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!

Sorry for your rough night. Been there many times as m/s/t floor nurse, charge nurse and manager. Early in my career I took report on a patient that was a hospice patient but family couldn't bear watching him pass at home. Told the ED nurse "okay, I am getting a patient back from PACU can you hold off bring the new admit until I get my post-op patient in bed and quickly assessed...vitals, etc., for 10 minutes because they are en-route now from PACU? Small hospital - just got PACU patient in bed and walk out to see him rolling the new patient by on the stretcher. I watch from the doorway while that ED nurse and a family member "assisted" the patient into the bed (I was 8 months heavily pregnant and not able to do transfers when patients couldn't assist). So as I stood there in the doorway watching them put this poor man into the bed I see his arm "flop" when they put him into bed. ED nurse rolled on out with stretcher and I kindly asked the family member to go to the family waiting room with the other family members (large Native American group) while I got his loved one settled. Now at this point in time I had been a RN for about 1.5 years but I don't think it takes a person too long to figure out when a person has passed away. Just to make sure - did vitals. Nada. Pressed the call button and another nurse at station answered (she was charge) and I asked if she or the manager could come in and help me for a moment. Charge nurse walks in and shuts the door and looks at me with the DynaMap and the look on my face and said - "He's gone isn't he?" SMH She went and got our manager who came in and was like, "are you serious?" She tore UP that ED manager on the phone. Poor man died either before leaving ED or en-route and the ED nurse still brought him to the floor which was HORRIBLE on the family since they didn't get to say goodbye. I called the doctor and he was like "you're kidding, right?" Yeah, I've had a lot of bad experiences coming on duty with IVs run completely dry, patients soiled to the extent it was dried on and you knew the ED knew long before bringing them to the floor they were soiled. Not bashing ED nurses - they have their own nightmare issues in their departments - I know. I've worked ED and was house sup and helped out EDs, too. I just think there needs to be a time frame of when ED brings the patients to the floor when it is around shift change. I established that with the ED manager once I took over managing m/s/t. Patient safety should and always be #1! Hope you had a better night.

8 patients is too much anymore. When I first started I would have up to 13 (1 hall) of patients on a busy and TRUE telemetry floor with 1 tech. It was exhausting and a lot were there admitted for true cardiac pain and would be nothing to have 3 or 4 with true gotta go to the cath lab now and I'm pushing Morphine left and right. SMH I am glad I am out of that mess and work still as a nurse but in a different environment.

Okay...lunch break over. :)

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Agree. M/S was my bread and butter for a lot of years both as staff and manager but have worked ED as well so I can identify with you. I briefly returned to work M/S PRN while I was in grad school but after years of lifting on too heavy patients without enough assistance and the fact that I've been (like many) pounding the floor for hours at a time without break - my poor legs and back couldn't keep up. LTAC was even worse. I worked LTAC ICU and was routinely given 3 (sometimes 4 if 1 was overflow) with multiple lines, TF, vents on all, IVPBs back to back and never ending, and ALL were typically in isolation and 200+ lbs requiring another person to help you turn q2 and no tech staffed and the other nurses who either were equally as overwhelmed or weren't team players. Totally unsafe conditions. That was a short stint and I was outta there!

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Specializes in Cath/EP lab, CCU, Cardiac stepdown.

I agree with many about how it is often times the Attending's fault for accepting a critical patient onto the floor but sometimes I find that the ED nurse is at fault too. I remember once when I was doing charge, and the ED nurse did not give an appropriate report of what the patient was going to be like. Gave me all these vitals that were a little below norm but nothing concerning. Fast forward to when the patient arrived, the patient was nothing like the report, altered, hypotensive, tachy, and couldn't get a temp on her, was a critical care patient and needed to be on CRRT. If the ED nurse had told me this in report, I would have told them that my unit isn't taking this critical patient and patient flow/attending can talk to me while I filed a safety report on them if they tried to force it. Needless to say, since the patient was there already, the nurse did what she could to stabilize while I was on the phone getting the patient an icu bed.

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I had the ER drop off an actively dying patient to me at the IMCU where I used to work. Pt died 6 hours later.

Not sure what the IMCU is, but was this patient supposed to stay in the ER?

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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.

I hope you don't mean you sent her back to the ER! That would be a huge EMTALA violation that could cost the hospital tens of thousands of dollars, among other penalties!

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That's not normal? Kidding....lame I hate lazy anybody. And that applies to all departments

How is this lazy? If someone is actively dying then it's expected that vitals are not going to be normal at some point, and presumably this patient is a DNR with comfort measures only. And someone else already stated that the appropriate thing to do with dying patients is to transfer them to a private room on the floor where they can be with family and have some privacy, not to be stuck in the ER. What else would you expect the ER to do for a patient like this???

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As far as the ER nurses rushing pt's to the floor, we have no choice but to send the pt up if the bed is ready. Sometimes I would like nothing more to hold an admit for a few minutes so that I can catch my breath. But the charge nurse has already assigned the room and an ambulance is waiting with their next train wreck right outside the room waiting to fill the room.

This exactly! If I had ready beds assigned to all of my patients with all of their orders completed and could hold these patients in the ED for an hour or two, I'd be on easy street and able to take my rightful 30 minute unpaid lunch break, which I normally don't get but get docked for anyway! Unfortunately, the scenario described above with an ambulance stretcher waiting outside of one or more of my rooms when ready beds are assigned is a daily occurrence.

Also, I get the impression that some are equating the "ED" to the ED nurse, as in "what the ED wants" means "what the ED nurse wants," when in reality it's "what management (the ED) wants." Throughput decisions are not those of the ED nurse, but of the ED manager and upper management, so the ED nurse is only doing what he/she is told to do by the powers that be.

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Sorry for your rough night. Been there many times as m/s/t floor nurse, charge nurse and manager. Early in my career I took report on a patient that was a hospice patient but family couldn't bear watching him pass at home. Told the ED nurse "okay, I am getting a patient back from PACU can you hold off bring the new admit until I get my post-op patient in bed and quickly assessed...vitals, etc., for 10 minutes because they are en-route now from PACU? Small hospital - just got PACU patient in bed and walk out to see him rolling the new patient by on the stretcher. I watch from the doorway while that ED nurse and a family member "assisted" the patient into the bed (I was 8 months heavily pregnant and not able to do transfers when patients couldn't assist). So as I stood there in the doorway watching them put this poor man into the bed I see his arm "flop" when they put him into bed. ED nurse rolled on out with stretcher and I kindly asked the family member to go to the family waiting room with the other family members (large Native American group) while I got his loved one settled. Now at this point in time I had been a RN for about 1.5 years but I don't think it takes a person too long to figure out when a person has passed away. Just to make sure - did vitals. Nada. Pressed the call button and another nurse at station answered (she was charge) and I asked if she or the manager could come in and help me for a moment. Charge nurse walks in and shuts the door and looks at me with the DynaMap and the look on my face and said - "He's gone isn't he?" SMH She went and got our manager who came in and was like, "are you serious?" She tore UP that ED manager on the phone. Poor man died either before leaving ED or en-route and the ED nurse still brought him to the floor which was HORRIBLE on the family since they didn't get to say goodbye. I called the doctor and he was like "you're kidding, right?" Yeah, I've had a lot of bad experiences coming on duty with IVs run completely dry, patients soiled to the extent it was dried on and you knew the ED knew long before bringing them to the floor they were soiled. Not bashing ED nurses - they have their own nightmare issues in their departments - I know. I've worked ED and was house sup and helped out EDs, too. I just think there needs to be a time frame of when ED brings the patients to the floor when it is around shift change. I established that with the ED manager once I took over managing m/s/t. Patient safety should and always be #1! Hope you had a better night.

8 patients is too much anymore. When I first started I would have up to 13 (1 hall) of patients on a busy and TRUE telemetry floor with 1 tech. It was exhausting and a lot were there admitted for true cardiac pain and would be nothing to have 3 or 4 with true gotta go to the cath lab now and I'm pushing Morphine left and right. SMH I am glad I am out of that mess and work still as a nurse but in a different environment.

Okay...lunch break over. :)

This is wrong if the patient died prior to leaving the ED, but if he died en route to the floor, there's nothing to be done except move forward because it's an EMTALA violation to return them to the ED once they have left that department. Whoever was transporting the patient should have at least said something to the receiving RN though.

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Specializes in OR, Nursing Professional Development.
Not sure what the IMCU is, but was this patient supposed to stay in the ER?

In my neck of the woods, IMCU stands for intermediate care unit. A transition unit between ICU and regular floor.

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In my neck of the woods, IMCU stands for intermediate care unit. A transition unit between ICU and regular floor.

Sounds like a step-down or progressive care unit.

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I hope you don't mean you sent her back to the ER! That would be a huge EMTALA violation that could cost the hospital tens of thousands of dollars, among other penalties!

What bigger violation is there than sending a full code patient to a floor where they can't possibly receive the care they need to continue to live? I'm not sure where she was "officially" sent (in the computer), but I didn't keep her. We do sometimes have 5150 hold patients in med/surg that are technically registered into the ER, so anything is possible, I suppose.

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Sorry for your rough night. Been there many times as m/s/t floor nurse, charge nurse and manager. Early in my career I took report on a patient that was a hospice patient but family couldn't bear watching him pass at home. Told the ED nurse "okay, I am getting a patient back from PACU can you hold off bring the new admit until I get my post-op patient in bed and quickly assessed...vitals, etc., for 10 minutes because they are en-route now from PACU? Small hospital - just got PACU patient in bed and walk out to see him rolling the new patient by on the stretcher. I watch from the doorway while that ED nurse and a family member "assisted" the patient into the bed (I was 8 months heavily pregnant and not able to do transfers when patients couldn't assist). So as I stood there in the doorway watching them put this poor man into the bed I see his arm "flop" when they put him into bed. ED nurse rolled on out with stretcher and I kindly asked the family member to go to the family waiting room with the other family members (large Native American group) while I got his loved one settled. Now at this point in time I had been a RN for about 1.5 years but I don't think it takes a person too long to figure out when a person has passed away. Just to make sure - did vitals. Nada. Pressed the call button and another nurse at station answered (she was charge) and I asked if she or the manager could come in and help me for a moment. Charge nurse walks in and shuts the door and looks at me with the DynaMap and the look on my face and said - "He's gone isn't he?" SMH She went and got our manager who came in and was like, "are you serious?" She tore UP that ED manager on the phone. Poor man died either before leaving ED or en-route and the ED nurse still brought him to the floor which was HORRIBLE on the family since they didn't get to say goodbye. I called the doctor and he was like "you're kidding, right?" Yeah, I've had a lot of bad experiences coming on duty with IVs run completely dry, patients soiled to the extent it was dried on and you knew the ED knew long before bringing them to the floor they were soiled. Not bashing ED nurses - they have their own nightmare issues in their departments - I know. I've worked ED and was house sup and helped out EDs, too. I just think there needs to be a time frame of when ED brings the patients to the floor when it is around shift change. I established that with the ED manager once I took over managing m/s/t. Patient safety should and always be #1! Hope you had a better night.

8 patients is too much anymore. When I first started I would have up to 13 (1 hall) of patients on a busy and TRUE telemetry floor with 1 tech. It was exhausting and a lot were there admitted for true cardiac pain and would be nothing to have 3 or 4 with true gotta go to the cath lab now and I'm pushing Morphine left and right. SMH I am glad I am out of that mess and work still as a nurse but in a different environment.

Okay...lunch break over. :)

I got one like that recently, although he was hanging on by a thread when he arrived. SBP was less than 40, breathing was agonal, etc. He died within three to five minutes of arriving to the unit.

I was actually OK with that transfer and happy that the large group of family had someplace private to gather. It was an expected death and the large group of family gathered was telling. I was able to summon the wife in fairly quickly, but I believe the patient was probably already gone at that point. Most of the other family were waiting outside while we got the patient "settled". My belief is that the family most likely had said goodbye before that point, and they had another opportunity to say goodbye afterward.

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