No beds available?

Nurses General Nursing

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I was admitted to a major hospital here in Houston. I layed in the E.R. for 7 hours waiting for a bed. When I was finally settled in comfortably in my room, the lady in the bed next to me told my husband that bed was open all day. Why would the E.R. say there were no beds available all that time? Just curious, is it possible that if there isn't enough nursing staff the floor cannot accept new admits?

Hey PRN that was my hospital that you posted that nursing was controlling bed placement.

Shocked to see that our little hospital was a "trendsetter". Actually the process works extremely well. What we have is a shift coordinator in which all bed placements are made. Then each floor has a "color board" in which data is entered and then a color is selected based on the amount of staffing and acuity of the patients. Patients in my opinion don't sit down in ER waiting for a bed. ER patients are placed generally as a priority, if you have a bed (such as a transfer) stays in that bed until a bed becomes available. Units have green, yellow, orange and red status. The shift coordinator sees the color and knows that a floor can handle more or less patients during a shift. The board is updated all the time. Sometimes you end up getting a patient that is not in your speciality but for the most part the system works really well. I love it and would never go back.

When the hospital is full then patients are rerouted to other hospitals or planned discharges are expedited. :kiss

http://www.metrowestdailynews.com/news/local_regional/walt_hospital04112002.htm

Please know that I am not trying to place blame OR open a can of worms, and I am not especially not trying to get in an argment, but there is no "you" or "I" in TEAM. Frankly, I think attitudes like those expressed by mattsmom are exactly what keeps the "us vs. you" problem continue to be a problem. I am the one to offer to hold patients and do so if possible when the floors are buried! If you want to get technical, the same could be said in reverse; if you are busy and the bed is staffed and empty then maybe it's the floor's problem and THEY need to get additional staff, but I defy anyone to find me stating that in a post, as I AM aware of both sides, thankyouverymuch!

An exerpt from RN magazine Sept '01 written by Valerie Lyttle: Before I movd to the emergenc dept. in 1995, I'd worked on a variety of different units over the course of my nearly 16 yr. career. So to me, this latest ove wasn't especially noteworthy. A collegue of mine, however, viewed things a bit differently. "I suppose you'll develope that ED attitude," she remarked on my last night in my old unit. "That ED attitude," I have come to learn, means having a reputation for being aggressive, assertive, loud, demanding, tenacious, and bossy. ED nurses are frequently called chronic complainers and are also accused of not understanding the floors, the pts, or their families. At times, ED nurses certainly are guilty of all of those things. While I don't excuse offensive behavior, I would like to share withyou some very good reasons why those of us who work in the ED behave the way we do. "The challenge of being a jack-of-all-trades" If on some days we seem to have an attitude, try to understand how many different nursing tasks we're called upon to do. Although we're best known for our ability to treat emergency trauma, we also have to be part labor/delivery nurse, part pediatric nurse, and part geriatric nurse. We must move among all of our duties quickly and easily, turning from a critically injured child to a pt with a sprained ankle to a cardiac pt without skipping a beat. We take on the role of clinic nurse, caring for pts who return for daily antibiotics and staying up-to-date on those diseases that are reportable to public health agencies. We are oncology nurses who have to help cancer pts through an oncological emergency or support them as they exit this world. But it doesn't stop there. For some pts, we are renal nurses; for others, we are orthopedic nurses, applying all kids of splints-and sometimes even making our own. We are pulmonary nurses, helping asthmatics and pts with COPD, and we are neuro nurses, rushing a stroke pt to the radiology dept for a CT scan to determine which treatment protocol he'll need. We are cardiac nurses when we must work feverishly to get enough IV's in place to administer thrombolytics to a pt suffering an MI. We are intensive care nurses when we are looking after a pt who's septic and going into multisystem organ failure. Then we may have to turn to a burn pt and know the priorities of care for someone with severe burns to 70% or more of his body. In addition, we must know what to do for a pt involved in a hazardous material incident. We are forensic nurses when we assist with the exam of a sexual assault victim, or attempt to collect and preserve evidence on gunshot victims. We dabble in psychiatry when we keep a pt experiencing an acute manic or paranoid episode from harming himself, or encourage a severely depressed woman to hang on. We are also educators, teaching pts how to walk on crutches or manage their asthma at home, or explaining to a new mother what to do when her baby develops a fever. We promote safety by reminding pts about the correct use of seatbelts and helmets. We're also the "SWAT team," responding to codes and crises throughout the hospital. "The added stresses of emergency care" In the ED, we have to be able to respond at a moment's notice, no matter what else is going on. The ED doesn't have the luxury of closing, can't turn away pts, and always has to make room. When a sick pt comes in, we can't say, "Sorry, we're full," or "Sorry, that nurse is on break." We have to pu ou feelings aside-in fact, we're TOO good at negating our own feelings, and as a result, we're at high risk for PTSD, an occupational hazard for all emergency care providers. In the ED, we also see humanity's worst. We deal with murderers and rapists. We look after victims of abuse. We care for innocent victims of alcohol-related car crashes. We see people during the worst tmes of their lives. We are there when a critically injured pt pleads withus not to let him die. We are there when a family tries to achieve a sense of purpose for the loss of someone they loved as we explain organ donation. "Why we are the way we are" If we seem aggressive, perhaps it's because drunk or distraught individuals verbally abuse us. We try not to take it personally, but it's hard to duck every arrow when you are in the line of fire. We also face the risk of physical assault and threats to our safety as part of the job. If we seem too assertive, it's because assertiveness is an essential quality in any nurse-especially those in the ED. We have to speak up for pts and their families in situations that are often chaotic. In addition, assertiveness is essential when we triage pts. We need this quality when explaining to the pt who feels miserable with the flu why she must wait for hours while another pt gets treated immediately. If we seem loud, it's because we sometimes have to shout to make our feelings heard in a busy trauma or resuscitation situation. If we appear demanding, it's often because we need to get admitted pts to their rooms to free up beds for another who's waiting-and there's ALWAYS someone waiting. We're also demanding when we have a full unit, plus six or eight pts in the halls on monitors, and we're running out of both beds and equipment. If we are tenacious, it's because we know that sometimes you have to prove your point with attending physicians or residents who may want to discharge a pt you believe shoud be admitted. ometimes tenacity is required for airway management, to do everything possible to avoid having to intubate someone in an acute asthmatic episode. Are we bossy at times? Absolutely. But that's because we have to be able to respond appropriately when a major trauma rolls in-whether or not a physcian is available at that moment. So if at times we seem curt or irritable, please bear with us. We realize these qualities can be exasperating. While it's true we chose the ED-and most of the time we love it-this nursing specialty can be physically, mentally, and spiritually draining. Please try to understand us when we get that ED attitude.

That about sums it up--Amy

Amy, what you call an 'attitude' on my part I call setting healthy boundaries. There is only so much patient care my unit can manage with 3 nurses on my 12 bed CCU with NO option to get more nurses.Please understand, I am an old ER nurse and do understand what is going on.. But when I am in ICU or CCU and ER starts pushing me to take more than my unit can handle safely I am obligated to set some limits. My BON mandates it.

The answer to ER's problems will not include my staff in ICU taking 4 patients each and this is what we would have (in my area ) if supervisors and charge nurses nurses did NOT set safety limits. If your facility does not do this, then you are fortunate, my experience is that most WILL if they can get away with it.

Another problem in my last facility...The ER medical director gets a bonus based on admissions and turn around time. So he and his staff attempt to push floors to bed capacity without taking into consideration the staffing situation. He gives the same speech you do, Amy, and I give the same answer ...:) One facility I used to work at made it against hospital policy to refuse admissions. I didn't stay on staff.

I'm not angry at you, Amy, just firm in my conviction. I would like to see California's ratio mandate spread to all 50 states. Nurses are leaving the profession due to burnout, and we have a shortage...let's look at the reasons. Ok, I'll get off my soapbox...;).

Peace! :kiss

Firstly, I would like to openly thank mattsmom for not taking offense to my response; I have seen it happen to others and boy, did I think I was gonna get it!!!

Secondly, I do agree with mattsmom, NO ONE should be knowingly placed in an unsafe position, period. But, the fact is, it happens everyday. may not be in my facility or mattsmom's, but somewhere in our big ole lovable corner of the earth it is. In my facility, our director gets no bonus (as far as I know), and I wish every facility was as receptive as yours when staff respond due to unsafe conditions. As for CA's staffing ratios proposal, wouldn't it be nice if there was a policy that was intended to support the nurses and promote safe patient care in a realistic way?!?

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