Appropriate patient discussion

[amtisdale]

So I'm just asking for an opinion. I work in a small hospital on a women's unit (ob/gyn/postpartum and level 1 newborn nursery) . We average about 30 deliveries a month. We usually have 1-2 Labor nurses and 1 newborn nursery nurse on the floor per shift. No secretary and no tech. Here lately they have been sending us medical patient's. The problem is some of us do not have medsurg experience. They are sending us male pts, we have started heparin drips, we had a positive troponin the other night that had to be transferred out due to o2 sats going into the 70s. Plus we have to take care of anyone coming in in labor. They tell us we can't refuse to take care of the medical pts and this is the new normal. I just feel it is very unsafe saying we are not trained with medical pts and also we only have 3 staff members on the floor. Most of us went into this specialty because we didn't want to do medsurg. Then they send us these complicated with all different comorbidities etc. Just wondering others opinions or if you work somewhere similar

[brillohead, ADN, RN]

Seems like a huge infection risk to me, too. Med-surg patients are typically covered with MRSA, VRE, C-Diff, etc., and you're going to be carrying those germs into the newborn's environment.

When L&D nurses from our hospital float to other units, they are only allowed to act as "helping hands" (basically, as a CNA / PCT) because they haven't been oriented to the non-L&D portion of the facility. They aren't allowed to take a patient assignment, although they can pass the occasional med at the direction of the primary nurse -- about the only thing they can do that an aide couldn't do.

[TriciaJ, RN]

Seems like a huge infection risk to me, too. Med-surg patients are typically covered with MRSA, VRE, C-Diff, etc., and you're going to be carrying those germs into the newborn's environment.

When L&D nurses from our hospital float to other units, they are only allowed to act as "helping hands" (basically, as a CNA / PCT) because they haven't been oriented to the non-L&D portion of the facility. They aren't allowed to take a patient assignment, although they can pass the occasional med at the direction of the primary nurse -- about the only thing they can do that an aide couldn't do.

Great point about the infection control aspect. I hadn't even thought about that, and clearly neither have the bean counters in that hospital.

[BSN16]

i work in an ICU and we occasionally get OB/post partum pts. we have no idea what to do with them, but still have to take them.

[Wuzzie]

Seems like a huge infection risk to me, too. Med-surg patients are typically covered with MRSA, VRE, C-Diff, etc., and you're going to be carrying those germs into the newborn's environment.

That's all I have to say about that.

[wondern, ASN]

and I'd like to add...

[moryaÄŸmur]

thanks.

[klone, MSN, RN]

I can tell you what we do at our hospital.

First, we typically only take med/surg or post-op patients from the floor during "red alert" times (times of extremely high census in the facility causing TPTB to be scrambling to get people discharged), and we have certain criteria: female and non-infectious. Typically the house supervisor will run down the list of appropriate patients with me or the charge nurse and we will tell them which ones are most appropriate to take.

Just as often, if we are low census and the rest of the hospital is high census, one of our nurses might consent to being floated out to the floor, as opposed to being called off. But it's entirely voluntary, as we try to respect the fact that most of the nurses on our unit have not taken care of any med/surg patients in many years and are unfamiliar with the equipment.

Finally, it is in violation of CMS and TJC to have a nurse use any kind of equipment without some sort of competency saying that she's been trained on its proper use. So it's quite likely that the facility would be cited for this.

[amtisdale]

Honestly our biggest concern is taking care of these patients with no orientation. Some of our nurses have only done labor and delivery for 20 years with no medsurg whatsoever. Then they send us patient's with positive troponins, etc. I just feel like the pts are not getting the care they deserve not because we don't want to give it to them but some of us have just never worked in that area

[NurseSpeedy, ADN, LPN, RN]

Honestly our biggest concern is taking care of these patients with no orientation. Some of our nurses have only done labor and delivery for 20 years with no medsurg whatsoever. Then they send us patient's with positive troponins, etc. I just feel like the pts are not getting the care they deserve not because we don't want to give it to them but some of us have just never worked in that area

I started my nursing career working med/surg for almost 10 years. I then worked in various other fields of nursing and eventually completed my RN. Since several years had passed since I had worked independently in a Med/surg environment I was required to have at least 6 weeks precepting (nurses new to hospital setting had 12). A lot had changed in those years, I can only imagine being out of med/surg for 20 years and being told "here you go". Some kind of formal refresher training with a current med surg nurse should be given.

[Ruby Vee, BSN]

Honestly our biggest concern is taking care of these patients with no orientation. Some of our nurses have only done labor and delivery for 20 years with no medsurg whatsoever. Then they send us patient's with positive troponins, etc. I just feel like the pts are not getting the care they deserve not because we don't want to give it to them but some of us have just never worked in that area

Are you willing to float to Med/Surg for a week or two to get some training?

[canoehead, BSN, RN]

Can you negotiate they types of MS patients you get? I'd ask for females, noninfectious, and no monitoring needed, to start. I imagine you wouldn't be comfortable with a cardiac monitor. It might be better for you if you took established MS patients instead of directly from the ER. Problems identified, and a careplan already started, it would be safer for the patients too. Perhaps a MS CNA would be willing to float over when you have a heavy load?

[amtisdale]

We would be willing to orient but we would have to do it in addition to the shifts we are already having to work due to our floor being short.