Standards for admission: Should they be more universal?

[AutumnApple]

My beginnings in nursing were on a M/S unit. I actually enjoyed my experiences there on that unit. I think my personality at the time contributed to me striving in the M/S environment too but, my unit was well managed.

Later on in my career I travel nursed. I saw how most M/S units are actually a chaotic mess lacking leadership and direction. Honestly, it was plain to see for me that all the workers were pulling the cart in a different direction.

I also see many threads in here about how M/S is a "jail sentence" and unbearable. I always point out that this has more to do with their unit than the M/S specialty but I'm often very alone in that opinion.

I believe I know what the problem is. Getting to the point where any action can be taken to address said problem is another matter but, to me it's clear where the problem is. And it's not all the time management suggestions that crop up in the "jail sentence" threads either.

I think M/S, being a specialty, needs to mirror other units (units that tend to be more acute, but not always) in that they should have better defined admission standards.

Psych units often will refuse a patient because their medical needs make psych treatment impossible. Rehab units are very strict on whether they will accept someone or not and will refuse anyone who they feel won't show objective improvements in condition as a result of their interventions. ICU and other acute units have guidelines to follow on who should and should not be there.

Yet, where M/S is concerned, it seems those units are turned into the dumping grounds. All patients who don't meet the other unit's admission criteria are sent there. This is folly in my opinion.

M/S units are designed to care for patients who have medical needs (and may require surgery) but are more independent than acute care patients.

This presumed independence is the reason for higher nurse to patient ratios. When the facility's policies promote the unit being used as a dumping grounds though, the reality is different.

I believe this fallacy of a belief that M/S patients are "easy, near discharge" is what puts many of their units on the wrong path. M/S patients require every bit as much nursing as any other patient, just the acuity of their needs isn't something that shows up on a data sheet.

Tighter standards for admission to M/S units would be a big step towards solving this.

(You may be wondering why I posted this in the General Nursing forum instead of the M/S one. I believe tighter admissions standards is needed everywhere, just using M/S as an example helps drive the point home. Also, if the standards did change, it'd affect everyone.)

[Asystole RN]

There is a certification and professional medical surgical organization for med surg isn't there? Do they have any standards relating to this?

[Sour Lemon]

M/S units are designed to care for patients who have medical needs (and may require surgery) but are more independent than acute care patients.

I've never heard anything like that, but I've only been a nurse for about six years. The majority of my patients in med/surg aren't anywhere near independent.

[AutumnApple]

There is a certification and professional medical surgical organization for med surg isn't there? Do they have any standards relating to this?

I'm aware of the certification, but an organization for M/S I'm not sure. They would have much to say on this I'm sure.

It could get complicated making the standards but, it'd be worth it. I'm sure the patients who have to be admitted would appreciate it. No more going forever without seeing anyone because two patients are ruling the staff.

[AutumnApple]

I've never heard anything like that, but I've only been a nurse for about six years. The majority of my patients in med/surg aren't anywhere near independent.

Yeah. The theory goes that M/S units are meant to take care of patients who are close to D/C, have less acute needs. So, of course, the nurses would have higher patient rations.

At some point, the lower acuity went away, but the higher ratios didn't go along for the walk with them.

[KatieMI, BSN, MSN, RN]

Lower acuity doesn't automatically mean "more independent". Just the opposite, patients who are perfectly able to perform ADLs and more but refuse to literally move their fingers usually happen to be less "acute", although overall not much "healthier".

[cayenne06, MSN, CNM]

This probably just shows my ignorance, but here goes- At the tiny rural hospital I worked at as an L&D nurse, your choices were pretty much PACU, LDRP, ED, ICU, psych, medsurg, transfer facilities, or go home. It just seems like there would be a lot of patients who would clearly not be a good fit for any of the other categories, if they did not meet the admission standards for medsurg. I am sure I am missing something here.

I definitely think med/surg nurses deserve to have adequate staffing and resources to handle the acuity of their patient population.

[Cat365]

This probably just shows my ignorance, but here goes- At the tiny rural hospital I worked at as an L&D nurse, your choices were pretty much PACU, LDRP, ED, ICU, psych, medsurg, transfer facilities, or go home. It just seems like there would be a lot of patients who would clearly not be a good fit for any of the other categories, if they did not meet the admission standards for medsurg. I am sure I am missing something here.

I definitely think med/surg nurses deserve to have adequate staffing and resources to handle the acuity of their patient population.

This is exactly what I was thinking. In several of the larger hospitals I have been in they had various Med-surg floors that specialized. Would you divide them again by acuity/assistance needed? Where do the people go who really don't meet any of the criteria?

Would we just have to make a new catch-all floor with another name? I always thought that was the best part of Med-surg each patient was different.

[AutumnApple]

Lower acuity doesn't automatically mean "more independent". Just the opposite, patients who are perfectly able to perform ADLs and more but refuse to literally move their fingers usually happen to be less "acute", although overall not much "healthier".

Exactly.

The problem I have with today's model of a M/S unit is: You have five patients like you described AND two patients with acute needs.

Five of your patients plus someone full blown in alcohol DT's and someone on blood glucose checks every three hours...............

Recipe for disaster.

I'm saying the two with acute needs should be elsewhere so the....as you put it.......unhealthy ones can get what they need and discharged faster.

[AutumnApple]

This probably just shows my ignorance, but here goes- At the tiny rural hospital I worked at as an L&D nurse, your choices were pretty much PACU, LDRP, ED, ICU, psych, medsurg, transfer facilities, or go home. It just seems like there would be a lot of patients who would clearly not be a good fit for any of the other categories, if they did not meet the admission standards for medsurg. I am sure I am missing something here.

I definitely think med/surg nurses deserve to have adequate staffing and resources to handle the acuity of their patient population.

This is exactly what I was thinking. In several of the larger hospitals I have been in they had various Med-surg floors that specialized. Would you divide them again by acuity/assistance needed? Where do the people go who really don't meet any of the criteria?

Would we just have to make a new catch-all floor with another name? I always thought that was the best part of Med-surg each patient was different.

Oh, M/S units would still have to be the dumping grounds, to a degree.

But the acuity would have to fall significantly. I don't believe it's the variety of pt problems that throws M/S units into chaos. It's having patients with high acuity needs thrown in as well that creates havoc.

In my idea of "ideal healthcare", M/S would continue to have it's variety but have better controls over acuity. M/S nurses are known for having a wide range of skills and being able to go from pt to pt when they are not all photo copies of one another. But these gifts are lost in cost saving decisions that place patients with too high of an acuity into the mix.