff in the ICU wherie I work, and our ratio most of the times is 3:1 and we also admit patients. There were times when we have 4:1, we're a 12 bed unit and even with 3 nurses managenent never block beds. I am so tired of the situation I will be resigning the end of January.:rotfl: :rotfl: :rotfl:
Specializes in Education, Acute, Med/Surg, Tele, etc.
When working in Neurovasc, we hit a highpoint, but never as bad as some of the nurses told me! All rooms filled that night, and we had everything under the sun in our unit! WOW, talk about doing some things I hadn't done in a while and doing my "refresher" on the fly! LOL!
The other nurses told me about one time they put the ED on divert, but people kept on coming in. They had people in all units on gurneys in the halls because they were out of rooms! I didn't believe it, and asked my charge nurse...sure enough...they have had that happen (and she told me...all to make a buck too...not necessary to do that at all!)! And what was 8 pts per nurse was beyond..and you were expected to do it! They called in everyone they could, contacted staffing agencies..the whole bit...but it was a piece mailed staff to say the least..but they did say.."well we got it done! Hurt like heck, but got it done!". Guess it lasted a total of 7 days! And this was a major hospial...
Glad I wasn't working then...whoaaaaaa nelly!!!!!!!!
Specializes in Geriatrics/Oncology/Psych/College Health.
Sometimes it means that each ICU nurse has 5 or 6 patients.
See - now that's what I'm talking about. Any money made on extra patients or saved on fewer nurses would be wiped out in one fell swoop in the event of a lawsuit because of a sentinel event. How can some of these situations NOT result in injury to patients?
:o:o:o:owhile my "helpful" administrator was passing out blankets to pts with fevers and water to pts who were npo:angryfire:angryfire:angryfire. Administration on the floor.... yeah, good idea. I don't even want to know what the waiting room looked like....
:smokin:
:angryfire
BittyBabyGrower, MSN, RN
1,823 Posts
We have closed our NICU due to having 50 some kids and not enough staff to take anymore. Our OB had to ship people out or divert. We rarely close and this was really a bad summer! We had to take the unforseen ones, but when hospitals called to send moms they had to decline. Our PICU has closed due to high census.