Thoughts from an RN working the Med\Surg floor:
Staffing could very well be an issue for a patient being detained in ER/ED when there are open beds available on the floors. I, for one, have a hard time justifying this practice though.
I think it's cruel and unnecessary to keep a patient in ER when a bed is available. I think it contributes to poor opinions of hospitals in general, and when the patient finally DOES arrive their attitude towards their hospital experience - to date- is very negative. It can sometimes take extra time and TLC to calm these patients.
Is it really any better to keep them in ER until day shift? I don't believe so. Yes, ER has faster access to meds, etc... but can they really deliver the care any faster to a patient simply because they are in ER? Look at the wait ER patients endure just in Waiting Room time... even before they are taken in and seen by nursing or a doctor. And the patient who isn't as high a priority as another will still have to wait for treatment.
One of the biggest problems I encounter are Units that don't/can't/won't take a patient not specific to their unit. And while I will agree that every attempt should be made to place medical patients on the medical floor, surgical patients to the surgical, ortho to ortho, etc... SOMETIMES we need to think outside the box and give our priority to the patient and their immediate needs... which are generally to get them IN A BED ASAP. They are much more understanding when they need to be transferred during the day shift to a more appropriate unit if they have a shorter stay in ER.
Too often, I've seen beds stay empty because Nursing is too preoccupied with wanting to maintain control... at the expense of the patient.