Long term patients on acute care floor

BFly85 · Jan 28, 2018

I am not sure how it is on other floors, but I am not sure what is expected to be done as if patient's need to be hospitalized, they need it. Insurance won't typically pay if there is a long term care facility that can handle the demands of the patient.

On the unit I am currently on, we do have many patients that are long term. Some have stayed over a year (though that is more uncommon). We just do our best to rotate them through the nurses. It is hard to compare though because I am on a pediatric unit and while a couple are in their teens, they are easier to control most of the time.

NurseC,RN · Feb 4, 2018

I have worked on a unit where at one point 14 of our 38 bed unit were LTC patients or those awaiting alternate level of care. Yes is it hard when you have acuity ill patients, mixed with dementias and behaviour type patients absolutely but you still have to provide the same level of care that you would for any other patient. If your hospital/unit has volunteer services that can visit with these patients or recreational therapy to prevent boredom/get them engaged activities bring it up with your manager as an option.

As for the falls we have used the least restraint policy therefore 3/4 bedrails at most, fall mats, bed and chair alarms

Assignment suggestion: ensure that a nurse and health care aide are not assigned the same LTC patient for more then 3 shifts in a row to prevent burnout

Four LTC patients on an acute care really isn't the worst of it.

amoLucia · Feb 5, 2018

to OP - please reconsider your use of the term "stuck" when referencing the LTC pts. They deserve the same amount care and consideration that the more acute care pts do. And it's seems like you're expressing your disdain for a whole specialty of care.

The geri population is becoming the largest growing population in healthcare and you'll be seeing more and more of them.

chare · Feb 5, 2018

[...]
I am curious to hear any feedback from nurses working on acute care floors that get "stuck" with long term patients. On the floor I work on we currently have 4 patients who are "living" with us. One of them is easy to take care, low risk in regards to safety and overall care, while the others are problematic i.e. verbally abusive, physically abusive, high fall risk, cognitive issues and of course incontinence (poop everywhere and hallway eternally smells of it).
[...]

Unfortunately this happens. However, I take exception to your describing these patients as "stuck" on your unit. Perhaps those that you describe as "verbally abusive" have picked up on the fact that you, and possibly your coworkers, view them as either a burden, or not worthy of your care.

[...]
I mentioned in a meeting with the manager that the high demand of some of these long term patients can bring moral down and pose risks to the nurses. A risk that specifically is concerning to me at this moment (one had a fall on my watch) is putting my job on the line for these chronically high risk patients. The response from the manager was not one that indicated anything was going to be done about it.
[...]

I'm sure that your manager is aware of the burden these individual can place on the staff. However, and this is something that should always be remembered: I doubt these individuals remain there by choice. If they were able to be transferred to another unit or discharged, I'm sure that they would welcome the opportunity.

Further, how exactly do you see caring for these patients as putting your "job on the line?"

[...]
Anyway, I was just curious to see if anyone else here has had this experience on their floor and were there any resolutions? I'm not exactly happy at my job and do plan on leaving within the next six months but I'm hoping to get out before getting written up, fired for a fall or groped by a sex offender.
[...]

We see this occasionally in the pediatric ICU with patients that don't qualify for transfer to a non-intensive care setting, or those unable to be placed in long term care or rehab. And yes, the needs of these patients can vary greatly. However, they still deserve the best care that we can provide, as long as they remain in our care.

As for resolution, what do you think should happen?

CardiacRNLA, BSN · Feb 9, 2018

I think that people should stop taking things so personally. I have said "stuck" before as have many nurses. It seems like the OP is more speaking about the situation as opposed to the actual patients themselves. In my case, I have used the word "stuck" but in no way have I expressed this to my patients or their families. Additionally, it is stressful because I DO give a crap and give my all. I will chase after every call light, wipe every behind and gown up every time. However, there IS a difference in alternative level of care patients versus acutely ill people. The plans of care are different with different goals. And often that is the challenge. On my unit, it can be very difficult to juggle three post-cath/EP admissions combined with two patients who are on isolation and bed alarms.

I really understood the original poster's sentiment. As far as job safety I also understand that. I have had a patient who multiple post-procedural patients, mant post-MI, risk for bleeds, on complete bedrest, etc who need q15 min checks and close monitoring. So when I have two patients on bed alarms, high fall risk, need food set-ups, etc, can really but everyone at risk. The post-procedurals are at risk for bleeding/complications and the LTC patients are at risk for falls or aspiration. It is tough juggling act. I can totally understand.