I work on a cardiac telemetry unit. We are staffed 4 to 1. We have hospital based protocols which tell us which patients are appropriate for our unit. Some are:
No arterial lines (we do pull femoral sheaths after cath lab however)
No levophed gtts, no neosynephrine, we can only do dobutamine and dopamine at a fixed dose.
No ventilated pts, no patients that require continuous bipap.
No pts with a potassium of less than 2.0
No one on a nitro gtt at greater than 50 mgs
Those are just examples, but I believe the guidelines were set up because at a 4 to 1 ratio, you simply cannot watch a pt closely enough to have the above type of patients.
Now our unit is just arbitrarily deciding to change its' standards. The management wants us to start taking thoracic surgery patients straight from PACU. THese patients will have art lines, need cvp monitoring, be on levophed, neo, bipap and have tubes coming from everywhere.
They seem to have thrown our guidelines out the window. They promise us know that they will staff those of us who have theses type of pts at 3:1 (although our ICU is 2:1). In reality what will probably happen is they will give us one pt like the above, and then say "Oh, your other patients are regular tele pts so you can take three of them plus your one thoracic patient.
If our ER has a pt that needs a bed, our hospital's policy is we take the pt whether we have a nurse to staff that bed or not, so you can see we cannot turn down a pt no matter our staffing.
My point is, after this long story, is that I feel these patients belong in ICU where they can be closely monitored. It's very scary to me. Funnily, it's all us older nurses who are scared ******** about this. The new nurses think it's no problem; I get to learn something new. I guess you have to love their enthusiasm, but I think they just don't know enough to be scared.
Yet after expressing my concerns to management, our clinical educator agrees with me that these patients are not appropriate for our unit but says they have to do something to take the pressure off our critical care unit which is always full.
So in effect, the floor nurses have no way to say I don't feel qualified to take this patient and refuse it, short of quitting and finding another job. (not a great time for that in this economy).
Has anyone face a similar situation and have any success in getting through it?
