ER rushing patients to the floor

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So I wanted to run something by everyone. I realize at my hospital, the ER try to push their patients out of their unit and onto the floors. I work on a med surg tele floor. Last night I walked into work and right off the bat had an admission. Well this admission was very unstable and was going into septic shock and my first hour was stuck attending the needs of the patient. This meant I was neglecting all of my other 8 patients. Were they alive? I couldnt even tell you. So a few hours later I transferred the patient to ICU. So yes this patient was my admission but the ER is so quick to rush patients onto the floors that they end up sending unstable patients to the floors and then cause chaos to us because then we need to do the documentation for the assessment and then all the transfer work for a patient we only saw for a few hours. Idk if this is more of a management issue on getting patients up to the floor quickly but it is very unsafe and it is a reoccuring theme at our facility. I understand patients statuses change and stuff happens but it feels like it is getting out of hand. My one co worker walked into work when I did and right off the bat had a patient that passed away on shift change (thats just bad luck I guess). But I really just wanted to know what is the real reason behind this? Last night was too much for me and my stress and anxiety level is thru the roof when I need to go to work. I left work at 10 this morning and am going back at 7 for another 13 hours so I dont know how I am going to manage this night. Just needed to vent! Thanks for listening!

Probably the rush was that patients were getting more and more backed up in the ER. I'm not trying to justify it, because sending an unstable septic patient off to be a med surg nurse's 9th patient isn't justifiable. I'm just saying the ER was probably crawling with patients and that's where the rush came from. It wasn't until I did house supervision that I saw how amazingly this chain reaction of delays in each area can domino and cause chaos for the whole building.

But that's not on the ER, that's on the doc who transferred him to a floor vs. ICU or stepdown. Additionally, the nurse to patient ratio on her floor is appalling-again, not ER's fault.

If a patient is being admitted vs. being sent home, they SHOULD be "rushed" out of the ER and into the appropriate floor/unit. As noted above, the longer the patient remains in the ER, the worse the outcome.

It's the ER's job to treat and transfer, not hold onto patients because the nurse doesn't want to take an admission. It's Administration's responsibility to staff the floors and units appropriately. It sounds to me that they have failed abysmally at that job in the OP's facility. 9 patients to 1 nurse is unsafe and should be illegal! Sounds like a lawsuit waiting to happen.

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Specializes in ER, Cardiology, Management, DOC.

As a former charge nurse of a very busy ED, I can say this happens a lot and, although frustrating there are a lot of things to consider.

As a ED department you are bombarded by the public who demand to be seen, others are too sick to demand anything, some are dying then your trauma's etc. You can have 20 to 30 people waiting in the waiting room or more ( now remember the triage nurse needs to keep the vitals up to date on those patients and most of the time with little to no help) and some of those patients are very sick. Now imagine the stress on that nurse, she is looking at these patients knowing they are very sick and roaming the department looking for a bed and there are none. So the push to move the other patients out of the department is always present, we absolutely don't want anyone dying in the waiting room (unfortunately it does happen).

The MD along with management want patients moved when there is nothing else "emergent " (Ie we have done the scans we have done the tests , we have given the meds or blood or whatever ) and the specialized unit is what they need. At times those patients can turn very quickly and without warning and it is usually once they get to the unit. Some patients won't tell you when they feel unwell because they want out of the ED as well and onto a real bed so they don't say they have pain etc, other times it is not asked of the ED nurse.

I never wanted someone who was palliative to die in the ED, it is just not right. Now having a trauma patient die after doing CPR and other interventions for 40 mins is a different scenario. So moving a palliative patient to a unit into a private room with their family to die in private....is the right thing to do, in my opinion.

No matter where or how the push comes from, it is really uncomfortable for all nurses and medical staff involved. I know my nurses worried about sending a patient to the units before the patient was stable but unfortunately that sometimes was the "most " stable patient to go. It is frustrating and we sometimes feel like we could direct 747's at the airport better than our own jobs, but that is what health care is all about....or at least in the ED it feels that way.

I agree that communication is key and the doctors should not be accepting patients that they think are unstable. We had multiple doctors who finally said " No we are not accepting they are too sick", it did get us a couple more ER nurses (which gave us a few more beds )and an additional triage nurse. But if they continue to go along because they feel pressured it will never end.

Just my own experience I realize that everyone's environment is different.

Just know that as a former ED nurse we all were frustrated ( at least in my facility)at the state of health care. I absolutely feel your pain.

I hope it improves for you. All the best of luck.

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Thanks everyone for the replies. I see the topic at hand in different perspectives as you each state in your reasonings. Yes our hospital is very short staffed and they do not care about having safe ratios. It is a huge issue in this community hospital and no one is doing anything about it. We usually start off with 6 patients each nurse (4 nurses, rarely 5 EVER) and then the other night we EACH got slammed with 3 more admissions back to back in 3 hours from the moment we walked in the door. That is 9 patients each nurse and talk about chaos! They leave us with no secretary at night so we are answering phones, dealing with upset family members and demanding their loved one to be moved to another facility. I dont blame them I wouldnt keep my loved one there. Meds pass finished around 2AM for me and then I had to chart on everybody. Its funny because the state came back to our facility because I guess someone complained about staff ratios and then when the state came, they pulled a few nurses aside asking about staffing and I heard no one opened their mouth and said anything. Like why WOULDNT you say anything?? And some nurses said they didnt want to lose their job. So that means this is never going to change and I better get a pair of rollerblades because continuous panicking and anxiety and MISTAKES start happening and every patient sounds the same and your brain turns to mush!!

sorry for the rant, It has just been out of control lately and Ive never had so much anxiety in my life working for this hospital. Me and my co worker cried in the storage room after getting yelled at by family members and it felt like everything we were doing was not enough and that it was pointless. It isnt like we are sitting twiddling our thumbs! We are RUNNING around in a complete panic for TWELVE hours. Ugh lord I dont know anymore!

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Oh and mind you, the nursing supervisors and managers wont allow for an extra nurse. They said it would never happen. I guess this is upper management's doing. They are sipping on their champagne sleeping like a baby while me and my coworkers put our blood sweat and tears in our job and dont even get acknowledged during the holidays or anything with a nice meal or holiday party or just little things of appreciation. Makes me feel useless and like I bust my butt for nothing. I feel like we are just maintaining the patient care on the shift making sure everyone makes it alive and give meds, thats it. No quality time, performing treatments, doing what you want to do but not having the means to do it given the circumstance

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Specializes in CVICU, MICU, Burn ICU.
Thanks everyone for the replies. I see the topic at hand in different perspectives as you each state in your reasonings. Yes our hospital is very short staffed and they do not care about having safe ratios. It is a huge issue in this community hospital and no one is doing anything about it. We usually start off with 6 patients each nurse (4 nurses, rarely 5 EVER) and then the other night we EACH got slammed with 3 more admissions back to back in 3 hours from the moment we walked in the door. That is 9 patients each nurse and talk about chaos! They leave us with no secretary at night so we are answering phones, dealing with upset family members and demanding their loved one to be moved to another facility. I dont blame them I wouldnt keep my loved one there. Meds pass finished around 2AM for me and then I had to chart on everybody. Its funny because the state came back to our facility because I guess someone complained about staff ratios and then when the state came, they pulled a few nurses aside asking about staffing and I heard no one opened their mouth and said anything. Like why WOULDNT you say anything?? And some nurses said they didnt want to lose their job. So that means this is never going to change and I better get a pair of rollerblades because continuous panicking and anxiety and MISTAKES start happening and every patient sounds the same and your brain turns to mush!!

sorry for the rant, It has just been out of control lately and Ive never had so much anxiety in my life working for this hospital. Me and my co worker cried in the storage room after getting yelled at by family members and it felt like everything we were doing was not enough and that it was pointless. It isnt like we are sitting twiddling our thumbs! We are RUNNING around in a complete panic for TWELVE hours. Ugh lord I dont know anymore!

That sounds awful. I hope you can find a job elsewhere. There have been some great perspectives shared in this thread, but none of that is helpful to your immediate situation. Go get you another job!

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My question is who are these admitting docs who are sending unstable pts to the floor vs ICU?

I got an admission once with a blood pressure of unstable over dying. When I questioned why the *bleep* the full code patient was sent to med/surg, they said the ICU was out of beds. Since the admitting MD couldn't send her to ICU, he just changed the order to med/surg. I sent her right back.

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Specializes in Critical care.

^^^That is some downright BS, OP! What a horrible situation. I had an entirely different, level-headed reply type out, but I erased it...I'm sitting here boiling mad for you.

I recently took a new job, after a long time a the bedside. This new job has greatly expanded my influence on patient safety in all areas, and has really fired me up as an advocate. I would peel the paint off the walls of your hospital's board room at their next meeting.

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Specializes in ER, Cardiology, Management, DOC.

Awe Freckles23, don't give up.

I know it is difficult at times, but you make a difference even if you think you don't, you do.

Now her is what I would do .

I am not sure what your facility has for reporting incidents or near misses, but I would direct anyone that listens to you to start filling them out, I know it is more work but fill them out every time someone yells at you, ,,,,(state you felt threatened and unsafe). Fill them out when you have extremely sick patients and are unable to get to assess them properly due to other patients being sick etc.

Every time a family member starts at you, tell them you say "I understand but that they are talking to the wrong person although you feel their frustrations "and then give them the managers number directly make sure and include the times they are in their office, you should not be taking this all by yourself. I can tell you as soon as they (management) start getting these calls daily they will be doing something to stop the calls.

There is no law anywhere that says that you can't do this....after all they are management and should be fielding these calls. Instruct family to write down their concerns then they won't forget.

Always reiterate that you are doing the best you can with the resources that you have and the time constraints that you are under. And if possible have another nurse with you so they can confirm your chain of events, then chart it with all the colorful words they might have used. Also include those colorful words in the incident report with quotation marks.

I got to the point in the ED that when family members started in on my nurses I would intervene and say "you know what I don't come to your place of work and harass you, we are doing the best we can with the resources we have and yelling at us is not going to change the wait times or quicken the treatments of other patients in the department, here is the managers number she is here from Monday to Friday 8-4pm, don't leave a message call until you are able to talk to her in person." Most of the time they realized that I wouldn't put up with it and they take the card. Then I would chart their exact words ,other nurse who heard the conversation and then fill out an incident report.

Don't give up. We have all been there.

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Specializes in SICU, trauma, neuro.
I got an admission once with a blood pressure of unstable over dying. When I questioned why the *bleep* the full code patient was sent to med/surg, they said the ICU was out of beds. Since the admitting MD couldn't send her to ICU, he just changed the order to med/surg. I sent her right back.

Dang... so what the bleep do they expect the medsurg nurses to do?? I mean I'm sure you're a good nurse, but you can't utilize an art line or pressors on the floor.

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Specializes in Public Health, TB.

Admitting provider doesn't always see the patient before admit. The ED provider can sign a preprinted admission sheet, with limited orders, that usually just say call the admit provider for stuff. Admit provider has 4 hours before they have to see the patient.

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Specializes in LTC, Rehab.

Similarly, in my LTC/rehab facility, sometimes we get someone that really isn't ready to be out of the hospital. So sometimes we have to send them back. Or sometimes we get them stabilized within a day or two more.

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Awe Freckles23, don't give up.

I know it is difficult at times, but you make a difference even if you think you don't, you do.

Now her is what I would do .

I am not sure what your facility has for reporting incidents or near misses, but I would direct anyone that listens to you to start filling them out, I know it is more work but fill them out every time someone yells at you, ,,,,(state you felt threatened and unsafe). Fill them out when you have extremely sick patients and are unable to get to assess them properly due to other patients being sick etc.

Every time a family member starts at you, tell them you say "I understand but that they are talking to the wrong person although you feel their frustrations "and then give them the managers number directly make sure and include the times they are in their office, you should not be taking this all by yourself. I can tell you as soon as they (management) start getting these calls daily they will be doing something to stop the calls.

There is no law anywhere that says that you can't do this....after all they are management and should be fielding these calls. Instruct family to write down their concerns then they won't forget.

Always reiterate that you are doing the best you can with the resources that you have and the time constraints that you are under. And if possible have another nurse with you so they can confirm your chain of events, then chart it with all the colorful words they might have used. Also include those colorful words in the incident report with quotation marks.

I got to the point in the ED that when family members started in on my nurses I would intervene and say "you know what I don't come to your place of work and harass you, we are doing the best we can with the resources we have and yelling at us is not going to change the wait times or quicken the treatments of other patients in the department, here is the managers number she is here from Monday to Friday 8-4pm, don't leave a message call until you are able to talk to her in person." Most of the time they realized that I wouldn't put up with it and they take the card. Then I would chart their exact words ,other nurse who heard the conversation and then fill out an incident report.

Don't give up. We have all been there.

That is a great point on how to handle the situation. I felt at a loss when the family member was yelling at me and she wasnt necessarily blaming me as a whole, she saw the whole unit in chaos, but I took the brunt of it. And I know I shouldnt take it personal but Everyone hits a certain boiling point where they break down. I really wanted to help her father but with the circumstances, me helping as well as I wanted was not able to happen. I called nursing supervisor when two family members were feeding off of each other on how this place is horrible in front of the nurses station at 930 at the start of med pass so meds were given very late that night. Even the nurse supervisor did not seem to care, she was more concerned with staffing for the 11-7 psa shift which *** is the point of worrying about staffing if u dont staff adequetely enough to begin with? So the supervisor did not help too much which left us nurses to deal with it. Im not even sure where or who to turn to. I kind of want to write a loooooong typed paper and stick it in the nurse managers mailbox about everything that has happend but doubt shell care either.

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