24-hour observation nursing

On the floor I work on, Telemetry, we have people admitted for 23 hour obs that are mostly chest pain r/o MI... draw their cardiac enzymes and go from there, maybe about 75% of the time they are upgraded to inpatient status because they have to stay longer for one thing or another.

I work on an observation unit. We get lap chole and appy's, lite ortho, cysto's, TURPS, thyroid surgeries, sleep apnea (turbanate reduction etc.), transfusions (typically on fridays because the infusion center is closed on week ends) and overflow from all units including women's. We have no monitired beds, so anything that needs one goes elsewhere. We get some medium surgery patients if we sent them and they had to go open due to rupture or other difficulties--they come back to us and stay until they are discharged. Also, on the week ends we tend to fill with medical patients because there are no scheduled surgeries on the week ends so we get what ever comes in the door. This includes nursing home, oncology, flu, pain mgt/drug seekers, copd..pretty much anything that is not monitored.

The beds turn over fast, if the unit is like ours you'll need skates. The record is 4 patients in the same bed during a 12 hour day shift--1st left, 2 admitted and d/c'd and the 4th came to the bed and stayed. The record for admits during one shift is 22 on days--we have 30 beds. Our ratio is 6 to 1 on all shifts, day nurses have a dedicated tech, night shift has 1 tech for every ten patients. Days also has an admit nurse which is an absolute must. Admit nurse also helps with discharges, med passes--whatever needs to be done until the admits start piling in.

From what I gather, hospitals do not count these obv beds as beds because they are outpatient. It's seems as though it is a way for them to increase the number of beds without having to get a certificate of need.

I've been on this unit for 4 years, I like the patient type and the pace. Codes are rare, and usually it's the medical/nursing home patients.

Hopefully this gives you an idea of what you might be in store for if you make the move:)

I work on an observation unit as a PCA/US and will be a RN on it in June. Our unit is a little different than the ones above. Almost all our patients come from the ED and are placed on our unit to r/o MI or other conditions. We do the lab work, tests, monitor the patient, and wait for a doctor to discharge or change the patient to an inpatient status. Once the status is inpatient, we move the patient to a bed on one of the other floors unless we're on bed alert. We don't get post-op patients or direct admits (unless it's an overflow issue). We do have a large turnover rate, so most days it's very fast paced on the unit.