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

[FurBabyMom, MSN, RN]

When I worked neuro stepdown/floor, we got whatever came in that didn't require a new vent or placement in ICU. We took chronic vents - rarely but they did happen. We were the only non-ICU unit in the hospital "allowed" to manage trachs. 29 of 31 beds could be tele beds, we got literally whatever needed admitted and needed a tele bed. We could run critical meds up to a certain volume/titration, and that meant that if a patient needed a "critical med" but wasn't on a vent? We got them. Sometimes I had a medicine patient who was deceptively "good" looking - didn't appear as sick as they were. Sometimes we had dialysis patients, etc. We called ourselves "acute inpatient psych" as we kept all the psych patients not requiring ICU care until they were medically/surgically cleared and/or a bed opened on inpatient psych.

I work in the OR now. We're a large academic medical center. Our units have target populations, but in the end, a bed is a bed. If the hospital is at 97% capacity at 0600 with outstanding inbound transfer requests and a full ED and full ED waiting area? Patients are going to go wherever is most close to their ideal unit. Sometimes we have neuro patients in surgery/trauma ICU, or even in medicine ICU. We've had surg/trauma patients or medical ICU patients in neuro ICU. We've put adults in pediatric ICU. Patients requiring ECMO or balloon pumps are on specific units. Patients requiring massive transfusion protocol are on specific units. The same thing happens on the floors - sometimes progressive medicine patients end up on progressive surgery, vice versa. It's true with the med/surg units too - and if a unit has a tele bed open, they're gonna get whatever's in the ED needing a tele bed or transferring in requiring tele. We have issues some days, and end up with inpatient admits boarded in PACU (and we board patients in the ED sometimes too).

[Forest2]

I do not agree with sending these patients to OB, but administrations usually don't care as long as no one dies. Guess who is to make sure that doesn't happen? I am not too happy these days with how nursing is turning. Too much is expected of a nurse. You wouldn't send a med/surg patient to a Obstetrician would you? It is getting out of hand. Yea, you can file a complaint but administration won't take too kindly to it. They expect nurses to tow the line and do what ever they say regardless of the jeopardy to safety. Unless it comes down to a malpractice suit they will ignore your input. Believe me I have seen this time and again. Such as ICU nurses working on MS even when they have their own patients.

[Forest2]

A week or two? It takes longer than that to train I think.