Does anyone else seem to experience when a patient has orders (even if written by the MD) to be transferred to an ICU bed, sometimes ICU will send nurses/resp therapists to the floor to "check out" the patient to see if "they really need the ICU bed"?
I've seen this happen 2x recently, including today with a patient who they "werent sure if they needed an ICU bed" (even tho their resp. were 6/minute! Dont ask me how she maintain a PO2 of 98%!). The patient had also been seen by the attending at least 2x that day, and the last time was obviously to write the transfer orders, yet here comes an RT from ICU saying she was asked by the charge to check on the patient to see if they really needed to be transferred. She literally looked like a dying woman, barely able to speak, couldnt move and had been A&O, pleasant, chipper a few days before on her admission. Even for a med surg patient, the amount of care this woman needed was TREMENDOUS.
I just dont get why ICU doesnt trust us to accurately assess a patient and outright tries to get out of MD orders?
Yes. :redbeathe So you get my point about having an easy patient come in once in a while...............(Not that it's an appropriate admission, but......hmmmmm......gee, maybe I need a day or two off LOL)
I get annoyed when I have too many "easy" patients, which seems to happen every so often (like in July and when the residents switch rotations at the beginning of the month). I love being busy in the ICU, but it is nice to have an "easy" patient every so often. However, I must admit, when I see the report sheet, I typically stay away from picking patients that have "2L NC, eating, up TID, etc" because I like challenges, especially since we only carry a 2 patient load.
Our intensivist is the only one who can admit to the ICU, that being said it isn't unheard of that beds are being "cycle cleaned", or whatever else for hours....in an effort to do away with that, our ER director now makes several trips during the day to ICU to make sure there is a full house. Additionally, if the floors are holding up the works for downgraded patients they are moved along so our sick patients can be taken care of at the level they require.
In the ER I cannot and should not ever be boarding ICU/CCU patients as I received more EMERGENCIES! While I understand no one want new admissions, the patient should be first! IF they would allow me to run the 1:2 I'd keep them all day! On some occasions they don't want the patient until the central line is placed and drips are running, excuse me where is the ICU?
As for the OP all I kept thinking is that you can show a good pulse ox reading and be hypoxic. You didn't mention an ABG, however I would've been up someone's behind to get the patient moving if they were truly in respiratory distress. U
Until we've all shared in the pain of being helpless, overwhelmed, undertrained, understaffed, misunderstood, and unable to do what we know is right-nurses will never get along! It's always us against them somewhere.
Specializes in PACU,Trauma ICU,CVICU,Med-Surg,EENT.
I work in PACU and fairly often we have pts who deteriorate postop for whatever reason, and in anesthesia's opinion, require ICU care. Now,even though anesthetists routinely take care of critically ill pts in the OR and some work as intensivists in the ICU setting when needed - they still must have a requested ICU bed OKed by the ICU service. A consult is requested,the ICU resident and/or intensivist comes and assesses the pt and then the transfer is arranged if they feel that an ICU admission is warranted -usually it is,sometimes it's not,at least not right at that moment - but this is never,ever decided by an RN or RT.
If it is a clear cut case that,without a doubt, ICU is the only acceptable place for the pt (or,if it's in an emergency)...ie. post MI,CVA,inability to wean off the ventilator,etc - it'll largely be a 'rubber stamping',(very rapid 'rubber stamping' mind you, but rubber stamp it is. ICU beds are usually at a premium and have to be wisely allocated. Usually,if they do not agree that an ICU admission is essential,they can offer valuable suggestions for additional or more appropriate care which may not have been tried/thought of.
In my experience,any admission to any unit or floor has to be oked by that service - not the service requesting the bed. It's even more important when an ICU bed is being requested.
I feel for the nurses on the floors,I really,really do -they are run off their feet,scrambling to take care of multiple,high acuity pts all at one time - never mind those pts who,on top of all of that,crash. In many ways,t's so easy for those of us (I'm including myself here) in our various ICU kingdoms,where we often have very controlled environments,with immediate access to residents and intensivists,RTs,ventilators,etc to deal with rapid change in pt status. It's really challenging to be on the floor these days,imo.
We must use brainstorming,collaboration,support,and creativity to assist the floors when they have an emergency that may not be 'ICU material' per se,but is too much for the floor nurses to handle safely.
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NeosynephRN
564 Posts
Totally agree....