No beds available?

  1. 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?
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    Joined: Jan '02; Posts: 78; Likes: 10
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  3. by   dawngloves
    That is a real possibility. They were most likely trying to cover the fact they are short staffed.
    Sorry you had to sit in the E.R. so long when you were sick. Hope you're better now.
  4. by   2ndCareerRN
    That is a very good possibility. In the hospital I work in we are often asked to keep the new admits in the ER until the day shift comes in and their staffing is more in line with the patient load. We will also often put med/surg pt's into PCU or ICU for a short while primarily due to staffing issues.
    I personally feel that is the pt needs to be held in the ED for a while it can be a positive thing. We can get IV ABX and other meds started sooner than if the pt went to the floor. Not because the floors are slower, but because we don't have to wait for MAR's, pharmacy delivery,,etc.

  5. by   Fgr8Out
    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.

  6. by   fergus51
    This is routine in our hospital. We keep several beds on one floor empty because we don't have the staff to operate them. It would be unsafe to put patients in them. I had one family get really rude with me when I was floating on a medical ward because they had to wait in the ER, but all the beds in the room were empty. I then calmly explained the difference between a staffed bed and an empty bed...
  7. by   P_RN
    I believe it would be better to stay in the ER rather than be placed on a unit that is so understaffed that meds and treatments might be seriously delayed. After all once they are seen by a doctor there the treatment can start, right? I am not condoning the practice, but when you already have 14 patients to care for one extra might mean the difference between fair care and dangerous care for all.

    One other thought is that while the bed may have been literally empty all may very well have already been assigned to another patient...say in PACU or one of the monitored units. We would frequently have all our beds assigned long before the "old" patient left and long before the "new" one arrived.

    If, for what ever reason the "new" one didn't show up, then the bed was released for the next in line.
  8. by   kaycee
    Most of the holds we have in our ER are not waiting for "empty beds", there are plenty of beds just not enough staff to take care of patients that are put in them. That's pretty much the case all throughout the city. Staffing is the major reason for diversion right now. Plenty of beds, just no nurses!
  9. by   P_RN

    Read this, from Brian's nursing news. It is a wonderful idea. NURSES manage beds......
  10. by   nurs4kids
    When we get low on beds and end up on "bed control", they will reserve the last two or three beds for trauma's and other critical patients. Patients with less critical needs are held in the ER until the d/c's begin the next morning.

    This may have been the situation.??

    lol, I had to come back and edit..
    7 hours is the average wait in our ER even if we have plenty of beds (from triage to floor)... many times patients are told they were waiting on a room to open up when in reality, they were waiting on houskeeping to clean the room..sad, eh?

    Nursing DOES control the beds in our hospital, have for years. I didn't even realize it was done differently elsewhere...
    Last edit by nurs4kids on Apr 29, '02
  11. by   thisnurse
    i was in kmart last night and the only checkouts open were the self service ones. i was wondering how this could translate to our less critically ill patients...

    lets take a patient with abdominal pain for example...

    vital signs..we already have machines that measure bp, pulse and respers..ppl can take their own temp ...we can use touch screens to record them.

    pain control...touch screen with diagram of body to point out location...then the 0-10 scale to rate severity.

    meds..doc puts the orders in...secretary programs them in a computer and that dispenses the an ATM machine.

    diet...they can order from a computerized menu within their docs set limits.

    tests...print out will come up telling them what tests they are having and what time. give them access to a frequently asked question

    they could have an "emergency menu"

    i need a (press button)


    my problem is (press button):

    im having a heart attack

    i cant breathe

    not sure

    we can take this all one step further by having botique like hospitals where they can choose the service they want...

    -self serve hospitals (like above)

    -semi serve get assessed daily but thats about it...everything else is automated

    -full service hospitals...what we have now without the pillow fluffing

    -chez hospitalitiques..all private rooms staffed with butlers and maids...fine cuisine chosen from a four star menu....king sized beds...nightly live entertainment (when applicable) ...designer hospital gowns...spas....staff of massage therapists, beauticians on call 24 hours (never know when a nail will break)...

    i think im on to something
  12. by   Jen911
    I hate to be the bad guy here, and I'll probably get yelled at for this.... but I keep going back to PRN's post about folks staying in the ER and getting their treatments started down there. I think we're losing some focus here.

    We need to keep in mind what the ER is actually for.. It's for the Emergency at hand. We end up holding patients for 16+ hours at times, meaning we're taking up monitored beds in the ER. When this happens, we can't use these beds for other patients who are coming in with new emergencies, but the beds are being taken up by other patients who have been stabilized and should actually be up on a nursing unit. Yes, I understand there aren't enough nurses upstairs to take care of the patients, but there aren't enough nurses in the ER to take care of these patients, PLUS those patients who are sitting in the waiting room, and those who you can't anticipate you'll be getting (the dreaded unknown in the ER).

    The ER where I work has 4 RN's from 3am-7am. Just a hypothetical: If we're holding several patients, and we have an ambulance bring us a cardiac arrest, that's going to tie up at least a couple nurses... Then we may have 2 patients come in the door with chest pain at the same time.. (it's happened).. Those patients who are being held aren't going to receive much care during that time since they're (hopefully) stable.. We'll do the best we can and see if we can pull a nurse or two from the ICU to help with the code.. but it can get pretty hairy at times.

    I hope you can understand where I'm coming from. Patients and families get tired of sitting in the ER for hours on end. Our guerneys are hard, it's noisey, there's no TV, no phone, no bathroom handy, no privacy, and it's just plain uncomfortable to sit there and wonder what's going to happen to their loved one. They want to see granny settled into a bed and tucked in so they can go home.
  13. by   hapeewendy
    well my motto is , have a bed, give a bed
    but nursing isnt in control of assigning beds in our hospital
    we have an admitting dept , that goes to emerg and figures out what the pt problem is, what their coverage is , yadda yadda then does a census of available beds per floor.
    they try to put pts where they "belong"
    IE- medicine for medicine , ortho for ortho
    but of course exceptions have to be made.
    and there are tons of occasions when a.we have no beds available - more often than not we have a full house, and b.beds are empty but not cleaned,
    this is especially a problem with rooms that were isolation and need deep cleaning, housekeeping doesnt rush unless paged stat- and that rarely happens
    and sometimes just sometimes the ER is so overfilled that we couldnt find beds for everyone regardless......
  14. by   SOCRATES SOUL
    So what ,we have to wait 6 hours or even 22 hours in the ER before the next ward transfer........I say we as westerners living in developed countries should be incredibly grateful that we are receving prompt, efficient and effective medical treatment at all....

    Whats time when you are sick?You are in and out of sleep anyway.... Patience is what we reinforce lets not forget it when we are patients....:zzzzz

    I have been to parts of Asia and some other countries in the world that are filled with medicaly starved people deprived of the basic human right and we in western societies should stop and think outside the bubble our society encases itself in.......:stone

    EMPATHY should make the world go round not money.......but that is an optimists' outlook anyway...........