Ever feel like the med/surg unit is the hospital dumping ground?

frustratedRN · Oct 8, 2001

we get the overflow from the entire hospital. if there are no open beds on that unit they come to ours. likewise, if the person doesnt really fit into a catagory we get those too.

weve been getting a lot of psych patients lately much to my dismay. we arent in a lock down unit like these patients need to be. im not a psych nurse and the same precautions taken in our psych unit, for example, not wearing a name badge, are not observed on our unit.

seems like we have turned more into a nursing home than anything else lately.

we have patients admitted with basically no acute needs. they are there for placement issues or because the nursing home just wanted to "get rid of them" for a couple of days.

they are admitted with strange things. for example we got one of our frequent flyers back from her nursing home.

she was admitted with possible aspiration.

lol

we couldnt figure out what she would be aspirating on. she had tube feeds going. tube in right place, no residual. cxr clear. o2 sat 98 percent on room air. she doesnt eat, swallow or talk.

you can tell her lungs are good cos she spends most of her time screaming just to scream. (oriented to nothing)

we just assumed the home needed a break from her.

we have a patient down the hall who is 39 years old with AIDS and aids related dementia. no nursing home would accept him. he has been in the hospital since june.

id say the last month or so we have had the same patients over and over and over. you look at the charts and there is nothing really acute going on. maybe a temp spike once in a while or some other issue that could have been handled in the nursing home.

we ARE the dumping ground....thats what med surg is

RNforLongTime · Oct 8, 2001

I'd have a prob with giving Primacor on a gen med/surg unit. Do they plan to put that person on telemetry while the drug is infusing? Are the staff trained in reading telemetry strips? This is big stuff!!!

I work on a cardiac/respiratory unit--well That is what we are supposed to be but we get ALL kinds of pt's--GI bleeds, kidney stones, etc, etc, etc..

Where I used to work--we would get pt's from nursing homes that would come in for a blood transfusion and then go back afterwards--half of the time these pt's would end up staying for a week or two because of some other problem. They were supposed to have the blood transfused on the short-stay unit but most of the time that unit was full so the pt got dumped onto my med/surg floor where we specialized in gyne/uro/dialysis pt's and we got surgical gynes/uro pt's too.

I remember one day, I had to care for some 80 year old lady from one of the local nursing homes who was just supposed to come for a blood transfusion(two units)--prob was she was a diabetic-a brittle one at that and had venous ulcers on both her legs--oh and the doctor wrote for each unit of blood to be given over 3 1/2 hours--so thats 7 hours of blood--well needless to say this lady ended up being admitted and stayed on our unit for 2 weeks. She could barely move! Oh well---so glad I don't work there anymore!

Kelly:)

deespoohbear · Oct 9, 2001

As far as I know, they do plan to put these patients on telemetry. The teles are monitored by the ICU nurse. I just get so aggravated that the hospital administration thinks our department is dumping station. It get so ticked off at OB. The only type of patient they will take is an OB patient who is either is labor or premature labor. If they have any other problems, it is ship them off to Med/Surg. Heck, one time we had a lady who was 8 months pregnant with twins complaining of severe abdominal pain. After ruling out that she was not in labor, she became our problem. I tried to convince her family practice doc that this lady belonged in OB. His arguement was that her problem wasn't OB related. No, but it sure could have been real quick. The lady ended up being transferred to a larger facility with high risk OB. She had an acute appy. Guess where they admitted to in the larger hospital. OB!! Duh!!! I better not even get started on OB nurses and med/surg. That is a whole different thread!!!

deespoohbear · Oct 10, 2001

It happened again today. Med/Surg got another "dump" admit. This patient was in our skilled nursing unit. The patient has pancreatic CA, acute renal failure, eloctrolyte imbalance, and asp. pneumonia. He is unresponsive except to verbal stimuli and is having Cheyne Stokes resps. The patient is a DNR, but the spouse isn't quite ready to give up. The doctor orders a dopamine infusion at 3mck/kg/min for this pt. Well, the skilled unit freaks out and wants the patient transferred to the our floor. They don't "feel comfortable" with a dopamine drip patient. The man wasn't even going to be placed on a monitor for pete's sake. The doctor is just trying to give the family the idea that we haven't totally given up on the patient. No titration involved, the man has a central line. So, we get the patient. I told my supervisor that if I knew the "I don't feel comfortable with this patient" line would work, I would have started using it a long time ago. I also said, you know what happens when we don't feel comfortable with certain things, we get inserviced. I told my manager this was a BS dump admit, but she didn't agree. Dopamine didn't even touch this person's HR. Still in the '50's 6 hours after starting the dopamine. Just needed to vent some more!!!

h vigliotti · Oct 10, 2001

why do you stay?!?! your mental health is important to you isn't it? i got out of medsurg because of that dumping ground junk. but mine was never half as bad as yours! until the powers that be devise something fair, and uh, SAFE they can keep their rat race all quantity no quality junk to themselves! my sympathies.

Originally posted by deespoohbear
I was wondering if any other med/surg nurses feel like their departments are the hospital "dumping grounds?" In our small hospital, our M/S floor basically gets what the other departments refuse to take. Besides are regular inpatient med/surg patients, are department also does the outpatient blood transfusions and outpatient surgeries. We also get patients from the doctors' offices who come for IV replacement therapy if the ER decides they are too busy to deal with them. We get Hospice Respite Care patients. We get hyperemeisis graviderium patients because OB doesn't want them. They say they are "infectious." So, now the latest thing is ICU has decided they are tired of doing their 3 patients who come in weekly for Primacor infusions and are trying to give them to Med/Surg. The really aggravating part to this is that sometimes are 4 bed ICU has 2 nurses for 7a-7p, plus their nurse manager. Med/Surg usually only has 3 nurses for 21-24 patients. The ICU manager contacted the hospital DON. Now there is an inservice scheduled for Med/Surg are taking care of these Primacor patients. I know taking care of them is that difficult (they all 3 have infusaports), it is just the idea. The nurses on M/S have absolutely no say in what kind of patients we get. Heck, we even get suicide watch patients who are on every 15 minute checks. Yeah, right. I would hope our DON would look out for us for once, but I have this sinking feeling that our department is going to be stuck with these patients also. Thanks for letting me vent.

PhantomRN · Oct 10, 2001

You dont have to necessarily get out of med/surg, but you may want to get to a larger hospital where Med/surg is really med/surg. I enjoyed med surg while I did it. Very diverse population. Many things to learn.

As far as the Primacor and the dopa, both should be on a monitored floor. They however, dont need the unit.

Especially the DNR dopa patient, DNR being the key reason why he dont need the unit. Also, He is only on 3 mikes, which is considered a renal dose (I know there is no such thing anymore). so you arent looking for pressure changes you are looking for an increase in urine.

The primacor, well, monitored is required. I have hooked up a few to their loading dose and they would immediately go into v-tach. Also, They have very frequent vitals when the drip is begun,(Q 5 minutes in the beginning---at least at our institution) which I really dont see how a regular busy med/surg floor could deal with. I would really resist this one coming to a regular floor.

deespoohbear · Oct 10, 2001

Taking care of the dopamine patient didn't worry me, it was just the idea that ECU decided they didn't want him. The doctor is just trying to give the patient's family the idea that we are doing something. I asked the doctor if he thought the dopamine was going to work, and he said no. Our policy states that if the person is going to be titrated on the drip, they have to go to ICU for continous monitoring. I wish I could go to a larger facility where med/surg is truly med/surg, but I live in a rural area. The nearest large facility is over 35 miles away. I don't want to be on the road that much, especially in the winter time. I have learned a lot of stuff on med/surg and generally enjoy working with true med/surg patients. I just don't appreciate our department being dumped on all the time.

h vigliotti · Oct 15, 2001

it is good that people enjoy the dynamics of med-surg, all in all i didn't hate it, but i have a problem with the lack of quality (in my opinion) that the nurse can give. i find your comment about working in a large hospital interesting, i travel for a living, so i have seen the gamut from teaching, county, private, catholic...from ny to california small and large hospital alike, and no matter what med-surge is a big dump. as maybe it should be (meaning all the garden variety) but i think it sucks how that nurse has to contend with 7 people on average, and then add crap that requires monitoring. no matter how skilled or how good the nurse is, that isn't safe. why should anyone accept (quietly) the risk? i agree, you learn alot in med-surg, but i am through being aggrivated with it. i have also discovered cardiac step down aint for me, so i doubt the unit would satisfy me either. i'll keep my talents where they are best utilized!

Originally posted by PhantomRN
You dont have to necessarily get out of med/surg, but you may want to get to a larger hospital where Med/surg is really med/surg. I enjoyed med surg while I did it. Very diverse population. Many things to learn.

As far as the Primacor and the dopa, both should be on a monitored floor. They however, dont need the unit.
Especially the DNR dopa patient, DNR being the key reason why he dont need the unit. Also, He is only on 3 mikes, which is considered a renal dose (I know there is no such thing anymore). so you arent looking for pressure changes you are looking for an increase in urine.
The primacor, well, monitored is required. I have hooked up a few to their loading dose and they would immediately go into v-tach. Also, They have very frequent vitals when the drip is begun,(Q 5 minutes in the beginning---at least at our institution) which I really dont see how a regular busy med/surg floor could deal with. I would really resist this one coming to a regular floor.

:)

willie2001 · Dec 9, 2001

I agree that med/surg can be a dumping ground. I work in a rural hospital and our unit does the out patient blood transfusions that come from LTC, oncology, clinic , etc. Sometimes we know they're coming to us and sometimes we get a call from the doctor that the patient is on there way to us from the clinic. Who cares if we don't have a bed and have to scramble for a place to put the patient. Occasionally, we have an admission just show up at the nurses station. No call to see if we have a bed, no orders etc. It's maddening some days and it always seems to happen on days when we're tearing our hair out busy in the first place. The other day a PIA patient showed up to be admitted out of the blue. The doc never called for a bed, just sent orders with patient. The woman wasn't even sick, but supposedly she was dehydrated from vomiting for 2 days. The first thing she wanted was food. The orders said NPO so we explained that to her and she got mad. She was mad that we had to start an IV because she was dehydrated and needed the fluids. She just didn't know why we had to do these things. This particular patient is notorious for being a PIA and I am convinced that the doc sent her be admitted because he was busy and didn't want to deal with her in the office. So what if we were busy with really sick and needy patients and had to scramble around for a bed for this patient who never should have been admitted in the first place. She ended up leaving AMA the next day. Does that tell you how "sick" she was.

deespoohbear · Dec 13, 2001

Don't you just love it when you get a patient for admission and no orders? We have one physician who is known for calling us and telling us he is sending in a pt for direct admit and that he will fax the orders. So the pt shows up 1/2 hour later and no orders. We call the office. They say the orders will be faxed soon. Another couple of hours go by, no orders. We call down and try to nicely explain to the office nurses that we are in a real bind and could the doctor please send us some orders? Their response is "The doctor is busy, he will send you the orders when he can." I hate to tell the doc this, but he isn't the only one who is busy!!! :eek: Anymore, I just say screw it. If the patient shows up before the orders do, I call the office once. Then I let it be. When the patient gets around to asking me why we haven't done any tests, why we haven't fed them, or why we haven't started an IV I just tell them I waiting on the orders from their doctor. My feeling is if a doctor believes a patient requires admission to the hospital, then that patient warrants timely admission orders. For crying out loud, this doc has the orders in a computer program that he just has to modify to fit the patient and click on a fax button. How hard can that be? :confused:

tenarnc · Jun 30, 2002

Hi all!

I've worked med-surg for 20 years now. Yes sometimes it seems like a dumping ground. But on the other hand, think about what Med-Surg encompasses... Everything. The one reason I've stayed in Med-Surg so long is because it is so challanging. You have to know alot about many different things. Everyone gets patients who don't really need to be there, ever the ICU. Ask them, tell will tell you. I know this because I've also worked as a House Supervisor. And because of that, I feel I can safely say that no patient is placed somewhere because nobody else wants to deal with it. You may have had the only available beds for that patient type. I lnow how you feel tho. A lot of times I've asked "does nobody else have a bed for this patient"? But you just have to grit your teeth and take it. As for the drips, our med-surg units do dopamine, dobutrex and primacor without a moniter, but we have policies in place as to how high the drip can go and procedures for the nurses to follow, like s/s to watch for and how often to do vs, ect. So that way you have guidelines to follow. We also take vent patients. My unit is mostly renal and respiratory, but we get everything. That's just part of it. Not everyone can do it, not everyone likes it. If you are truely unhappy, m/s nursing is not the only option. But if you look for something different, just remember that everyone gets those patients that shouldn't be there