Hi! I'm Tweety Your Critical Care Med Surg Nurse (Or long waits for ICU beds)

nursemaa · Mar 6, 2004

We try very hard to keep an ICU/CCU bed open for that unexpected "crash and burn" (or someone like your patient) from the floors. That means getting after docs to transfer patients out who no longer need critical care nursing. It's a tough battle, and I hate when we have to go there, but as an ex-supervisor and now a unit manager, it's really uncomfortable not to have that bed available. Sometimes, if no one can transfer out, you just have to punt. But you can almost always find a patient in ICU/CCU who really doesn't need to be there, and if you tell the doc that you need to make a bed for another patient who's condition is deteriorating, he/she usually will comply. I've been successful by using the " Dr. so-and-so, we're really in a pinch and I'm hoping you can help...." approach. Our nurses are terrific about getting patients out quickly when the floor has a patient who needs to be transferred. I also try to get another nurse, or cover the patients for the nurse who is dealing with the deteriorating patient. I would say we can usually get a floor patient into ICU/CCU within an hour or two. 12 hours is WAY too long.

unknown99, BSN, RN · Mar 6, 2004

We try to keep 2 beds open in ICU for inhouse patients, but we have to keep one open

at all times. Sometimes it gets a little crazy trying to move beds around, though.

EastCoast · Mar 6, 2004

tweety, i can sympathize. i've seen in our faciltity the floor patients waiting to be moved while the ED patient gets the bed. I think what everyone fails to realize alot of the time is that a floor patient who needs ICU is an ICU patient who is in the wrong place. A lot of times the assignments are 'lightened' for the nurse but usually the nurse is ill-prepared to care for a critically ill patient as it is beyone the scope of her current ability in a lot of the cases. We are lucky as our ICU medical director can make all decisions to move patients without calling the attending docs but when there are 'no beds' we are screwed.

The oddest case of inappropriate care was a patient i consulted with ARF and a creatinine of 9.0 who didn't have an icu bed immediatley available so she was put on the GMF and no provisions were made in the assignment. When i went in to see her in the AM and i couldn't find her in the unit or the ED i almost fell over when i found her on the wards. It just made for a lot more work for everyone to know move her to a monitored bed.

MandyInMS · Mar 6, 2004

Ohhhh how many times have we played Ring Around the Rosie..shuffling pts back and forth....~singin~...take one down,pass him around....99 bottles of beer on the wall~

totally frustrating ..not to mention dangerous :/

bellehill, RN · Mar 6, 2004

Wow does that sound familiar...just last night we got an admission on the floor from and outlying hospital that immediately began seizing and became unresponsive. Guess what, no ICU beds in the hospital. Our neuro ICU was short staffed and couldn't take the pt even though they had two empty beds but we couldn't keep the pt on the floor. Thankfully our ICU staff sucked it up and someone tripled patients. This morning the pt was vented and they discovered a huge head bleed, not a good prognosis.

Marie_LPN, RN, LPN, RN · Mar 6, 2004

They're turning half of another floor into another ICU. Twenty new beds. We never had any empty beds for anyone who took a turn for the worst.

fergus51 · Mar 7, 2004

You keep vented patients on med surg? This is exactly why I avoided medsurg like the plague once I finished school. I have never worked in a hospital that had enough ICU beds....

Marie_LPN, RN, LPN, RN · Mar 7, 2004

You keep vented patients on med surg? This is exactly why I avoided medsurg like the plague once I finished school. I have never worked in a hospital that had enough ICU beds....

(Who were you asking?)

fergus51 · Mar 7, 2004

Asking Tweety or anyone who knows. I have never heard of a vented patient being on a med-surg unit. Maybe stepdown, but even that would scare me. Can you tell I admire med-surg nurses, but NEVER want to go there myself? Too scary!

Marie_LPN, RN, LPN, RN · Mar 7, 2004

Our ICU/CCU is on a 2nd floor. The med-surg floor above it is a 40 bed private room floor. That floor is laid out in an H-shape, the horizontal part of that H is where the one nurse's desk is for now.

The left side of that H will be the new 20 bed part of ICU. There will be 'minidesks' set up for each nurse (six of these) and one main ICU desk. This is also the side of the hall that has the direct elevator to ICU/CCU. The goal is to keep 5 beds reserved for the inhouse pts.

The other side of that H, plus the horizontal part is supposed to be just med-surg, but they are thinking of turning that into part of telemetry, since they are short on space as well. And the telemetry floor is the 4th floor, so this new part would be below them too.

IOW: The end result will be same floor, two different units. No vents on the med-surg, unless it's something like a 3 ft snowfall that keeps this place full.

CCU NRS · Mar 7, 2004

We try to keep 2 beds open in ICU for inhouse patients, but we have to keep one open
at all times. Sometimes it gets a little crazy trying to move beds around, though.

Same in my unit we always have one bed open for codes etc. the worst thing is when you are on divert from outpatient admits but ER continues to fill and then they need unit beds but have to wait until as above mentioned we make some moves. We always take or our inhouse Pt's tho.