Holding admitted patients in the ED

[hella_RN]

How do you feel about it? I just started at a new ED. I feel like I am not practicing ED nursing anymore since the patient is admitted. I feel like a Med Surg/Tele/ICU nurse. It can be a bit overwhelming since I am not used to drawing "routine labs" and giving "routine meds." It also can be very busy because I still continue to get "real ED" patients on top of my admitted patients. I'm having a difficult time adjusting to this pace. I'm so used to stabilizing the patient and either discharging them or admitting them STAT. The reason why I love ED nursing is because I don't have to do anything routine, now I feel like I am not in my comfort zone because this is not what I am used to. Please help

[NickiLaughs, ADN, BSN, RN]

We've boarded ICU patients for 3 days before. It's horrific. My joke is our ER nurses should get float pool pay. We try to keep the boarded patients in one area, but it isn't uncommon for us to be boarding 30 to 40 patients (including psych). With 66 beds, and 12 of those that are up front care closing at 10 pm, 4 reserved from traumas. You can imagine how bad the waiting room gets.

[bebbercorn]

I consider myself a compassionate nurse, I really do enjoy taking care or patients. I'm just having a hard time managing my time with the routine things on top on dealing with things that need to be done stat. And the charting system we have is a pain. I just hope that we are only boarding patients because of the season, I sure hope it's not the norm at this new place, but I feel like it is.

ED holds are a nationwide problem. I share your frustration, though. It sucks to have to do all of the admission paperwork plus your load, plus new pts. That plus trying to get the ones who have beds up to the floor. But look on the bright side... you could be a floor nurse, instead...

[1fastRN]

Same problem at our facility, it is so frustrating. Not to mention patients will be asking for their 6pm Lipitor when they hit the ED doors at 545pm and haven't even been admitted yet. I try to put myself in their shoes and understand it's disturbing their daily routine... I'm sorry it's 3am and you still haven't had your Lipitor but trust me... you will live!

Our facility also tries to float nurses down to take care of the admitted patients, but it can be a lot to juggle.

I atleast try to give them a heads up and tell them it could be a while until they get a bed. And I'll try to get them transferred to a hospital bed instead of a stretcher while in the ED (especially if they're older or very uncomfortable).

It is a challenge to care for boarders while also getting new patients.

It's best when the boarders can be grouped together so that the nurse pulling "floor" duty isn't also pulled back into "ED" land but that's rarely practical in our department.

[msjellybean]

I don't mind taking holds, so long as they aren't ICU patients.

And my reasoning is this: while they're held in our department, they are to receive the same care standards as if they were actually on the floor.

Except I can still have up to 3-4 more ED patients, with varying levels of sickness. Unfortunately when patients are roomed from triage, thought isn't given to what nurses also have holds. While actually in the CCU, those nurses have two patients. I don't relish the thought of having 4-5, one of whom is ICU status.