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

Tweety, BSN, RN · Mar 8, 2004

hmmmmm What is a boarder nurse, I have never heard this term, is it like they float a nurse from ICU to your floor for the PT or they give it to a nurse that can work ICU?

I've never heard that term either. But when our ER is olding a higher number of critical care patients than they can handle, the units are required to send any on-call people down there to take care of those patients, or to float any extra nurses they might have (of course, they never have any 'extra').

New CCU RN · Mar 8, 2004

3:1 ratio for semi-stable hospitalized vents sounds about right. Nurses in LTC vent facilities take more, but generally they are stable trachs. My new manager would like to implement this on our stepdown, we'll see if this comes to pass. Unfortunately our hospital has a problem with our doctors placing their 'favorite' patients on our stepdown because of the better ratio/better care.(not necessarily that they NEED the critical care...the doc wants it...and our CM's are trying in vain to fight the docs on this) So our stepdown and ICU are always packed, with patients waiting for critical care beds in ER and PACU forever. We NEVER are allowed to keep a bed open for codes, etc anymore and are generally playing 'musical beds' in hectic fashion to accomodate patients who really require critical care....gets tiresome doesn't it.

LOL...sounds like my hospital. We have some docs that are NOTORIOUS for keeping patients in the ICU rather than stepdown for "better care", reasons such as: "they won't get CPT in stepdown" or other things in like that.. meanwhile they are not ICU patients and there will be an ICU patient in the ER needing a bed or on the general med floor but crumping. We do try and save a bed for a code. However, there are some units that play the game of we want the code bed until there is a code and then it should go to the cardiac unit b/c it was a cardiac arrest...meanwhile we had to admit a neuro bleed bc nsicu had the code bed.... some units also like the misuse it as their "case" bed for the next day...

Katnip, RN · Mar 8, 2004

We take vents in our intermediate care unit, often in worse shape than they ought to be, but when ICU needs a bed for someone worse, there's not much else we can do. Anyone who has been stable and on a vent for more than a few days can come to us.

Our ER will hold patients only when there are no other critical care beds available at that time. We work really hard to move patients who don't need to be there, but I get so ticked when a patient is in a critical care unit on VIP status because they happen to know the CEO or something and there are no private rooms available anywhere else. THAT really burns me up.

No matter how bad it gets, we never, ever send vented patients to med-sug. The bed nurses and docs will shuffle for hours until we get room. One day we had to put two vented patients in the hallway while they swapped rooms and the rooms were being cleaned. God forbid anything would have happened to them while they were in the hall. Never saw housekeeping work so fast. And we have a decent housekeeping staff.

SmilingBluEyes · Mar 8, 2004

boy we better be afraid, very afraid....

this care we see

is what we will get if not worse when we need it......

sad and scary.

kimmicoobug · Mar 9, 2004

Man, we have patients ALL the time that are just too acute. A few weeks ago, ICU was full,so I had two chest pains and a guy that I coded in one night in a group of seven on med-surg. Dx of patient A. "Chest pain" with positive isos, and classic MI symptoms. What the hell was she doing admitted to med surg?!!! Why wasn't she in ICU on the r/o MI protocol. I went to my director and complained, in a civil fashion of course. The other patient, went into a long run of V-tach (she was alert, and ok in the end...but still). Then the patient that did make it ICU was the one that coded and placed on a vent. And this is in one night. :angryfire

Last week we had a float that works alot in ICU make the comment that there are several patients in ICU that she couldn't understand why they were up there because they were actually less acute than a lot of the patients on the floor.

Tweety, BSN, RN · Mar 9, 2004

boy we better be afraid, very afraid....
this care we see
is what we will get if not worse when we need it......
sad and scary.

Absolutely! The general public should be afraid. Here and now they should be afraid. I'm afraid.

fergus51 · Mar 9, 2004

Well, I am just not going to get sick Tweety;) Seriously, I love the med-surg in our hospital. They do primary care and have 5 patients.

CCU NRS · Mar 10, 2004

I work in the ED and if a floor patient requires and ICU/TELE bed and there are no beds in the hospital, we get the patient and HOPEFULLY we also get an ICU or TELE boarder nurse... But sometimes we don't
Becky:)

BUMP again what is boarder nurse?

EmeraldNYL, BSN, RN · Mar 10, 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!

Our med-surg units will occasionally take stable vented patients. Usually they are vent-dependent quadriplegics. The criteria are that they must be hemodynamically stable, trached, and must be on AC settings (pressure support weaning is done in the ICU only). These patients also must be placed next to the nursing station.

GOOSE2 · Aug 17, 2007

Hi Tweety thanks for your infor. early. I just moved from OKC to New Hampshire. I worked in the ER in OKC and I can tell you I have waited as long as 29 hours for an ICU bed just for the ER. I have always worked nights and found that even if there are 20 beds avail. in the am when I got there, there was only 1 or 2. What I found in our facility is that alot of the pts. that are put in ICU from the ER really don't need to be there. It is primarily doctor choice. What I found is that with all the new HOSPITALISTS they prefer the ICU (nurses) because if they screw up (docs) with their diagnosis and something goes wrong they are covered. I myself have taken pts up to the ICU in a wheelchair and no monitor! Primarily the ? drug overdose just to be watched. Anyway that is my take on it.

thanks

EmmaG, RN · Aug 17, 2007

We never have enough ICU beds in our hospital. They fill them up with ER admits and never have enough beds for in-house emergencies. We had a patient with sepsis low blood pressure that was low all day, well after nearly 5000 cc's of fluid bolus and a bp in the 80s they md decides to transfer to ICU for frequent bp checks and montoring. The patient had a wicked case of pneumonia and was on isolation for rule out tb.
It took 12 hours to get a bed. I took care of the patient on the floor the entire time. Taking bps q1h and running fluids at 250 cc/hr. She did o.k. and eventually I got a bed, that had been open but was unstaffed. The patient wasn't crashing and burning, and I felt confident watching her, but I neglected other duties and "my" nurses, as I was in charge, and I had another patient that was stable but vented. I also felt sure because the super. knows my skills and what a nice guy I am, she felt o.k. with making me wait. But she was a bit frustrated trying all night to figure out a way to creat a bed, the big problem being she was on r/o tb.
I filled out an incident report.
So how long do you wait for critical care beds in your hospital?

Before traveling, I worked at a 500 bed hospital with only 3 12-bed ICU's (MICU, SICU, CCU). The bed availability is misleading; that includes L/D, psych, rehab, and potential patient rooms. The actual census when full ran around 250-300, from what I remember. The wait time really wasn't too bad, though. There was always a 'code bed' held, of course, but I rarely had an issue getting a patient moved. At times, we would have to make a "trade", taking a relatively stable patient from the ICU or PCU in return for moving our patient in.

We were generally able to get a patient transferred within an hour at the outside. With sepsis (keep in mind our patients were neutropenic), we moved pretty quick.

Something that we did NOT have was a rapid response team. So often we did have shifts where we were doing some pretty intensive care prior to getting a transfer order. I always tried to give the supervisor a heads up when I saw a patient heading down that path so that they could start figuring out where to put them.

At the larger trauma hospital in our town (with a plethora of ICUs), the wait time could be much longer. Hours. I don't recall it taking quite as long as you state here, but I do know of some that took most of an eight hour shift to get moved. The clinical resource nurse was required to stay with the patient on a monitor and a crash cart and accompany them to the unit, regardless of how long it took to get them there.

Since I've been traveling, I've worked mostly larger hospitals and trauma centers. Surprisingly, the wait times haven't been excessive. Perhaps because of rapid response? I don't know .

Twelve hours? That's insane. I think you were right in filing an incident report. Not to place blame, of course, but risk management needs to figure out where the kinks are in your system.

Edit: oh for Pete's sake... I just noticed the date of this thread LOL.

Got me again :stone

All_Smiles_RN · Aug 18, 2007

At my hospital, I have to say they are good about moving a pt to ICU when things take a turn for the worse. Our problem is sending inappropriate ED pts to my floor (PCU) that should have gone to ICU. Also, med-surge pts that have a rapid response call will sometimes come to my floor, and more often than not they should have gone to ICU.