Delaying transfer of pt. to other unit, due to not wanting to send staff home

BlueDevil,DNP, DNP, RN · Aug 13, 2012

When I used to work in a hospital charges weren't dropped until midnight, so the patient doesn't incur any extra expense by waiting. I worked critical care and couldn't wait to get people out of there, especially if it meant I could go home! Transfers get delayed for hundreds of reasons, often so and so's lunch break, etc. I'm not sure how it is unethical. It's mostly just bureaucracy.

iluvivt, BSN, RN · Aug 13, 2012

I see it more as a manipulation of the system. I definately WOULD not drag my feet on a transfer to a higher level of care but if it was just a lateral transfer and I had no compelling reason to get it done fast I would work it into my plan for the day. If our census dropped b/c I had to transfer a patient which then meant I had to send someone home I still may drag my feet a bit on sending the person home again depending upon several factors. If it is too early in the shift you risk getting more patients and then may end up short..so you have to play the game carefully.

sapphire18 · Aug 13, 2012

Where I work, there are certain time limits on transferring pts, from when the bed is assigned to when the pt gets to the receiving unit.

OnlybyHisgraceRN, ASN, RN · Aug 13, 2012

Thanks for the input. I still have to get used to how the "game" is in hospital settings. So let me get this straight: if a nurse does not want to get sent home they may delay a transfer. If a nurse doesn't want to get hit with an admission they may delay a transfer. If a nurse wants to get sent home she may speed up the process and be the first to volunteer to go home. Ha, think I got it now. As for me, a few extra hours short on my check does not make or break me. If I have transfer orders and a bed, I will get them out ASAP, focus on my other patients so if I do get an admission I'm not so behind. I don't like this game and don't want to play it...

Been there,done that, ASN, RN · Aug 13, 2012

Where is nursing supervision during these delayed transfers ? It is a big part of their duties to watch the flow of activity.

Your facility should have a policy regarding how long after the order has been written ,for the patient to be moved.

However, I can see both sides of this. The nurse has committed to the shift. A minute change in census should NOT allow the hospital to send s/he home so the facility can save a few bucks.Unless of course they want to ( watch me peel out the door!)

It is a very small way we can hold out against administrative b.s.

Double-Helix, BSN, RN · Aug 13, 2012

I'm not sure "unethical" is the right word for it. Where is the patient before being transferred? If they are awaiting transfer to the ICU, than I could see how it would be unethical. But if it's ICU to step-down, or step-down to the floor, or floor to floor, or ER to floor, I don't see it as an ethical issue as long as the patient is in a place where they are being provided safe and adequate care.

I work in PICU, and we often transfer patients to the general floor when they are able. However, if census is low, we will hold onto them for longer to make sure we have adequate staff. It's not a matter of not wanting to be down-staffed and use PTO- it's a safety issue. If the staffing office sees that we have extra staff and demands we send someone home, but 30 minutes later we get a call about a sick child who needs to transfer from an outlying hospital, suddenly we are short-staffed. This does not allow us to provide safe and effective care to the new admissions as well as the remaining patients. Unfortunately, administration doesn't care about the "what if" scenario. So it really is necessary that we maintain an adequate census in order to ensure we can provide adequate care to any new admissions later in the shift.

That Guy, BSN, RN, EMT-B · Aug 13, 2012

We cant wait to ditch people out of the ER. So no, we dont have that issue ever.