Inpatient Boarders?

[EDnurseNY]

I work in the ED in a mid-size city in New York. It seems that the hospital floors are always full, and most of the time we have over 30-40 inpatient boarders, sometimes up to 55. We have 60 beds in our acute area, and this leaves almost no normal patient care areas in which to treat ED patients (and so we have 50+ in the waiting room every day). We end up treating patients in stretchers and chairs in the hallways, and most of the time, my colleagues and I are acting as med/surg nurses because someone has to take care of the boarders. The ED looks like a war zone with people stacked up in the hallways.

When bringing this up to any of our nurse leaders, we're told hospitals are like this everywhere and we shouldn't complain (or go anywhere else) because everywhere else has it this bad.

I guess this is all a roundabout way of asking: Do other hospitals actually have these problems/is it that bad everywhere? I hear back from people who have left to travel and it seems like they don't have these problems.

Sidenote: Then again, we're also told to shut up about our 6:1 staffing because back in their day it was 8:1 and we should just be thankful to be 6:1 with no PCTs, even if you have ICU players. So maybe I'm just salty in general.

[Kuriin, BSN, RN]

It happens from time to time that you board inpatients patients in the ED for >3 days. However, I haven't been in a hospital that sounds like that bad.

[EDnurseNY]

Thanks, Kuriin. I think our management has its head in the sand a bit.

A lot of people are leaving d/t these problems we're having and they act as though everything's great.

[SheriffLauren]

at my hospital i know part of this issue is that we have too many 1:1 patients in the hospital (each unit has 3 on average) and too little staff (poor retention d/t wages) which causes beds to be blocked on almost every unit, so while we have empty bed we dont admit to the units from the ed, which causes them to board patients right now. people are getting very frustrated and some are leaving. its a bad cycle . i would say a retention/hiring issue at its core.

[Swellz]

I'm not an ED nurse, so forgive my ignorance; are ED holding units uncommon? Not necessarily on a different unit/floor, but I've worked a few places as a traveler where we designate a block of ED rooms for boarders and us floor nurses will take them until they get a bed. Doesn't solve the space problem but a few float nurses to manage them would let you focus on your ED patients. But like you said, it sounds like your hospital is satisfied with the way things are, so I doubt suggesting that would get you anywhere.

[Kallie3006, ADN]

At one place I worked the float pool would go to the ER to take "holds" until a room became available, there was usually more during the winter "flu" season. Another hospital the ER held until the room was available, but it was usually 1 or 2

[PeakRN]

With very rare exception we do not hold patients in the ED, we know that prolonged time in the ED results in poorer outcomes for patients. If we cannot admit a patient upstairs then we will transfer them out, but this is uncommon and excluding insurance repatriations this only happens a couple of times a year. There was a period last year in which there were no inpatient pediatric beds in the region and we did have to hold a couple of kids for a day or two but we never had more than 4 in the ED at a time. We also generally won't transfer out our adult BMT or liver transplant patients, but because of their specialty needs it would be difficult to find another hospital that could provide the care they need in the region; I've never had one of those patients held in the ED for greater than 12 hours.

[Leader25, ASN, BSN, RN]

Unfortunately in areas where 3-4 hospitals have closed down this is not unusual.Horrid ,but not rare,one ED saw over 100,000 in a year.Daily back up were 40-50.They hire new blood,they leave.

[guest769224]

Sidenote: Then again, we're also told to shut up about our 6:1 staffing because back in their day it was 8:1 and we should just be thankful to be 6:1 with no PCTs, even if you have ICU players. So maybe I'm just salty in general.

Wow, this right here is bad enough. My ER ratios are 4:1 with techs to help and even then, it's outrageously busy. However I work in a very busy ER with high acuity.

6 is too much, let alone 8.

NY has the weirdest ratios. I've heard in NYC it's even worse. I'd never work out there.

[Bcollins94]

I work in a large inner city ED, we usually only board our ICU patients because our ICUs tend to be full even though we have about 50 ICU beds. Patients who are intubated tend to get a bed within a few hours because they shuffle patients around to accomodate them, but it's relatively common for me to have one or two ICU/CCU or stepdown patients that have been waiting in the department for 24+ hours. Also this doesn't effect our ratio at all, we're still expected to care for 6-8 patients with the ICU included

[JKL33]

I seriously think all instances of boarded inpatients being cared for without dedicated staff should be considered fraudulent and investigated as such. ^

It is utterly ridiculous from the fraud standpoint as well as others.

[EDnurseNY]

I seriously think all instances of boarded inpatients being cared for without dedicated staff should be considered fraudulent and investigated as such. ^

It is utterly ridiculous from the fraud standpoint as well as others.

Thanks for the replies, everyone! I appreciate them. It's pretty demoralizing not being able to do the job I was hired for. And yeah, between the boarders and the ratios (and being called lazy), we're losing nurses left and right.

JKL33, can you clarify? How is it fraud? (I'm just confused by your comment. Help me understand?)