No beds available?

CEN35 · Apr 30, 2002

keep in mind here, i am not trying to stir the pot here.

however, if i had a nickel for everytime i heard........"everybody is shortstaffed but i can only do what i can do and i won't risk my license if it can be avoided."

so it brings me to this point? every goverment agency and agency r/t healthcare prohibits hospitals form refusing patients. the er gets the brunt of this situation, because we are the door into the hospital.

so makes me wonder sometimes, why some are allowed to refuse patients...because of safety? yet they pile up in the er halls, waiting room etc etc.

once they enter the waiting room, and log their complaint, seen or not, they are our responsibility.

i guess it takes a family member of someone working in the hospital to die in the wr, while having an my, pe or some other thing for anybody to see this issue.

that's why there ends up being a wait to get up to a room many times. at least patients that head upstairs have been treated and stabilized (unless it is a unit patient).

just my two cents again.....not being mean or rude

me :)

fergus51 · Apr 30, 2002

well then, what's the difference? They either die in the waiting room or on the floor...

lgcv · Apr 30, 2002

This is not an issue that nursing can fix. The patients do not belong in the ER or on a floor with inadequate staffing. Hire more nurses, pay permanent nurses what travelers are paid...(i wonder how much of the shortage is attributable to nurses who are now travelers). If all else fails divert..If more patients were diverted ...less hospital income...increased incentive to hire more nurses. The more we are willing to suck up and roll over, the less likely change will ever occur.

mattsmom81 · Apr 30, 2002

Emergency rooms have core staffing. Floors do not in general---we are staffed by numbers of patients and limited by what level of 'shortage' exists in the facility. Acuity systems are out the window, and most of our patients will be as sick as they can be; AMI's, CHF ....many need ICU care but there are 'no beds'.

If hospital policy states 5:1 patient nurse ratio max on stepdown, it would be ridiculous for me to exceed it if it is against policy and unsafe. If I break hospital policy, there will be NO representation for me should an adverse outcome occur. I'm on my own and hopefully I have good malpractice insurance cuz the hospital will NOT represent me. Let's be real here. Two wrongs don't make a right, and just because 'ER nurses can't refuse patients' does NOT mean MY practice should be unsafe. I WILL refuse what is unsafe and I've told the ER doc this many times, much to his chagrin.

OC_An Khe · May 1, 2002

The answer to this problem is simple, have enough nurses available to care for your patients. If you don't have enough Nurses then first divert to another facility and secondly truly and honestly assess why you don't have enough nurses. The problem can only be solved by nurses uniting and controling their profession and their practise.

If left to the bean counters nurses would be able to care for an infinite number of patients.

RoxiRN · May 1, 2002

The government is telling us to cut back, we are spending too much on health care. Okay, so we decide to reduce overtime. Oh yeah, and there's a shortage of nurses. So we close beds. Now we have medical patients and patients awaiting extended care placement on the surgical floors to the point where we cannot even accomodate our own OR slate! I work on an Ortho Surgical floor. Surgical nursing is my area. That means patient care is maximized when I get the surgical patient and the palliative unit gets the palliative patient on our floor. I think that you have to consider patient safety from the perspective of staff training. Many nurses are reluctant to care for off-service patients not because they are lazy or unco-operative, but because they feel uncomfortable when patient care exceeds their knowledge base. If you are a nurse on a medical floor and you have just received a patient from ER with a tib-fib #, are you going to know whether or not the patient is at risk for compartment syndrome and how to assess for it? Likely not. This could have implications for care, couldn't it?

Right now on my floor there are 30 physical spaces for patients. 22 beds are open - we admit up to a max of 22 patients; we will go 1 over census only for an ortho. The slates are packed, the surgical wait lists are long. But 14 out of 22 patients are either extended care or medical patients with no discharge plans in the foreseeable future. Grrr. This does not make sense!

There is no such thing as an empty bed. It's not as simple as that. The bed may be physically empty, but that doesn't mean anything. It could be that the bed was designated as closed until ward had a discharge, so their census could accomodate another admission. It is also true that during the week when the ORs are fully operational, a certain number of beds are designated to accomodate that day's slate. That means, Ortho's first priority would be ensuring enough beds for the Ortho's on the slate, etc.

RoxiRN · May 1, 2002

Hey all you ER people out there,

If safety is that much of an issue in any particular ER (unsafe nurse:patient ratio) then what's to stop the hospital from closing the ER dept? Up here in Canada it happens routinely. ERs have sometimes closed for an entire weekend. At our hospital when there is more that 16 patients in emerg, they call a 'code gridlock.' That means every unit MUST accept one patient to relieve the pressure on emerg. My point is, there are things that ER can do if staffing compliments are not sufficient to handle the patient demand.

Just providing a little balance

amy · May 1, 2002

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kaycee · May 1, 2002

RoxiRN,

ER's can technically be on code red (divert) to ambulances yes. Unfortunately people can still walk in and be just as sick. Also code red means nothing if an ambulance has a critical enough pt they have to go to the closest ER, on diversion or not. So in reality we have no real control. They just keep coming!

shannonRN, BSN, RN · May 1, 2002

wow...is just about all i can say right now! :eek:

i work on a med-surg floor. we often have a problem with finding housekeeping to stat clean rooms for direct admits. since when does a stat clean take 2 hours?! yes, i know that there may be another room on a different wing that requires a stat clean...but please tell me there are more than 2 housekeepers working on a 3p-11p shift.

sometimes it is the fact that we are just plain out of room. our hospital doesn't close it's doors. we have 2 campuses and the one campus is located in a not so nice area and is the only hospital around...i heard a story of one patient waiting 20 hours for a bed.

we used to be an mainly surg floor until management ticked off the docs and they started doing only required cases in our or. so to fill the beds, we were taking med patients, which is fine with me...but they ran out of places to place fresh surgicals. one would think that they might cancel a few of the electives but no...so our 33 bed unit is full with maybe 4 discharges and 16 surgicals that we can't place. i don't understand...but maybe that is why i am not management. eventually a same day surg floor was opened and they tend to house patients for us. which has been very helpful...but stinks for patients. they don't feel well and are getting transfered from floor to floor. oh well. i think the whole situation is sad.

mattsmom81 · May 1, 2002

This 'ER vs the Floors' battle is just another stressor in our already overstressed workplace, IMO. So why get caught up in all the drama? Why can't folks problem solve instead of the 'us vs them' mentality of blame?

I will not be pushed to go way past my safe care limit. Administration pushes us as far as they can, we're the ones with licenses to protect, not them. I am 'on the line' constantly these days; it's like a battlefield mentality most shifts. When ER starts pushing me, I know how to push back and I do. If ER nurses feel they are working in unsafe conditions this is the ER's problem, not mine...and I've more than got my hands full.....so ER nurses, address YOUR problems. Thankyouverymuch.

bestblondRN · May 1, 2002

I wish I had a dollar for every time I have been involved in looking at the problems of beds, patient flow, ancillary and support services--I could retire!

The problems are very common from one place to another--no beds, more elective admissions than available beds, ERs backing up and having to divert, inefficiencies in getting patients discharged in a timely manner and then getting the beds cleaned and ready for the next patient. I think the days of 75% occupancy are over--hospitals can't afford to run at those levels anymore. Unfortunately, that also takes away the buffer of having empty beds to place waiting patients in. It's become a real catch-22 trying to juggle patient flow anymore, and I don't know that there are any hard and fast answers to solving the problem. Add to the lack of beds the lack of good support services, and you have a recipe for disaster--I'm sure many of us have been in the position of calling housekeeping and having to harass them to get one bed cleaned.