I need advice. Our ER is dumping patients onto floors with little consideration to patient safety. My floor is medsurg with tele (which is how management can get around RN/pt ratio limits). We get fresh MI's, strokes, and all drips except nitro, with a ratio of 8:1.
The problem is that the ER is always sending pts with no orders other then call DR for orders, and usually before the labs have resulted, so don't know how bad the pt is, or even if stable. They mostly don't even give report, but drop the papers on the desk and run (some of the older nurses do give report in fairness). I have lost count of how many pts we sent to ICU after getting them from the ER. More then once we sent 2 in one shift. Once they even sent someone after she had expired, sorry, but that's a little to stable for me. The s++t hit the fan over that one, and they were good for a while, but are now back to their old tricks.
Most of this started when we got a new DON. In north Jersey, hospitals frequently go on bypass. In an effort to stop this, the DON canceled the 1/2 hour rule (1/2 hour from being told there is a pt in the ER to when they can send. To give us a chance to get ready). The ER called and sent at the same time, ready or not. After being swamped a few times with sometimes 3 admits in a ten minute period (with no orders), our nurse manager was able to get us a 15 min wait (even now we don't always get it). God help us if we try to go over 15 min.
The other day I got a pt with an active occipital bleed. The ER wasn't busy, and her primary said to admit, over the phone. Neuro said not to admit, as he was sending to NY, ER to ER. They admitted anyway. Neuro hit the roof, but didn't want to transfer to ICU as she was too unstable, and wanted as few moves as posable. I had her for 5 hours before transporting. I hardly saw my other pts.
What I need to know is what I can do to stop this. It is dangerous and life threatening. We have tried complaining, but are ignored. I'm going to write a letter of concern to management about the bleed, but if I'm the only one writing these letters, will they be listened to, or will it bite me in the back.
Sorry it's so long, and thanks for letting me get it off my chest.