I just wanted to ask everyone if they have the same problem that my ED is currently facing. The last three weeks we have been holding patients in our department because the hospital is full.
My department is a 34 bed Level II ed. The last three weeks we have been holding patients up to 24 at a time and some pt's sometimes stay for three days. I can see it burning the staff out because we are running a department on top of caring for these patients. Our adminstration currently has no plan and the ED nurses take care of the holdings and ED patients. I work nights and we sometimes go down to three RN's and have 20+ holding patients and a busy department. Our waits for non urgents to get seen has gone up to 12 hours+ because the hallways are literally lined with patients. A Very dangerous place for a RN to work and I see the patient care suffering; since we are emergency nurses by nature and tend to neglect the holding patients. They do get care but I also find myself caring for the MI patient or the trauma first.
Is there anyone out there in the same predicament? Any solutions? Ideas? Your experiences in dealing with such situations?
Are you all holding pts in the ER because there are no beds? Or do you have the beds, just no staff to take care of them. Our holds last night were because we had no nurses. Had to have ER staff work overtime to beef up the staff to help cover the holds. We are down two full time and 1 part time positions and are working alot of overtime ourselves. Seems like it will never end.
The most we have held at one time is 18..and that is recently..so I'm sure we will be breaking our record if things keep going the way they are.
We have to hold due to the hospital being full or there is not enough staffing on the floors to take the admissions.
What I do not understand is why I have to take care of at 4-5 "boarding" med-surg/tele/ICU patients.... plus all my ED patients that keep come strolling through....plus any trauma that happens to pop in...and this is safe for an ED nurse but it is considered UNSAFE for the floor nurse to take one more over her ratio during the times when it is like this????
well i had to laugh today, when i walked into work today! we have had to hold as many as 18 patients in our 21 bed adult er overnight! i walked in and saw a sign, that some joker put up that read:
We do it too, and it scares the bejeepers out of me. Not only that, but the pts. and families of those being held seem to think it is the ED's fault that they don't have a room, and if they yell at you enough, you'll give them a room.
Then, the pts in the waiting room yell at you for waiting, the pts in hallway beds yell at you because you put them in the hallway...and the hits just keep on comin'.
i hear ya fab! it does get old! i had a lady that went on and on, about her husband needing a room. we got him a hospital bed, the whole nine yards! even his food trays on time! yet she went on and on, she would not let it die.
i turned around and told her (although not the right thing to say i am sure) "i'm sorry....i feel for you and your husband. this is a problem everywhere, not just here. unfortunately we cannot just wish new rooms to be in existance, and currently we are very busy, and don't have time right now to get the mortar and bricks out and start making new rooms either."
well yeah not right, but i couldn't take it either......and said that as politely as i could.
funny thing? when they finally did get a room, a message was relayed to me through fellow employee. the lady wanted to thank me for letting her vent! go figure?
For those who have never worked on the floor, then how do you know that the floor is not busy? I used to work on busy orthopedic floor when I first graduated from NS, and we had a waiting list of patients from ortho docs wanting to admit to our floor and then take them to surgery, of course we were the dump floor also, ususally from the ED, and usually patients that were surgical, some medical but usually surgical that would end going to surgery (lap choles, appendectomies, etc) so our beds would fill up with non ortho patients and the docs would get mad because there were no rotho beds. Anyhow, there were times when I was the only RN on the floor, because the staffing office in it's infinite wisdom would pull the other RN to another floor, and leave 1 RN for a 43 bed unit, and at the time we were running an ADC of about 28-30 patients, so yes a couple of times when I was the only RN I used some of the more popular excuses not the ones mentioned above, more like the TRUTH, I would tell the ED they would have to wait, until I was caught up, unless they wanted to send me a nurse with the patient. One of these times I started with 28 patients, and received 5 more (3 from surgery and 2 from ED) in an 8 hour period. I told the supervisor that she would have to find me a nurse from somewhere if she wanted me to take this many patients. Well that never happened. One of the patients from surgery I received no report on, just arrived from PACU, cause they needed the bed for an ICU overflow patient. So the 2 surgeries I knew about were both TKR, both of which had ortho-evac to do, and the other supprise surgery patient was getting their first of 3 units of PRBC. The 2 ED patients, were non ortho imagine that. One older than GOD, with no family, and a very poor historian to boot. As the only RN I had to open all of the notes, do all of the assessments of 33 patients, start the blood, give the 2 surgery patients their ortho evac blood back, do all of the IV meds, not to mention see the original 28 patients I started with. I did see them, all 33 got assessed by me, some more thorough than others, but assessed notheless. I was lucky that 3-11 shift, because they only pulled the other RN, and left the 3 LVNs and the CNA and the US....I would have lost it had they pulled one of the LVN's and left me with only 2. That said, I left and went to work in the ICU. But at least 3x month I would get pulled to the ED because the stupid ED manager would leave holes in her schedule, and not even try to fill them. Well I also was house supervisor , and learned pretty quickly, that nurses like their days off. I mean you can't make a nurse come in on their day off to work. It just that simple, well tell this to the nurses in the ICU, the ED and on the floors who ar working short handed. I finally, told them that when I learned to SH** nurses I would SH** them nurses until pigs could fly, that usually shut them up. I have been in the ED as a float nurse, taking care of the code 3 that was tubed, on dopa, levo, with lines in place, etc..Waiting on an ICU bed to open up.. Or waiting on the room to be cleaned...That was always a good one...So I guess have seen both sides of this issue, and there is really not a sure fire solution to it.....
Now I am not disagreeing with anyone here, its the walk a mile in their shoes advice.....
I, too, have worked both the floor and the ER now and I love the ER hands down. However, I, too, asked the ER to hold a patient until I got caught up.
The ER does not have the luxury of saying to the 5 ambulances that just pulled in "wait until I get caught up". When the "bus" arrives and 50 people are in triage, they don't want to hear "wait until I get caught up."
Now, as an ER nurse, if I can wait, I do it patiently. That is not always possible. And by the way, no one sits with our one on ones. We have all our other rooms and the tubed patient. And don't forget, it took us a couple of hours to stabalize that patient while all the others flew on auto pilot.
i think jw knows.........i think everybody knows. fact is......everybody is being pounded into the ground, without enough help or support. the end result is, stress, snippyness, attitude, and then nobody gets along.
it does get old! i had a lady that went on and on, about her husband needing a room. we got him a hospital bed, the whole nine yards! even his food trays on time! yet she went on and on, she would not let it die. 
kaycee
518 Posts
Are you all holding pts in the ER because there are no beds? Or do you have the beds, just no staff to take care of them. Our holds last night were because we had no nurses. Had to have ER staff work overtime to beef up the staff to help cover the holds. We are down two full time and 1 part time positions and are working alot of overtime ourselves. Seems like it will never end.