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!

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.

Well, I wasn't going to bring it up but your original story doesn't even make sense. A patient is sick enough to meet ICU criteria but the admitting MD just arbitrarily downgraded the patient, not to step-down or even tele, but all the way to M/S where she wouldn't even be on tele just so the patient would have a bed on the floor??? Nope, something's missing here.

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Specializes in Cardio-Pulmonary; Med-Surg; Private Duty.
Well, I wasn't going to bring it up but your original story doesn't even make sense. A patient is sick enough to meet ICU criteria but the admitting MD just arbitrarily downgraded the patient, not to step-down or even tele, but all the way to M/S where she wouldn't even be on tele just so the patient would have a bed on the floor??? Nope, something's missing here.

My hospital offers telemetry on all units. MOST tele patients are placed on the cardio floor, but occasional med-surg, ortho, or neuro patients ALSO need tele monitoring while hospitalized, so they get placed on the floor best equipped to deal with their actual need for hospitalization, with tele added on.

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Well, I wasn't going to bring it up but your original story doesn't even make sense. A patient is sick enough to meet ICU criteria but the admitting MD just arbitrarily downgraded the patient, not to step-down or even tele, but all the way to M/S where she wouldn't even be on tele just so the patient would have a bed on the floor??? Nope, something's missing here.

There was no dedicated telemetry (or step down) unit at that hospital, but we were able to do telemetry monitoring in our med/surg. It was a two-story community hospital.

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Specializes in Public Health, TB.

As someone who's parent died in the ED, I can verify that that having a private area for family to be present at the last moments of life is much appreciated. Since then, I always tried to bring up an expected death from ED, asap, if I had the room.

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Specializes in Med-Surg/ ER/ homecare.
Yeah, that made me raise an eyebrow, too. I'm not a m/s nurse, but I was under the impression that 5-6 is standard/high, but 8 is ridiculous and dangerous. Especially on a med/tele floor. Geeeeeeeeeez. Scary scary. That's the first and biggest problem, IMO.

Ha! 8 patients was standard when I worked in med-surg, and as a new grad at the time, they gave me 10. Insane.

Back to the OP, when I worked in the ER, you had 15 minutes from the time you got a bed assignment to get the patient to the floor, or you got written up or at least questioned. Beds=money for the hospital. I hate to put it that way, but it is true and is one of the things that is terribly wrong in health care and needs to be changed.

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There was no dedicated telemetry (or step down) unit at that hospital, but we were able to do telemetry monitoring in our med/surg. It was a two-story community hospital.

The point of my comment wasn't to say that the patient wouldn't have access to tele, but that if the patient was downgraded to M/S then tele isn't part of that order when the patient was supposedly sick enough to require ICU originally, where tele is included included as part of the original order.

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The point of my comment wasn't to say that the patient wouldn't have access to tele, but that if the patient was downgraded to M/S then tele isn't part of that order when the patient was supposedly sick enough to require ICU originally, where tele is included included as part of the original order.

At that hospital, we called for orders after our patients arrived to the floor. Sometimes telemetry monitoring was ordered, and sometimes it was not. In obvious cases, like "chest pain" admits, we'd just go ahead and connect them in anticipation of an eventual order. Your suspicion is amusing, but I'm not sure where it's coming from.

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At that hospital, we called for orders after our patients arrived to the floor. Sometimes telemetry monitoring was ordered, and sometimes it was not. In obvious cases, like "chest pain" admits, we'd just go ahead and connect them in anticipation of an eventual order. Your suspicion is amusing, but I'm not sure where it's coming from.

Interesting choice of words, "amusing."

I don't disagree with your general comments in this post about tele. Any nurse in the profession longer than a minute knows that it's a given that chest pains go on a monitor, but you are side-stepping the issue of the ICU patient in your original story.

My point, which I'm honestly baffled as to how you missed it, is, how does a patient who is truly sick enough and meets criteria to require being sent to the ICU get downgraded all the way to M/S within a matter of minutes of leaving the ER just so that the patient can have a bed on the floor??? A doctor would have to be out of his mind to do that! If your original scenario played out at my hospital the nursing supervisor would have been involved and it wouldn't have gone down that way. I also can't imagine a competent nurse allowing a patient meeting ICU criteria to be downgraded to M/S, or that the MD wasn't called out for that one if it truly happened the way you described. Of course there are incompetent doctors and nurses but the scenario as you have told it is so blatantly wrong that it truly blows me away!

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At my hospital, the er has taken to just showing up with patients. It's about 50/50 whether you actually get a call. I've gotten some sick ones that show up without an Iv and without any documentation that an ER doc has even looked at them. I just think that this is a lawsuit waiting to happen so I document document document. The ER charting at my hospital is so minimal, something bad is gonna happen. I get focused assessments but you at least have to chart that the patient is breathing and sometimes that's not even in the computer! I don't know what the solution is but somethings gotta give. Telling an RN what is coming up to the floor would certainly help.

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Interesting choice of words, "amusing."

I don't disagree with your general comments in this post about tele. Any nurse in the profession longer than a minute knows that it's a given that chest pains go on a monitor, but you are side-stepping the issue of the ICU patient in your original story.

My point, which I'm honestly baffled as to how you missed it, is, how does a patient who is truly sick enough and meets criteria to require being sent to the ICU get downgraded all the way to M/S within a matter of minutes of leaving the ER just so that the patient can have a bed on the floor??? A doctor would have to be out of his mind to do that! If your original scenario played out at my hospital the nursing supervisor would have been involved and it wouldn't have gone down that way. I also can't imagine a competent nurse allowing a patient meeting ICU criteria to be downgraded to M/S, or that the MD wasn't called out for that one if it truly happened the way you described. Of course there are incompetent doctors and nurses but the scenario as you have told it is so blatantly wrong that it truly blows me away!

It blew me away, too ...that was pretty much the whole point of my original complaint. The report given prior to the patient's transfer left out quite a few important details!! ...and the supervisor did get involved. Along with the charge nurse and rapid response team, she took over care and got the patient off the floor.

I don't know how things were handled with the MD, but he was surely made aware at some point in some way.

What more can I say? Truth is sometimes stranger than fiction.

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Specializes in OR.

9:1 :no:: Oh **** no. This is the kind of stuff that makes me appreciate my unit all that much more. our ratio is 4:1, maybe 5 for the more experienced nurses, tops out at 6:1 on nights. On top of that is Charge (who does not take patients) and if we are on the full side, an intervention nurse who runs around and helps you with meds, dressings, discharge teaching, etc.

Getting a patient from the OR/PACU? We get a "taping and sending" heads up, which is a taped report by the sending nurse that we can listen to instead of playing phone tag or getting no report at all. I have also heard charge dispute a patient that we were being sent, and she is actually listened to!

This is the only surgical (mostly, with occasional medical) floor I have worked on and I am very fortunate. In my opinion, this is how it should be.

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A lot of these comments sounds like nurses blaming other nurses. Unfortunately, we work in a healthcare environment where we are understaffed and management also has their hands tied by the corporate powers.

I am truly sorry that you had such a bad night. While I think the ED nurses usually do their jobs appropriately and you are being honest about the acuity of your newly admitted patient, the only thing I can offer is advice. Whenever you are posed with a situation where you feel like your patient is unstable or deteriorating, you need to do two things: 1) Call an RRT. This will make sure a team of nurses and docs are at the bedside to help you make sure your patient is safe and your license is protected. I know floor nurses can be afraid to call an RRT, but the fact is, if your patient is unstable and you feel the level of care assigned is inappropriate it is your DUTY to call an RRT and escalate. 2) You MUST tell another nurse AND your charge "hey can you just keep an ear out for my patients while I am handling this Rapid." Not only does this ensure your other patients are being looked after, but also ensures that license is protected if any of your other patients fall, deteriorate, or die.

We have to understand our limitations as human beings. We can only be in place at one time. Another piece of advise I can give you is to IGNORE paperwork when you have a dying patient. Don't worry about it- it will get done. Your first priority should always be patient safety.

Finally, if I were you I would do plenty of incident reports and also formal complains to the Department who licenses hospitals in your state with details of each time you had to file an incident report.

Our jobs as nurses are are already tough- it's the nature of the beast. The last thing we can do is make it worse for each other by passing blame. Personally, that ratio seems unsafe. I've only ever worked ICU and in one ICU we would routinely be assigned 3 patients but the third was usually as cruise-control type patient and we had plenty of techs to help out.

I wohld strongly reccomend moving to a higher acuity unit because you'll have more control over the care your patients receive and if you're working in a true ICU, you'll never have more than 1-2 patients.

I wish you the best of luck and I hope you decide to resign from your position and take ANY Job until you can find a safe nursing position. You've worked really hard for your nursing license and the last thing you want is for management and physicians to pass blame onto you and place a complain on your license than to have to accept responsibility themselves.

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