Admitting More ICU Patients than Hospital is Licensed To Take - page 2

My hospitals has a 4-bed ICU. We are constanly admitting up to 9-10 ICU patinets at a time, and using completely underequipped mulitbed tele rooms as an ICU "Overflow". Nurses are put in those... Read More

  1. by   HiddenAngels
    Yeh that was my question.. Were they admitted ICU status. I have seen overflow from PICU and such but not 9 or 10. This would concern me.. I wouldn't end the shift without speaking to someone
  2. by   HiddenAngels
    I'm a little shocked your docs are okay with this..
  3. by   Katillac
    Your state is an employment at will state which means among other things that you can be fired for anything and nothing at all, including refusing an assignment. You could probably get unemployment compensation if you documented that you refused the assignment(s) believing them to be unsafe, even though the employer will say you were fired for cause. They are at the very least out of compliance with the DOL regs around breaks and meal times unless you get paid straight through or have legitimate non-working breaks.

    I haven't read all of the great information and links provided here, but if you reported the facility for wrongdoing, whether billing fraud or noncompliance with regulations, you might be covered under whistle blower protections. However that typically means only that you are entitled to fight for back pay and have the money and your job back if you win.

    Don't forget that if you take report you are presumed by most BONs to have accepted the assignment. Refusing at that point may well be considered abandonment, no matter how unsafe it is.

    Best of luck with this. It sounds like multiple disasters waiting to happen, and if nothing happens it's only because of the professionalism, competence and dedication of the nurses. At the very least keep a daily record of what you see happening, and consider bringing your concerns to your administration, or risk management so they can't say nobody said it was unsafe - not that they shouldn't know.
  4. by   Mini2544
    Quote from J Friday
    These are real ICU patients....If it was just an insulin or heparin drip on a stable patient, I wouldnt' be concerned. These are septic, ventilted, hypo/hyperthermic, unstable patients on multiple vasopressors, propofol and other titrated meds...
    Have you found out about your particular states safe harbor rules yet?
  5. by   JustBeachyNurse
    Quote from Mini2544
    Have you found out about your particular states safe harbor rules yet?
    Safe Harbor is unique to Texas though proposed in New Mexico.
  6. by   MunoRN
    Keep in mind that safe harbor laws don't protect your job, they provide a way of communicating that you feel an assignment is unsafe to potentially protect your license, you can still be fired for refusing an assignment. This may change if a current federal bill is passed.

    Generally hospitals aren't licensed for any certain number of "ICU" beds. The number of beds expected to be used as critical care beds is included on the license application and renewals, but it's not something the hospital is required to stick to. Typically hospitals are licensed for a certain number of adult inpatient beds and overflow beds. In general, there's nothing that prevents a hospital from having fewer dedicated ICU beds than they might use and to use overflow beds for these patients.
  7. by   amoLucia
    Quote from JKL33
    It's pretty hard to think there isn't some fraudulent billing involved...
    This was my first thought, too!

    And re 'Safe Harbor'. "Safe Harbor" is that you are basically accepting an assignment UNDER PROTEST. You can outright refuse an assignment but then that would be grounds for dismissal for refusing to perform your job as assigned.

    There was an article not so long ago from another poster, the Commuter, that explained SH very well. At the time, I think only California (??) had a law for SH, but other states usually have some mechanism for this type of formal Labor dispute.

    You have to notify your supervisor that you are invoking 'Safe Harbor' and then there is a very specific procedure to be followed (before you take the assignment).

    You must accept the assignment UNDER PROTEST and do the best you can.

    While you may have some protection against facility retaliation (per 'Whistleblower'), you will have prob painted a target on yourself.

    To OP - how far do you want to push this? Could you enlist the help of the physician body? Do you have a union?

    I recommend that readers here go back and read the Commuter's post (3 yrs ago?). Very informative.
  8. by   not.done.yet
    Exactly. Safe Harbor doesn't mean you don't accept the assignment. It means you are accepting the assignment but want documentation of those issues that hamper giving ideal care. It isn't able to be used punitively and it requires documentation up front. If you are in Texas you should absolutely be calling Safe Harbor on these assignments.

    Your employer can indeed decline to keep you employed if you are in an employment at will state. This can happen whether you protect your license or not, so you may as well act in your own best interest. If a bad outcome happens on one of those patients, you better believe you will lose your job anyway and likely take the brunt of the blame for NOT speaking up.
  9. by   J Friday
    SO... through talking with staff that has been working this ICU for over a decade, it turns out the hospital does have a negotiation with the state to open up tele room for ICU overflow patients. It's a very underserved community and many hospitals will not accept transfers being that most patients have no insurance. That being said, the state has allowed this because they do not want ICU patients sitting in the ER for countless days and they know we have problems transferring out. It's a really loose negotiation--meaning there was no hard limit on number of overflow beds. I can hardly imagine they would allow limitless ICU paitents, however there is no hard limit. I suppose I have to either acceot these terms or find another job.

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