Combining Adult Med Unit with Peds Unit

[veegeern, BSN, RN]

Long story short here...Census has been low on our adult medical unit for around 1 year. Pediatric's census is up and down, so they've been bumped from floor to floor. Now, they're with us, and possibly will stay.

Peds nurses are being crossed trained to recover heart cath and stent patients. The peds nurses on the floor are doing all that they can to take care of the kiddos. This means that the peds nurse is taking care of anywhere from 3 to 12 or more patients. Many of them have taken care of adults, and chose to take adult patients if their census is low.

I (and most of my peers) have never taken care of peds patients. We have not had orientation to peds, nor do we have the experience to take peds patients. At this point, we are expected to take peds patients prn and when peds does not have an RN scheduled (mostly at night) to be the charge nurse and do admin assess for both peds and adults.

At this time, I'm the only nurse that seems to have an objection to this. The others have been at the job longer and have more experience. Their attitude seems to be resigned.

I spoke with my manager about my concerns. I said that I believed that this was a safety issue for peds as well as adult patients. I was told not to say anything because the CNO was looking at saving jobs, and that I could "take the pull" (float to another floor) if I wanted to avoid working in this situation. (That got me taking 6 different patients on 3 different floors in a 12 hour shift.)

Am I missing something here? Please tell me that it's not like this everywhere. I like hospital nursing, but I need something else...

[Mimi2RN, ASN, RN]

I worked in a hospital that had a dedicated Peds unit. We also did Ambulatory srgery care on all peds, and on the adult one day surgery patients who stayed longer than Flexcare wanted. We were steadily busy, but in their wisdom, management decided to absorb the unit into m/s........ After all, any nurse can take care of a peds patient!

That's when I started job hunting. You won't be able to change the system, so if you are not happy it may be time to move on. To me, you either like peds or you don't. I realize that as a nurse we are supposed to take care of any patient, but I would have loved to see our Nurse Manager at that hospital come in and take care of ANY patient, never mind a Peds patient.

At that time, we were able to relocate, and I started work in a NICU. Look around, you may find that there is a position waiting for you, either where you are now, or in a new place. Good Luck!

[jessyjaneRN]

hi,,

sorry to hear about this. when i was a traveler and was assigned to m/s adultfloor i got floated to a peds/ adult overflow unit. before i got there i told them i would only take care of adult pts.... well got on the floor and the had more peds. than adult pt., wanted me to take peds. i said abosolutely not. that meant the charge rn had six peds icluding less than 1yr olds and i just had 4adults. i felt bad but stuck to my guns. told the supervisor the same. let me tell u, dose calculations and drips total didderence, med error could case a life and ur licence. if i were u i would stress getting appropriate cross train, no short cuts, real orientation to peds or start lokking for another stable unit or job. by the way... i did help that nurse out by taking vs on her peds. pt (we had no CNA). i was so unfamiliar with what vs are "normal" for peds. that was lerned in nsg school which i long since forgot.

[Tweety, BSN, RN]

I think what your manager is telling you, is that despite your objections the plan is not going to change and you need to learn to take peds patients, float, or quit.

If you choose to continue to work there, I would definately ask for some kind of training on peds. Ask if there is some orientation or training they can provide, some CEUs or something. Rise to the challenge, but not until you're trained and comfortable.

I understand perfectly. Even though I'm quite confident in my adult skills I would raise the same objections as yourself.

Good luck.

[veegeern, BSN, RN]

Thanks to all who replied. You all are voicing what I'm thinking. Even though I'm a very independent person, it's nice to have validation at times. From what I've seen so far (almost 3 years with this hospital) this seems to be the norm rather than the exception for doing business. If I want to be trained/oriented and stay within my comfort zone,then I'll have to transfer to L&D, Cath Lab, ER, CCU...Floor nurses are treated as generic nurses. AND as there are no openings in theses areas, I'm now looking at other options.

[Mulan]

Sounds very dangerous to me. I would look for somewhere else to work myself. Good luck.

[QTBabyNurse, BSN, RN]

i work in a small community hospital and our peds and med/surg have always been one unit. i have never liked the idea and thought it was an accident waiting to happen. luckily that's not the unit i work on!

[rnurse2b]

I'm on the other side on this issue. I work Peds and love the kiddos. I HATE it when tptb decide to send us adult patients. I don't regularly work with adults and feel that this is also a safety issue. Managements view on this is that everyone of us is a nurse, we all have CPR training and we have to take adults. I asked if the other (adult) floors would be willing to take the pediatric overflow this winter since they were all nurses, all having CPR and I was told absolutely not! What's up with that?

I know I'll probably get flamed for it, but this is from a pedi viewpoint.

[Corvette Guy]

At Madigan Army Medical Center, the only difference from ICU - East [where I work] & ICU - West is the East side takes Peds, as well as Adult patients, whereas the West side takes S/P CABG & Heart Valve patients.

I recently certified in PALS, but really have no Peds experience. The other day we had a seven year old patient that would not stop crying. I felt bad for both the patient & nurse. By the end of the shift the nurse had a splitting headache.

For the severely critically ill Peds, we transfer them out to a local Childrens Hospital... thank goodness. I love kiddos, but hate to see them in chronic distress.

[veegeern, BSN, RN]

I'm on the other side on this issue. I work Peds and love the kiddos. I HATE it when tptb decide to send us adult patients. I don't regularly work with adults and feel that this is also a safety issue. Managements view on this is that everyone of us is a nurse, we all have CPR training and we have to take adults. I asked if the other (adult) floors would be willing to take the pediatric overflow this winter since they were all nurses, all having CPR and I was told absolutely not! What's up with that?

I know I'll probably get flamed for it, but this is from a pedi viewpoint.

This was my point exactly. What do peds nurses know about all of the adult cardiac rhythms, meds and dosages...and all the other dxs that we have on our internal medicine floor. What do we know about peds dxs, meds, doses, etc...It's a safety issue.

[veegeern, BSN, RN]

As for me, I don't know if I would like peds or not. It was okay in nursing school, but I've never actually taken care of them as a nurse.

[imenid37]

The hospital where I work has a small Peds unit. Any kids go there, except ICU type kids which are ususally transferred to a tertiary children's hospital about 50 miles away. The peds unit also takes uncomplicated (how uncomplicated are some 80 years olds on tons of meds, really?) ortho and GYN patients. They also have an infusion unit on peds staffed by the peds nurses where outpatients get blood, antibiotics, gamma, etc. The nurses are great. I think most really like kids best. They do a good job. It is better than working on a regular med-surg unit. There are 8 privates rooms. Usually staff is 1 or 2 rn's and 1 or 2 LPN's

(2-3 nurses total).