Bed assignment

LM NY · Dec 2, 2018

You're not offending any ED nurses. I'm sure they put someone at least as sick in the bed they managed to clear out...
However, you might be offending the safety people. They are working harder than any of us on making things appear to be safe.

Lol @ safety people. I guess someone is bound to get offended in the hospital world. I understand they cleared out an ED bed for someone just as sick, but if that patient was never truly stable then they should have at least sent them to a monitored setting. I have found important details left out of reports from ED multiple times. I always try to give the benefit of the doubt, but it is possible someone just wants to pass the buck. There was a roadmap that they recently implemented, which is supposed to decrease the time it takes from the moment of bed assignment till actual transfer of patient. If we pretend like hospitals aren't looking at the big picture($$$) then we would be lying to ourselves.

JKL33 · Dec 2, 2018

There was a roadmap that they recently implemented, which is supposed to decrease the time it takes from the moment of bed assignment till actual transfer of patient. If we pretend like hospitals aren't looking at the big picture($$$) then we would be lying to ourselves.

Whatever their "roadmap" is, it has been implemented as a direct result of the related CMS Core Measure for the ED.

LM NY · Dec 3, 2018

Whatever their "roadmap" is, it has been implemented as a direct result of the related CMS Core Measure for the ED.

I'm sure you're right. You are quite the resourceful one, my fellow AN'er. One of the underlying issues is unsafe nurse/patient ratios. Nurses wouldn't feel so overwhelmed with new admissions/transfers filling up empty beds if they didn't have a heavy patient load.

nursej22, MSN, RN · Dec 3, 2018

Now that's a different story. The purpose of ER is to treat and stabilize. Does your management get the drift?

That used to be the purpose of the ED. Now it is diagnose and place. Patients may or may not get treatment started, or any measures to stabilize. Now it's all about through-put.

Rapid afib? Get the labs drawn, EKG and X-ray done. Notify hospitalist of admit. Possibly get a bolus of cardiazem, and then transfer to floor, whether or not they even have telemetry.

Its up to the floor to address hypotension or bolus with metoprolol, electrolyte replacement, draw coags, start cardiazem & heparin gtt, and let patient void, orient them to room, let family know what to expect.

Daisy4RN · Dec 3, 2018

Lol @ safety people. I guess someone is bound to get offended in the hospital world. I understand they cleared out an ED bed for someone just as sick, but if that patient was never truly stable then they should have at least sent them to a monitored setting. I have found important details left out of reports from ED multiple times. I always try to give the benefit of the doubt, but it is possible someone just wants to pass the buck. There was a roadmap that they recently implemented, which is supposed to decrease the time it takes from the moment of bed assignment till actual transfer of patient. If we pretend like hospitals aren't looking at the big picture($$$) then we would be lying to ourselves.

We know that hospitals are only interested in the big picture($$$). It is just sad for patients who suffer bc of it and also nursing staff who can never catch up and it can pit units against each other. The last hospital I worked at would not call report nor even let charge know the pt was coming up. We had patients left on the gurney in the halls who were not stabilized, confused, needing immed med interventions etc without one word (the way the floor was you might not even see the gurney for 30min or so) And this was an acceptable practice to management. This was a step down unit and I cannot tell you how many people ended going to ICU without ever being admitted. Such poor practices!

LM NY · Dec 3, 2018

We know that hospitals are only interested in the big picture($$$). It is just sad for patients who suffer bc of it and also nursing staff who can never catch up and it can pit units against each other. The last hospital I worked at would not call report nor even let charge know the pt was coming up. We had patients left on the gurney in the halls who were not stabilized, confused, needing immed med interventions etc without one word (the way the floor was you might not even see the gurney for 30min or so) And this was an acceptable practice to management. This was a step down unit and I cannot tell you how many people ended going to ICU without ever being admitted. Such poor practices!

WOW!!! I honestly felt resentment towards my hospital because I thought we were the only place that did crazy things like that. I am so grateful for this platform. Thank you to all for sharing.

Kooky Korky, BSN, RN · Dec 3, 2018

And it will all continue until all of us find our courage and start putting our foot down.

Until we get the attention of TV stations and lawmakers and the regulatory bodies and family members of patients, it will be business as usual.

You can lament as much as you want, but nothing will ever change unless you start speaking up. Loudly.

"Kneel" like the football players until things change.

Axgrinder · Dec 3, 2018

I left working in a certain ICU 18 years ago for the same reason - an open bed does not always mean we have enough nurses to take that admit (sometimes with no warning at all).

I usually got stuck being charge (with 2 of my own very sick patients) because most nurses refused to agree to do it. The last straw was a night when PACU was wheeling in a fresh AAA at one end of the unit, and ER was wheeling in an unstable cardiac patient whom they had just floated in a transvenous pacemaker from the other end. Neither one could give any warning?

I remember standing in the middle watching both with my vision telescoping down thinking, "OMG! Now what???". We had already called in our on call nurse - there was no one left to call.

The stress from that job made my hair white long before it's time (but it wasn't the only one).

martymoose, BSN, RN · Dec 4, 2018

Well I hope they're happy when all the people with any experience at all vote with their feet. I hope none of my family ever has to go to a hospital.and yep, I have no reason to complain anymore.i just make myself look like an ass the longer I stay and complain about things.thanks for listening.moving on....

Neats, BSN · Dec 5, 2018

I remember when I was charge I would always ask for assistance with admissions...in the end I would track our patient load, patient acuity, and high need time constraints, I would complain loudly at management meetings with the proof...no one listened, got my hands slapped. Only one hospital I worked for in Colorado took me up on the ideal of adding a nurse for "Light touch assistance" this nurses duties was to work in not one but two units throughout their shift helping other nurses. It started out OK but real quick, was abused, for a lot of nurses would give that nurse the tasks they did not want to do until I stepped in again, having to designate what that nurse could/could not do for the unit. After that it got better and they did a lot of DC and admitting, IV starts/pharmacy clarification and blood cross/match-- (why you ask....we lived at a high altitude of about 4500 feet above sea level). They also ran interference when a patient/family member has complaints. At least where I was at those were the duties that nurses needed help with the most.

After a year it started to "Gel" and the nurses became very wise at the value of the nurse who was assigned this duty. Not sure what happened to that position but we did receive recognition for enhancing quality cares and patient seemed to like it.