ER nurses bringing pts to the floor soiled

Emergent, RN · Dec 30, 2013

Part of this problem is flow of work, the culture, the type of person who ends up in ER. ER nurses are just not too into fluff and buff. ER nurses aren't into bed baths. Often, when there is finally a room available, the SBAR is filled out and sent, the receiving nurse is tracked down and report called, the pt packed up and ready to go, we send them on.

In my unit, management tracks the time between when the doc presses the admit button to when a room is obtained, to when the final disposition occurs. We are under a lot of pressure to move the pts upstairs. So, if a pt says, right before dispo, that they need to go to the bathroom, I tell them that they will have one in their room upstairs, plus a comfortable bed, rather than a gurney.

Anna Flaxis, BSN, RN · Dec 30, 2013

at my hospital this is becoming a norm. im wondering is this a common unethical practice seen alot by nurses elsewhere? i find it really disrespectful and inconsiderate to floor nurses.

Gosh, what about how disrespectful and inconsiderate it is to the *patient*?

I have never knowingly sent a patient to the floor soiled, but sometimes when we're getting killed down there and it's all I can do to keep up, I can see how one might slip through every great once in a while.

If it's becoming a norm at your hospital, perhaps you could look into it and try to find out the root cause rather than assuming it's out of a lack of ethics or disrespect toward the floor nurses. I'm not defending the practice, I don't think patients should ever be left to sit in their own urine or feces, but maybe there's more to the picture than you're aware of.

DoeRN · Dec 30, 2013

This happened so much at the hospital I used to work at. When we would get a patient from the ER into the ICU's the nurse getting the admit would have a bath in a bag ready to go and a couple of us and a tech would go in and clean the patient real quick if they weren't too unstable. If they were crashing then of course we couldn't do this. I and several other ICU nurse in the other ICU's mentioned it to the managers and all of the ICU and ER managers discussed it and it actually did get better. We still got one or 2 who hadn't been cleaned but it was usually the ones who weren't stable. And trust me I was pulled to the ER a lot too so I know it was crazy busy there too.

Just mention patient satisfaction scores increasing and I'm sure someone would take notice.

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ParalyticAgent · Dec 30, 2013

At my hospital it's not patients coming up soiled, but all the AC IV sites. The patients have other sites, but the AC is an easy stick to send the person up and fill the bed again. There's no way every patient has an MI or stroke behind them. No offense to the ED RNs or anything, I might even want to work there some day, but whatever is perpetrating this quick-fix, gets-the-job-done mentality needs to stop. "Oh the floor nurses have all the time in the world they'll figure a new IV out when this AC site infiltrates 30 minutes post placement."

I stick 95% of my patients in the AC. Many diagnostic tests require an AC site, and to be perfectly honest, if I have even the slightest concern that the patient is sick, I want a large bore IV ASAP. I don't know if my dyspneic patient will end up being pneumonia or a PE. ER nurses think worst case scenario.

If I have time, I will try to start another site. Often I do not have time.

psu_213, BSN, RN · Dec 30, 2013

The patients have other sites, but the AC is an easy stick to send the person up and fill the bed again.

When the CNO is standing at the nurse's station saying "why has this pt had a bed upstairs for 45 minutes, yet they are still here?" then where the IV is placed is not high on the list of concerns. I certainly would like to place the IV in the place where you would like, however, you won't fire me if the IV is in the AC....if my times are bad, she can.

NurseOnAMotorcycle, ASN, RN · Dec 30, 2013

... You know, I was a floor nurse who went to emergency and like most emergency nurses, have been on both sides. I had this very long list of logical and completely appropriate reaons for some of the angst written here.

Then I realized that this isn't a "let's be intelligent and mature" thread, but another specialties war where everyone just wants to attack like piranhas.

Ok then, I'm thinking it must be ok to start a topic on how floor nurses try to pawn new admissions onto the next shift so that I get crapped on by cranky floor nurses during shift change. I'm constantly being told by charge nurses "Bring them at 1100" or "Bring them at 0700".

Or the complaining floor nurses who loudly swear about getting the incontinent pt who I've cleaned 4 times an hour saying "It's ok, you do what you have to do and we'll keep up with you." The patient gets to hear the nurses talk about why they don't belong on their unit and how unfair it is to have a new admission. I've seen patients cry at being left on the floor with sarcastic nurses after I told them how much nicer it would be to get to where things are less intense than the E.R.

TU RN, DNP, CRNA · Dec 30, 2013

I'm glad psu said it above me, somebody is usually on your back trying to force the patient upstairs or out of the ED at the expense of quality care. Same goes for us upstairs. Does every nursing problem some how relate back to the hospital's business model?

Emergent, RN · Dec 30, 2013

I'm glad psu said it above me, somebody is usually on your back trying to force the patient upstairs or out of the ED at the expense of quality care. Same goes for us upstairs. Does every nursing problem some how relate back to the hospital's business model?

Some do, but sometimes people are lazy and want to pawn work off on others. You can't blame everything on management.

ADeks · Dec 30, 2013

At my facility we run CT/MRI not on the IV site but functioning IV gauge (20 or bigger). In the ED I'm sure the AC site is great but if the patient is alert at all it has no longevity for those of us who spend longer than a shift with the patient. You try bolusing a r/o sepsis patient in the ED with brand new 20 in the AC very nice. Pressure responds, cipro/ceftriaxone/vancomycin, send em to the floor for monitoring. You try bolusing a now +BC hypotensive septic patient on the floor via a 12 hour old IV in the AC [/quote'] Well, in the case of sepsis one IV won't cut it. As the ER nurse, my goal is to get a central line on my sepsis patients and get them to ICU. Though unfortunately some of our docs aren't too keen on pulling that trigger. Also for even r/o sepsis I do my darnedest to get a couple of different iv sites in. That way I can get all the fluid boluses and antibiotics in. We actually had to do a push on that because ER nurses would only have one iv to run 2L+ abx in and it would take too long.
Also we run CTA on 20 G but it has to be mid-forearm or higher. A hand or lower wrist won't cut it.

ArtClassRN, ADN, RN · Dec 30, 2013

at my hospital this is becoming a norm. im wondering is this a common unethical practice seen alot by nurses elsewhere? i find it really disrespectful and inconsiderate to floor nurses.

"It" happens.

That Guy, BSN, RN, EMT-B · Dec 30, 2013

Well, in the case of sepsis one IV won't cut it. As the ER nurse, my goal is to get a central line on my sepsis patients and get them to ICU. Though unfortunately some of our docs aren't too keen on pulling that trigger. Also for even r/o sepsis I do my darnedest to get a couple of different iv sites in. That way I can get all the fluid boluses and antibiotics in. We actually had to do a push on that because ER nurses would only have one iv to run 2L+ abx in and it would take too long.
Also we run CTA on 20 G but it has to be mid-forearm or higher. A hand or lower wrist won't cut it.

I dont know why some of our nurses think you can do all this with one IV too. They will be far behind the clock and be like "I only have one IV" THEN START ANOTHER ONE. Its that easy. And I dont even look at the hand. Ever.

nrsang97, BSN, RN · Dec 31, 2013

I agree that bringing pt up from the ED soiled is bad. But sometimes stuff happens. Usually the ER nurse doesn't want to just leave the pt soiled. If this is a regular issue then you need to bring it up to your manager. Sometimes the ER can be so insanely crazy. I have never worked the ER, but have been down to our ER as rapid response helping with a trauma and can see how crazy busy they are at times.