ICU holds

[samie]

I would like input as to what others are doing with ICU holds in the ED.

The ED I work in is holding patients nearly everyday. I can handle the M/S folks but the ICU holds leave me nervous. I do not have ICU experience and am not familiar with the paperwork. When we are holding, we are assigned a hold room and 4 other ER rooms to equal 5 rooms per nurse. At that level I can not provide the same standard of care that they do in the ICU where the nurse to patient ratio is 2:1. I have discussed this with my manager but am told that if I can work ER I can handle an ICU hold. What to do?

Thanks for your feedback! :)

[samie]

Thanks guys for your response.

wayover... your situation sounds live one I've been in more than once. It used to be a rare thing now it's almost weekly. I've been in some situations that I felt were unsafe and I went up the food chain..... chrg nurse, manager etc.. but, I did not document it. I will in the future.

I love the ER but I've found myself wondering lately if it's worth it.

I keep a smile on my face and focus on what's right in front of me.

sam

[wayover20]

Thanks guys for your response.

wayover... your situation sounds live one I've been in more than once. It used to be a rare thing now it's almost weekly. I've been in some situations that I felt were unsafe and I went up the food chain..... chrg nurse, manager etc.. but, I did not document it. I will in the future.

I love the ER but I've found myself wondering lately if it's worth it.

I keep a smile on my face and focus on what's right in front of me.

sam

I know samie....I'm finally realizing that as much as I love(d) the ER, it has changed for the worse. And it's not just where I'm at, it's everwhere. I feel sorry for the newer nurses who really want to do a good job, as they don't know what it's like to be able to call report and actually take the patient to a waiting bed within the hour. Or to have the medicines you need on hand and not have to call the super to get into the pharmacy because they too had their hours cut/deleted. Gosh, we don't even have a cafeteria/dietary service after 7pm.....too much expense. So now our patients that need a meal after 7 get a dried up sandwhich that's been sitting in the units refrig. for who knows how long. Oh brother....I could go on and on but it's too sad. I need a break.

[TinyNurse, RN]

YES, it happens all of the time!!! at the level I i work at now and at the level II that I used to work at......................

but when i apply for jobs I "do not have Icu experience" for some odd reason................

it really is hard caring for your one icu admit on a vent, with several drips, while you've got 3 other ER patients at the same time..................(but we do it)

my last ER was great about helping out, but my current ER isn't so good about helping out.

I guess I also need advice for your and my current situation.

xo Jen

[chip193]

At our place, when there are unit holds, we get additional ER staff to stay over for the night shift. Our Day and Eve staffing is 10 nurses, but nights is only 5. We can't cover the place with ER only patients well with just 5, but it's impossible with holds too.

As for ICU/CCU nurses getting "called off", it happens in our place too. And, they never come in when they're called off - even if we have admissions.

Chip

[sadrn]

Wow- these problems are so universal.

The level I trauma center that I work at is really great about the ICU holds. It's not so much admin or mngt but more our peers and other ER staff members. I work nights and it is difficult b/c of the fewer RNs. What we do when we have a unit admit, that nurse will take that pt as a 1:1 until that pt is stablized. Once that pt is stablized- that RN will take other patients but the very easy patients- ankle pain, finger lac, ect... Being a level I, we are so used to team work b/c when a trauma comes in- you need to drop what your doing and go to the trauma. We rely on our coworkers to "cover" our patients while we are gone. (I make sure I document who I have given report to, when I left, and when I reassumed care of my patient- I am a huge advocate of the CYA).