How does your ED address the Observation Unit?

[RAWells61]

In my ED, when a patient is admitted for a observation admit (also sometimes called a 23 hour hold) they are admitted to an inpatient unit specifically designated as such. The key here is that it is an inpatient unit. The charting is different, the way that the meds are obtained is different, the way that labs are done is different; everything is different.

The issue is that this inpatient unit is considered part of our ED and as such we are rotated to it on a semi-regular basis. We are told that this is a common practice. Is this how it is done at other hospitals? I HATE rotating to this unit, even for a single shift. However, if it is common practice, I will swallow my dislike and be a good soldier. Thank you for your input.

[Nalon1 RN/EMT-P, BSN, RN]

In my ED, if you sign up as an ED nurse, you work only as an ED nurse.

Some nurses do float, but it is an option to them (and they get paid more as a float nurse).

Obs is its own specialty, way different than that of an ED.

Every hospital I have seen has an Obs unit staffed by Obs nurses, not ED nurses being forced to float up.

That said, if that is how your hospital does it, then that is how they do it. Every place is different, and someone in management saw it as a great was to save the hospital some money (while I am sure getting a nice little bonus check out of it).

[Bobjohnny]

The hospital I work at has done it 2 different ways in the time that I have been there.

The first way, and the way we are now back to doing it, is we have a dedicated obs unit that has the obs patients. Unless, for some odd reason they are too sick for obs but don't meet criteria for inpatient status. then they go somewhere that can take higher acuity.

The other way they have done it is to disseminate the patients throughout the inpatient units. Which the inpatient nurses love because then they get to share in walkie-talkies.

As far as floating, our ED is basically a closed unit except for float pool. The rest of the facility is able to float, but we can't because our documentation system is different. Until recently, in very dire situations, ED nurses that had come from inpatient could float or sign up on inpatient because they still knew the documentation system. However, we have recently moved all of the hospitals documentation and our former inpatient nurses will now not be oriented for the inpatient documentation. Yet, they still didn't make the documentation for the ED the same as inpatient.

[bear14]

Our ED nurses stay in the ED but obs nurses and other med/surg nurses float where there is a need.

[AZQuik]

We staff our obs unit with a few obs only nurses (who will be cross trained to the Ed or weeded out) Ed nurses, or floats. Ed nurses hate working there cuz it's so close to inpatient, floats hate it because we use Ed charting, and obs nurses are usually just waiting to get cross trained to the Ed. Nobody really wants to be there.

There was talk about taking it away from Ed staff (we sometimes have an Ed tech as well) but it looks like that may have fizzled out. The only people who really seam to like it are people with homework to do (nights)

BSN GCU 2014.

Sent from my iPhone using allnurses

[Lev, MSN, RN, NP]

My ER currently does not have a built in obs unit. We have one floor where half the beds are dedicated obs tele or IMC beds. The tele floor takes obs patients as well as the M/S floors. There are plans to open up some dedicated obs beds in the fast track area. These beds would be staffed by dedicated OBS nurses.

[SquishyRN, BSN, RN]

At my hospital, Obs is considered part of the ER and uses the same documentation system as the ER. However, Obs is staffed with its own Obs nurses. Theoretically ER nurses can be floated to Obs. I was told when I was hired that occasionally we could get floated into Obs or urgent care, but in practice I've found that the ER nurses don't get floated outside of the ER simply because we are chronically short staffed and can't afford to let one of our own go elsewhere.

[Birry]

My facility has the obs unit completely under the umbrella of the ED. It's all ED nurses and techs. Not many like it, but sometimes it's a much needed "break" from the main ED.

[LookingforChange]

Nope. We are ED nurses only. Heck, we barely have enough staff to cover our shifts, little alone cover other areas.

[abundantjoy07, RN]

Our Obs unit is considered part of the ER. However we as ER nurses do not float to Obs and Obs nurses don't float to ER. Honestly, the ER staff regards OBs as a completely different unit. The acuity of the patients are lower, the patients are already packaged up when they get over to Obs and Obs nurses tend to not be able to handle critical situations the way ER nurses do. We see the OBs unit as a regular unit with just a shorter stay. Sad to say, but Obs has always been ER by name...only.

[guest464345]

The ED where I worked had an Obs unit, and it was considered part of the ED. Used the same charting system, somewhat different Pyxis setup, and sometimes phlebotomy would draw labs....we all had to work there a day or two/month. Wouldn't say that any of the ED nurses loved it, but it worked OK. A few people enjoyed training on additional skills over there (for stress tests, etc). As another person pointed out, it could sometimes feel like a little break from the acuity of our very busy department...one day you're rushing between codes, and then suddenly the next day you find yourself handing out Miralax :)

[RainMom]

My small hospital just disperses them thru the inpt units. They tried to have one floor take all obs but then that floor would get overwhelmed with admissions & filled up with chest pain obs & other random pts while the other units had low census.