ER rushing patients to the floor

[freckles23]

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!

[quazar]

The bottom line I'm seeing here is that unsafe staffing is a ubiquitous problem and it's having a dangerous ripple effect across hospitals everywhere. I wonder when the right people in charge will finally, FINALLY sit up and take notice? /general lamentation

[Lev, MSN, RN, NP]

The first thing that jumped out at me was your insane and unsafe ratio of 9 patients to one nurse. Then I remembered the past couple shifts I have worked in the ED. Last shift - 5 cardiac arrests, critical and after critical, 25 tele patients boarding waiting on beds, full waiting room. The shift before, left the ED at 11pm with about 70 patients in the waiting room, it peaked that night at 82, also many critical patients.

[Kooky Korky, BSN, RN]

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

Call State back and this time do make sure to give them the true story.

[emmy27]

If med/surg is at 9:1 ratios I can only imagine what the ER is like.

This sounds like a nightmare place to work, OP. Staffing is bad in most of healthcare these days but this is truly, exceptionally awful. Find a new job, any new job kind of awful. I honestly think even if you quit to work in a non-nursing job you could explain it adequately in future interviews by saying "we were regularly given 9 med-surg patients." With modern acuities that is just unfathomable, and any manager you'd care to work for knows it.

[foggnm]

I have worked both on the 'floor' and the ER. I'd say in general floor nurses don't understand that when someone sits in the ER, another patient waits to get care. I have zero patience for nurses that stall admissions because they have other patients. The nature of the hospital is patient turn-over. The second an ER nurse has an empty bed, a new patient goes in that bed. Don't be mad at the ER for doing their job. Help them move patients and get more people get seen. That being said if your patient was an ICU patient and was admitted to a floor with an 9:1 patient to nurse ratio (which for the most part shouldn't exist in a hospital even on a general medicine floor), that was not the ER's mistake. That was the mistake of the admitting physician for not adequately assessing the acuity of that patient, though sometimes that happens especially with sepsis. I do have sympathy for floor nurses though when it comes to being overwhelmed and being dumped on with paperwork. The extent of admissions assessments and other paperwork a floor nurse has to do is beyond ridiculous and almost no reasonable human being should be expected to keep up with such a demanding workload of patient care and write small novels on each patient. There is a reason med/surg/tele jobs have the biggest turn over and all the job ads are for those types of floors. It is just because of the reasons you mention. But don't blame the ER for 'rushing.' You feel dumped on as a floor nurse because ultimately you don't get treated well as a floor nurse. My advice is realize the type of nursing you are doing is not to be a long-term career choice. It isn't healthy, you get treated poorly, you have no autonomy, you are always behind on your work/charting. Take care of yourself and advance to a different type of nursing where you won't come in every day being overwhelmed. Or move to another hospital that has more reasonable patient ratios. Most facilities now have less than 5:1 on med/surg/tele and some even have ratios as low as 3:1.

[XNavyCorpsman]

Not all ER's are as busy as yours. The day that I received my patient, that was actively dying, the ER only had 3 patients. The ER nurse dropped my patient off and he had a RR of 45 rpm.

[blondy2061h, MSN, RN]

Keep in mind that the admitted patient is eager to get to the floor, to their comfier bed, to some privacy.

[LetLoveNReasonUnite]

If med/surg is at 9:1 ratios I can only imagine what the ER is like.

This sounds like a nightmare place to work, OP. Staffing is bad in most of healthcare these days but this is truly, exceptionally awful. Find a new job, any new job kind of awful. I honestly think even if you quit to work in a non-nursing job you could explain it adequately in future interviews by saying "we were regularly given 9 med-surg patients." With modern acuities that is just unfathomable, and any manager you'd care to work for knows it.

I agree. And it's stressful for you OP to have to worry about your other patients while you are prioritizing the sickest one.. I am sure you were doing your absolute best with that patient, but it's frustrating and stressful to imagine what else could have been going on with your other patients. Please ensure you stand up for yourself and your safe practice. Your health is a priority too.

[Esme12, ASN, BSN, RN]

Well.....this is another age old complaint. If it is any comfort to the OP it isn't just her facility.

I have found this complaint to be universal. Hospitals are decreasing staff and increasing the workload of everyone. I have studied this over and over again. While there are some variations unique to each situation they have many more in common.

There has been this push to decrease ER wait times. In this present culture of "patient satisfaction" and having to have "good scores" pressure has been placed to get the patients out of the ED ASAP. It has been well documented that longer the wait in the ED from door to door is one of the biggest complaint generators.

Tufts MC Emergency Room - Don't Wait in The ER, Wait at Home‎

ER Wait Watcher

ER Wait Watcher Massachusetts

There are factors that are common to many hospitals. ER nurses know that their ED doc's vary greatly as to the efficiency of that MD. Some ED docs are quick and accurate while others...well....lets just say they have 2 speeds. Stop and reverse. These MD's will just get slower, take a long meal break, and dictate the H/P for 2 hours simply out of spite because you tried to get them to hurry (my personal favoutite....NOT!) Many MD's will leave patients in the beds to limit the amount of patients they see that shift and will suddenly disposition the entire department when the next MD is due to arrive...they don't want their fellow MD kick the bejesus out of them for leaving a mess.

Sometimes the attending/PCP will drag their feet until all of "their" patients are ready for disposition to "see" all the patients at once. This will vary greatly depending on whether or not there is a hospitalist AND when the hospitalist shift begins/ends and do they have another position/shift at another facility to get to that day. Another is where the patient is being admitted; telemetry, step down, ICU and the hospital policy how when the PCP/specialist/attending has to see them personally.

Then we have staff (nurses,CNA's) shift times and census to contend with. I can tell you that there is always that one notorious floor that will actually hide discharges by leaving the beds unmade and unstripped to appear that the occupant is down for testing. That dreaded shift change patient. You the one...that train wreck that hits the floor and drags you into a sucking void of no B/P that will ultimately crash once all the admission orders, and paperwork, are done and gets transferred to ICCU leaving you with 6 other patients that have not been seen and another admission waiting for your bed....Murphy's Law.

Why does that sick patient come to YOUR telemetry unit?? WELL....most facilities have policies that when a critical patient is admitted to the ICU that patient must been seen by the ICU certified MD with in, usually, one hour. HOWEVER! IF that patient is admitted to the floor THEN crashes and TRANSFERRED to the ICU the MD, usually, have 8 to 12 hours before the patient must be seen in person.

See how that works? Crazy isn't it?

Can it be corrected? Yes, but not without an administration that is willing to hold the MD's nose to the fire. Supported nursing supervisors that run behind these MD's and make them behave and a progressive policy for the staff nurses supported by their management to stop hiding beds until shift change so they can dump on the next shift...I mean why not they have all night...right?

To fix the problem...it really isn't that easy but it isn't just your facility ((HUGS))

[KandidNurse]

Having worked in the ED for almost 2 years now I can tell you that our ratios are beyond crazy (true in most ED's I know of) and we are dealing with everything from finger lac's to strokes etc. nevertheless I know where I work we do everything in our power to make sure patients are going to where they will receive the most appropriate care but dispositions change, some get better and others worse as time passes in the ED

Anyway if you really did have 8 other patients I agree w the others that your ratios should be dealt with because that's a safety concern within itself!

[LessValuableNinja]

You describe a situation that reads more as, "what type of unit should the patient be sent to?" rather than, "is the patient ready to leave the ER?" It also asks implied questions such as, "was the charge involved?" and so on. It isn't the function of the ER to hold the patient until they're low acuity enough for an 8:1 ratio floor, and the ER doesn't decide where they're going, just that they need to go.

[LessValuableNinja]

I just realized people already said what I said, then elaborated on it. Party foul yo.