Ummmm..are they ALLOWED to do that?

  1. OK, I have worked in about 5-6 different ERS, both as staff and agency an I have never experienced this. Right now I am doing a contract in a dinky little community non-teaching hospital. The ER is understaffed and bursting at seams because they admit everyone who rolls in the freaking door. Well the other night nursing supervisor called to say that she was sending the ER a patient from med surg with a positive troponin because ICU was full. Ummm can they do that? We only had 4 nurses first of all(no secretary, no tech), with almost every bed full most of them in a holding pattern. And the patient was going to be MINE. I already had 7 patients, ALL of them holds. Its like I am not even an ER nurse anymore. But can they do that....just turf pts from the floors BACK down to ER, especially when WE are already overwhelmed? The ER nurses say it is done all the time and when they threatned to complain they were told by supervisor that " Go ahead and when we get shut down we will all be out of a job" So there are 12 ICU beds with 6 nurses and 30 ER beds, with 4 nurses? How is that fair?
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    About NurseJacqui

    Joined: May '03; Posts: 213; Likes: 77
    RN

    91 Comments

  3. by   UM Review RN
    Only reason I can think that this might be necessary is that typical MS units do not have telemetry equipment or nurses able to read EKGs or push cardiac meds.

    Our unit once had to have an ICU nurse come down to take care of a patient for hours who had to go on a portable vent on our unit because none of us were qualified and there were no beds in ICU, and we were not allowed to turf the patient back to ER.

    Sorry I couldn't be of more help and so sorry you were put in that position. ((((hugs))))
  4. by   TazziRN
    If that's the best place for the pt at the moment, yes. I would rather have a positive trop level pt in the ER with monitors and a critical care nurse than in a non-monitored bed with only the crash cart available.

    In your shoes I would have said, "If you give me this pt you have to take one of the admits out of here."

    From a nurse who works in a dinky little non-teaching community hospital.
  5. by   tridil2000
    Quote from TerraRN
    OK, I have worked in about 5-6 different ERS, both as staff and agency an I have never experienced this. Right now I am doing a contract in a dinky little community non-teaching hospital. The ER is understaffed and bursting at seams because they admit everyone who rolls in the freaking door. Well the other night nursing supervisor called to say that she was sending the ER a patient from med surg with a positive troponin because ICU was full. Ummm can they do that? We only had 4 nurses first of all(no secretary, no tech), with almost every bed full most of them in a holding pattern. And the patient was going to be MINE. I already had 7 patients, ALL of them holds. Its like I am not even an ER nurse anymore. But can they do that....just turf pts from the floors BACK down to ER, especially when WE are already overwhelmed? The ER nurses say it is done all the time and when they threatned to complain they were told by supervisor that " Go ahead and when we get shut down we will all be out of a job" So there are 12 ICU beds with 6 nurses and 30 ER beds, with 4 nurses? How is that fair?

    i don' think this is an acceptable solution.

    i might have had a pcu/tele nurse take a port monitor to your floor and monitor the pt. I also would have looked through every chart to get someone else OFF tele etc so that pt could have been moved to that bed.

    the pt could have always been transfered to a facility that could provide the care he needed if we could not provide it.
  6. by   Bluehair
    I also work in a dinkly little nonteaching hospital. We have never actually sent anyone back to the ER as far as I know, but I know that is the emergency game plan if a patient on the floor were to code when the ICU was full. It would be a temporary measure until the bed shuffle could be accomplished.
    We do have the somewhat common practice of sending patients out to another hospital (usually far, far away...) if we are not able to provide care for them (they need a higher level of care than we have at our hospital, or we can not provide that care today due to cardiologist is out of town, etc.)
    Hope that helps in the future!
  7. by   NurseJacqui
    Thats what I said...if they cant accomadate the number of ICU pts then they should transfer some people out or throw a little money at the problem and bring some nurses in. Do you think it was any safer having an extra ICU pt in ED with only 4 nurses and 30 pts and more coming in through triage and the ambulace bay?With all the holds we had our own med surg/tel icu floor! We were already holding 4 ICU'S. I wouldnt object to the pt coming to ED if an ICU nurse was coming with her. But why is everything the ED's problem? And when something bad happens...who will be the first to get blamed? ER. Whats the point of having a monitor if there is no one available to monitor the pt? The point of ICU is to have intensive monitoring. How can I effectively monitor the pt when I have SEVEN other patients? ITs not fair.
    Last edit by NurseJacqui on Mar 10, '07
  8. by   TazziRN
    Terra, it sounds like this is not a facility for you. I doubt any kind of solution would be acceptable.
  9. by   BULLYDAWGRN
    We've had similar situations in the past. Pt on the floor goes sour or needs more acute care, the units full and all the pt's to critical to move out for a bed. they have sent them to the er in the past. But since our er visits have increased around 25% within the last yr. there is no room or staff numbers that would be any safer. In that case we have transfered out to another facility. Of course the "bean counters" upstairs don't like it, but what can you do.....But to answer your question, I've seen supervisors try to pull every dirty trick in the book to take care of that problem right then, and never mind the other problem that they have just created with their idea, some of them don't care if you'er stuck with 7-9 pt's in the er, heck to them whats one more.
  10. by   f360
    The answer is yes and no... it really depends on your hospital's and emerg's policies.

    Unfortunately, many administrators don't see a problem with making the ED a dumping ground for all of the hospital's problems... so, not only do you get sick patients coming in off the street but you get them internally too. This is just wrong on many levels (interrupts ED patient flow, increases ED overcrowding, no privacy for the 'in-patient', noisy environment=no rest ((your pt was a post MI it's just not a good situation for the pt at all)) etc etc). They tried this at my hospital and we have a fantastic ED Chairman who jumped on it quickly. In the past they've also tried to make us have the hospital code bed one night because ICU was full .

    We now have a policy that states once the patient becomes an in-patient they never return to the ED. If a patient deteriorates on the floor and the ICU is full, the ICU must find a way to accommodate the patient (transfer a patient out etc.) It is an internal problem NOT an ED problem.

    One solution to this issue is the recovery room. They have all of the monitoring equipment and if the recovery room nurses aren't capable/comfortable looking after this type of patient, an ICU/CCU nurse should be called in.

    Another thought... don't the ED attendings have a say in this? Afterall, another service is coming and occupying a valuable ED bed reducing ED resources that should be available to the ED. In our hospital, the ED physician can trump the nursing supervisor.

    Personally, I think the nursing supervisor made a very bad decision.
    Last edit by f360 on Mar 10, '07 : Reason: typo
  11. by   NurseJacqui
    Quote from TazziRN
    Terra, it sounds like this is not a facility for you. I doubt any kind of solution would be acceptable.

    It is not a facility for me and I will not be renewing contract...however my walking away is not going to make it any safer of an enviroment for patients.
  12. by   NurseJacqui
    P.S. Ummm..there are MANY acceptable solutions, by the way. Please don't presume to tell me what I would or would not find acceptable. Its just EASIER for administration to use ED as a dumping ground because THEY are not the ones who are talking care of the patients.
  13. by   f360
    Who was presuming? You asked if they are 'ALLOWED to do that', many people answered. There was no presumption in any of this.
    The real question is... what did you do about it? If you knew it wasn't safe and you or your charge nurse allowed it to happen, you are responsible for your part in it.
  14. by   cappuccino
    Unfortunately it seems that administration just kind of wings it at times. We all have similar stories. It is extremely frustrating. It seems that what makes so much sense to us-makes absolutely no sense to them and vice versa. I can easily see one of my supervisors doing the same thing. I've never heard of sending a patient back to the ER. We have sent patients to the recovery room when the ICUs are full.

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