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!

Specializes in PCCN.
On my unit it is fairly common for floor nurses to end up with seven patients.

That is so unsafe. I think more states need to follow California and have a max of five patients per nurse. Really, I think more than four is when quality of care starts to decline. Five is doable. Six is tough. Seven or more? Nuts.

Yes , but that way they do with one less nurse.

Ooooooh ,look at all that money saved..........:facepalm:

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Agree with above, and my intent is not to bash my beloved ED colleagues, but my experience, over the past 37 years, has been that Nursing, rather than physician providers, drives the timing of admissions from ED to the floors or ICUs.

It's been a nursing ritual, at many hospitals where I've worked as a staff nurse, that these admissions are batched to arrive at change of shift.

OMG, fellow ED nurses. We have been totally outed! Yes that's exactly it. We have all the power when it comes to admissions. In fact in our morning huddle we actually decide which unit we are going to mess with that day. If we're lucky someone will know one of the floor nurses so we can actually make it personal. Those silly doctors, nursing supervisors and bed-placement people are just a cover for the ones who are really running the show...the ED nurses. The actual ritual of doing it is really fun and the costumes we wear are divine! You should see my crown of power!

Do you think they know about the other things we do on purpose just to make the floor nurses' shifts awful? You know what I'm talking about. Loosening the Tegaderm so the IV goes bad as soon as we transfer them from the gurney to the bed. And don't forget the Kayexalate/Lasix cocktail which is to be given 60 minutes prior to our scheduled dump (pardon the pun) on the floor. It IS mandatory after all. Promising the patient pain medication when we know none is ordered. It's so much fun. I probably should stop there. Wouldn't want to reveal all of our secrets.

PANYNP, did it ever occur to you that the reason is SEEMS like the admits all come at shift change is because that's when the beds finally become available. The vast majority of discharges are in the afternoon. Then the rooms need terminally cleaned and there are only so many housekeeping staff to do the job. A "ritual"? Seriously? You are blaming the one group who has the least control over the situation. How is that not "bashing" them?

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Specializes in Emergency.

Our facility, we don't even take report from ED unless the room is ready. We get a patient without report? The nurse who transfers the patient gets reported to house supervisor and an electronic error reporting form gets done. Why do we wait? Because once you get report from ED, they will automatically assume that bed is ready even though you tell them that it's not ready.

In terms of this patient that was transferred to ED to your floor: write it up to your supervisor. Patient was too unstable to be admitted to a MS/Tele floor. Speak to a union rep as well.

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Not trying to justify the ER, but the ratio really fluctuates and one minute you have 5 patients and next thing could be a serious trauma that really needs to be dealt with. Also, many times you get bombarded with a flow of people at the same time. So after stabilizing patients, if they need to be admitted then its better than sooner. Your ratio is too high and that is really dangerous. This sounds more like a management issue because sufficient staffing would alleviate the ratio and drop the amount of patients you were assigned to.

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Specializes in Emergency medicine, primary care.

We have management breathing down our neck about dispos and it's ultimately up to the ED doc to decide whether a patient is floor versus ICU. I have had several patients where I've had to cajole the resident and then the attending to rethink their dispo...we have had patients they've tried to wean off bipap to send to the floor who are unstable on regular O2 and some docs are adamant about avoiding ICU admissions even though we know the longer a patient stays in the ED the worse the outcomes generally are. I try not to send patients up to the floor between 1830 and 1930 if I can help it as a courtesy because I know they do shift change at 1900 but we have had so many people we have run out of tele monitors and people are jammed in hall spots. I feel bad for the floor. I really do. I try to call if there will be a delay in bringing up a patient or if there's a change in status. Sometimes I can't though when we get slammed. I have had 2 vented patients and an LVAD at the same time some nights. It's chaos.

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Our facility is call and go if the room is ready. If we call and you have to call back or cant take report right then its 15min we wait then we take the patient to the floor with a hallpass that has our name and number for the floor nurse to call with any questions, ICU is bedside report. Next month they are starting a new thing where the floor nurse is to comedown to get their patient within 30 minutes of the bed being ready and we will do bedside report in the ED so we will see how that goes.

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Now that just sounds STUPID and unsafe. A hall pass? Sounds like not the best patient endorsement, I wonder what the boards of nursing would say about that. Having a floor nurse to pick up her patient? That's also stupid and unsafe. Your hospital should invest in Transport nurses. It's safer and cheaper than a potential law suit.

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Our facility is call and go if the room is ready. If we call and you have to call back or cant take report right then its 15min we wait then we take the patient to the floor with a hallpass that has our name and number for the floor nurse to call with any questions, ICU is bedside report. Next month they are starting a new thing where the floor nurse is to comedown to get their patient within 30 minutes of the bed being ready and we will do bedside report in the ED so we will see how that goes.

Are you people serious? The floor nurse is supposed to leave her other 4-6 patients to go transport a patient from the ED? Does your director have a picture of the CNO with a goat? Utter BS.

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Next month they are starting a new thing where the floor nurse is to comedown to get their patient within 30 minutes of the bed being ready and we will do bedside report in the ED so we will see how that goes.

It's not going to go well for either side. The floor nurse won't have time to actually show up in a reasonable amount of time. The ED nurse won't be able to drop what they're doing for report when the floor nurse finally does show up. What a stupid idea.

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Specializes in ER, Med-surg.
Are you people serious? The floor nurse is supposed to leave her other 4-6 patients to go transport a patient from the ED? Does your director have a picture of the CNO with a goat? Utter BS.

You realize that when an ER nurse transports the patient (mandatory for ICU patients in all facilities I've worked and common for all patients, especially on night shifts and weekends), she is also leaving her 3-7+ other, frequently unstable patients for the duration?

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NO Kidding! Bad enough that you rarely get a break let alone a full uninterrupted meal! Where is the house supervisor? I transported plenty of times when the ED, ICU and M/S were being slammed.

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You realize that when an ER nurse transports the patient (mandatory for ICU patients in all facilities I've worked and common for all patients, especially on night shifts and weekends), she is also leaving her 3-7+ other, frequently unstable patients for the duration?

ER nurses have never transported any but vented patients anywhere I"ve worked. Nice try.

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