The Push to Move Pts Leading to Unsafe Practices

  1. Hi,
    I'm interested to hear feedback. Is the following occurring at all hospitals nationwide? At my hospital there is this push to move pts, meaning admit, transfer, and discharge all pts in under 3O minutes. In fact we are timed and the average time is reported in shift report. These are the following things that are occurring at my hospital, which is stressing me and other nurses out, and I think creating an unsafe environment for pts. I am scared a terminal event will need to happen before anything will change, as they keep adding new expectations to this need to move pts.

    1. Now calling report is optional for all transfers of pts in the hospital. The ed RNs NEVER call report, and the hospital RNs are left with the responsibility to look up everything about the pt, And this is complicated by the fact that ED charting is poor and the MD admitting notes are not even finalized in some instances.

    2. Now charge RNs are required to place pts in beds within 15 minutes once they are are notified to look up a pts. Then, if this doesn't happen, the bed planner will automatically drop the pt into the bed and the pt can possibly just show up without anyone being notified. What if the charge RN is busy with an emergency and can't be looking up a pt in 15 minutes? Also, what if the pt is not appropriate for the unit-i.e. pt started on levophed or on a drip more appropriate for the CCU or ICU?

    3. If we are late in placing pts, our management is notified of the delay and asked to follow up-24/7.

    4. ED admits always show up during shift change. White you are getting report, your new pt will roll up. Management doesn't want overtime, yet this happens and the outgoing. Nurse is delayed in giving report, and report may be poor as a result. This is happening on a PCU, and sometimes the pts need immediate care due to low BPs, BG greater than 400, blood transfusions, etc. Not to mention the fact that the oncoming RN gets to start her shift in a shitstorm, which always makes for a great night, right?
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  3. by   Sour Lemon
    That all sounds miserable, but not surprising.
  4. by   JKL33
    Fun, isn't it.

    This has to do with reducing ED overcrowding, which is a worthy effort but yes things have become ugly for all of us. Our various timers start when the patient walks in the door. The very issue you are discussing is a CMS quality measure.

    Sorry I really don't have any helpful suggestions other than that your unit should be very clear about who is doing what when patients arrive at shift change and you should be calling the supervisor to arrange additional assistance when a patient has immediate needs during this time. I say that knowing the admission fairy isn't going to show up to help you.....but I do think it's important that they keep hearing about instances where it causes patient care to be compromised.

    We always seem to have a very hard time improving one issue without creating others that are just as (or nearly as) bad.
  5. by   morte
    send the problem right back to the government,,,
  6. by   MunoRN
    Not giving report is abandonment in states I've worked in, these nurses should be reported to the appropriate licensing agency, whether the facility says it's OK or not doesn't change the nurse's legal obligations of their license.

    At the same time, it's not acceptable to refuse to take report or accept a patient during the time period designated to getting report, it doesn't matter where the patient you're getting report on is physically located, if that's your assigned patient there's no reason not to get report on them. Whenever a patient arrives they will need nursing care, to delay their transfer just means they will be farther in the weeds by the time you start caring for them, that's your patient you're ignoring even if they are still physically located in the ED.
  7. by   mandomania
    I'm picking up hrs in ICU at large medical center in Chicago for extra money part time. ED dropped off elderly patient on a vasoactive drip and left. Didn't notify ANY RN at all. No report, no communication of any kind at all. I'm like, *****? Really?
    I'm so pissed about this pt abandonment issue and the lack of urgency about it. I'm supposed to work today but I've already applied to 3 other positions.
    I have almost 20 years experience working with high acuity patients and I have never seen the equal to the unsafe practice issues that I have seen at this hospital. It's even a national safety patient safety goal.
    Initially, I was going to post to get this off my chest and get feedback but I'm so f**&king pissed that I think I need to leave this place.