ED staffing and transportation of critical patients

[1fastRN]

Wondering if anyone else runs into this situation...

When transporting a critical patient to CT/Xray or the unit (step-down/ICU), it is required that the nurse travels with the patient and monitors them on the portable monitor. We are SUPPOSED to have an extra nurse that is pulled from floating or whatever he/she is doing to transport the patient. So if I have an assignment another nurse would come and take my patient for their imaging studies while I take care of my other patients.

Working nights with less than ideal staffing, this rarely happens. On days they usually have enough floaters to do the transport along with the transporter to push the stretcher. The role of the nurse is to monitor the patient and transfer them in a safe manner (i.e. maintaining c-collar precautions while putting them on the table for CT. Lately we don't even have enough transporters so I end up going by myself. Kind of unsettling because if I'm taking a patient to the ICU I am literally by myself at 3am in the desolate hallway if something goes wrong.

Lately I've been taking my own patients. I'll literally have 8 patients or so, and I have to take my intubated ICU patient so he can get whatever needs to be done completed. So I have to walk away from my other 7 patients for however long and then come back with the patient. So I end up informing the other RNs in my area that I'm going and ask them to keep an eye out on my patients, pretty much just telling them "patients 1,2,3,4, and 5 are fine, just please keep at eye on this patients BP, he's on a cardizem drip." We work as a team a lot on nights so we all do this for each other no problem.

One night I had to bring my guy up to ICU, me and the other RN in the area had 8 patients each. So this leaves the RN with 16 patients to keep an eye on. Safe, HA! I've been on the other end of this as well. It's either we personally transport the patient or they don't go.

So then I come back from transporting/monitoring and have to play catch up with my other patients. It's terribly frustrating because A) It's not safe B) I'm behind with my other patients.

Do you have the same issues at your facility? I'm going to send YET ANOTHER email to management addressing this issue. It puts us RNs in a bad spot because god forbid something happened I'd have no one to back me up; my patients were left unattended which is unacceptable. I'd be thrown under the bus in a heartbeat. But I have no other option!

And night after night with no break or and "unoffical" break as we break each other so we can unload our bladders and get a quick snack in. The expectations they place on us with so few nurses and so many patients is unrealistic and a major safety issue.

Any of this non-sense go on at your facility?

[Gabby-RN]

We are required to transport critical patients to CT/MRI where I work as well as transport any patient that has telemetry or is going to a step down or ICU. I work days and it is a rarity that any float nurse is available to do the transport for you. We usually do not have 8 patients, typically 4-6 including the one we are transporting. We ask another nurse to keep an eye on the other patients or the charge nurse but we are all busy so usually they are not able to do much for the patients during that time. It is frustrating. There has been talk of hiring a medic to do the transporting of monitored/critical patients but it is doubtful that will ever happen. We cover each others 30 min lunch break too. Fun times.

[1fastRN]

We are required to transport critical patients to CT/MRI where I work as well as transport any patient that has telemetry or is going to a step down or ICU. I work days and it is a rarity that any float nurse is available to do the transport for you. We usually do not have 8 patients, typically 4-6 including the one we are transporting. We ask another nurse to keep an eye on the other patients or the charge nurse but we are all busy so usually they are not able to do much for the patients during that time. It is frustrating. There has been talk of hiring a medic to do the transporting of monitored/critical patients but it is doubtful that will ever happen. We cover each others 30 min lunch break too. Fun times.

Well atleast I can rest easier knowing someone is in the same boat.... LOL

Ugh how frustrating is it to come back to an assignment full of new orders to catch up on, and patients that are upset because they didn't get their meds yet? Meanwhile I was in CT with the stroked out lady.

Keep on fighting the good fight!

[ChristineN, BSN, RN]

On my unit we only have a float nurse for half the day, to overlap day and night shift. If the float nurse is available they can transport critical pts or listen out for the rest of the pts while the primary nurse transports the pt.

However, in my ER we have 3-4 pts, and if you have an intubated ICU you are generally a 1:1 or 1:2. Last time I had an ICU pt on pressors my charge nurse divided up my other two pts among nurses with small assignments so I could focus on my critical pt.

[turnforthenurse, MSN, NP]

We have 4 patients but if we're short, then we can expect to take 5-6 patients. If the patient is intubated the primary RN and RT must accompany the patient to CT/XR and when transporting to the floor. If the patient is on a drip of some kind, the primary RN needs to accompany the XR/CT tech to their department and same with transporting to the floor. If the patient doesn't meet those criteria, the XR/CT tech takes the patient to their department for their test and then brings them back and (sometimes) reconnects them to the monitor.

If the patient isn't intubated and they aren't on any drips, we can have a tech (our techs are medics) take them up to the floor. Otherwise we have to and yes, that means leaving our patients unattended for 15-20 minutes. I tell a fellow nurse or the charge nurse to keep an eye on my patients but that usually doesn't mean anything unless I specifically tell someone something particular about a patient.

[Gabby-RN]

On my unit we only have a float nurse for half the day to overlap day and night shift. If the float nurse is available they can transport critical pts or listen out for the rest of the pts while the primary nurse transports the pt. However, in my ER we have 3-4 pts, and if you have an intubated ICU you are generally a 1:1 or 1:2. Last time I had an ICU pt on pressors my charge nurse divided up my other two pts among nurses with small assignments so I could focus on my critical pt.[/quote']

Your staffing ratios sound wonderful.

[Gabby-RN]

Duplicate post.

[Esme12, ASN, BSN, RN]

Where I have worked the house supervisor (night supervisors are CC nurses by facility preference.) also accompanies patients with the monitor....or the rapid response nurse....while the RR nurse is tied up....the ICU covers RR calls. The RR nurse covers me if I m called away

[zmansc, ASN, RN]

Someone goes with the patient and someone covers the other patients for that nurse. We don't have a set protocol, or if we do it's in a binder that hasn't been opened since the George Washington administration....

It's a matter of patient safety in both ways, you can't let a patient in that condition go to xray or wherever without a nurse monitoring him/her, and you can't leave your other patients along either. We just all juggle whatever needs to be done at the time.

[1fastRN]

Someone goes with the patient and someone covers the other patients for that nurse. We don't have a set protocol, or if we do it's in a binder that hasn't been opened since the George Washington administration....

It's a matter of patient safety in both ways, you can't let a patient in that condition go to xray or wherever without a nurse monitoring him/her, and you can't leave your other patients along either. We just all juggle whatever needs to be done at the time.

I can't think of a better word than "juggle" to describe our jobs.