Overflow in the er

[LJ85, ADN, BSN, CNA, LPN]

First off, in my ER I had very little training in holding pts..I would suggest learning floor nursing for a few days at least to get the hand of the flow and the other software...Second, the patients absolutely get neglected. The orders have to be scanned, then the pharmacy has to put them into the system, and I spend a ridiculous amount of time trying to get the meds from pharmacy for each patient. Patients get snarky...families get impatient...it all gets dumped on the holding nurse and makes for a grueling day. Its hard to mentally prepare for this and lately nurses are calling out on a daily basis...it just plain stinks.

[tamara04]

I think having home patients is dangerous for the inpatient hd and for your other ER patients. Neither is able to get the care and attention that they need and deserve. Not to mention increased wait times in the waiting room because you can't move patients. Just last night at work we had 7-8 inpatient holds.

The hospital I currently work at recently thought it a good idea to close almost 50 beds. We have been holding in the ED since!! I'm not sure how a nurse can be expected to care for her ICU hold, floor hold, and sill have to take care of anything from the sniffles to an MI. It's so unsafe and so unfair to everyone involved. This has been part of a deciding factor in me wanting to leave my current job.

[tamara04]

I think I'm kind of jealous now.

Me too!!!!

[medic978]

Thank you everyone who responded. Everyone seems to have pretty much the same concensus

[Anna Flaxis, BSN, RN]

But if there were no open beds where did you put them?

We don't hold patients in my ER either, and if we have no beds in the house, we transfer to another facility. Transfers are a pain in the behind with the EMTALA paperwork, arranging transport, calling report, etc., all while caring for other patients, but it's better for the patient and better for us than boarding them until we have an open bed/a nurse at our facility.

[Lunah, MSN, RN]

We don't hold patients in my ER either, and if we have no beds in the house, we transfer to another facility. Transfers are a pain in the behind with the EMTALA paperwork, arranging transport, calling report, etc., all while caring for other patients, but it's better for the patient and better for us than boarding them until we have an open bed/a nurse at our facility.

It's funny, because at my per diem job, we ARE the facility where everyone transfers their patients when they don't have beds. We're the end of the road, unfortunately - we can't transfer anyone out, they just wait and wait and wait and wait.

[MassED, BSN, RN]

oh my goooodddddd, it's awful. We have boarders (admitted holds, no bed upstairs) every night. This is what makes ER nurses want to leave the ER. Not being an ER nurse, but a floor nurse. That's not what we do, yet this is how many days have become - floor nursing, alongside a smattering of ER patients. It stinks. Poop rolls downhill and lands right in the ER! From the top down, things don't change. The floors max out on patients, but we don't in the ER. We must adapt and accommodate with very little, if any, help from management, the house supervisor, or floats!

[Bobjohnny]

I'm fortunate that my ER manager has recently made it the standard for us to not do holds. Which is great because the only people in our ER that can do holds are people that moved from inpatient(like me) because the charting is on a different system. So, now everybody gets transferred out. Although if they're just doing the patient shuffle on one of the floors and actually have a bed we'll "hold" the patient for a couple of hours, but that's about it.

[countyERNICU]

I think the most difficult thing about all these patients waiting for their beds upstairs is that they get ANGRY! And as their assigned nurse all that frustration / angry is now directed towards YOU the nurse. "How much longer?" I think even for the most seasoned ED nurse having hours and hours of all that negative energy directed towards you it becomes extremely mentally draining. Not to mention making one dread coming in for the next shift.

[Anna Flaxis, BSN, RN]

^ Yes, that's part of it. Spending a good portion of your shift trying to appease patients and families over something you have no control over can be incredibly taxing. I can only apologize so many times before I just can't anymore.

I've worked in a facility where we boarded at times, and it was awful for both the patient and the nurse. I'm so glad we don't do that where I work now. It seems as if expediting transfer to the floor is a top priority for everyone involved, from the ER staff, to the hospitalists, to the floor staff (who have been amazingly understanding and accommodating- sometimes I wonder if I am on Candid Camera* or something).

Ordering meals, frequent toileting, getting the home meds ordered and figuring out which ones are in our Omnicell and which ones have to come from Pharmacy, then standing there for 20 minutes giving 15 different pills that the patient has to take one at a time- all while balancing an ER patient load, is not enjoyable. I did my time on the floor, and while I found it incredibly rewarding and instructional and a useful experience at that time, and I applaud those that do it, do it well, and enjoy it, I am not a floor nurse nor do I ever want to be one again.

*I just dated myself. Yes, I am a child of the 70s. Candid Camera was a TV show where they would set up a hidden camera and pull harmless pranks on people.

Edited Mar 25, 2015 by Anna Flaxis

[Bobjohnny]

I think the most difficult thing about all these patients waiting for their beds upstairs is that they get ANGRY! And as their assigned nurse all that frustration / angry is now directed towards YOU the nurse. "How much longer?"

I can only apologize so many times before I just can't anymore.

I quit apologizing a long time ago, and now I tell people I have absolutely no control over how quickly they get an inpatient bed. Typically that with a promise that I will update them as soon as I know and get them moved as quickly as possible thereafter appeases most people.

[maelstrom143]

I just finished a paper ....

Thank you for sharing the these resources. I look forward to reviewing them.