Pacurn

I need some advice from my fellow nurses in surgical services in particular pacu and phase 2 nurses. I work in an ambulatory care unit doing phase 2 recovery (though the majority of my experience is in phase 1) my fellow coworkers and myself are constantly receiving patients in phase 2 that are not appropriate. We are regularly receiving patients coming straight from the OR (bypassing phase 1) who have undergone general anesthesia, who are requiring oxygen, far too sedated, the crnas are pushing neo on the way out of the OR then walking away; patients straight out with spinal anesthesia, uncontrolled pain and nausea, ASA 3 and 4 patients and are even getting patients with chest tubes and on those who require telemetry on the floor. To be clear we are a DISCHARGE unit. The patients coming to us are NOT on monitors. We have a 3:1 ratio with only 9 bays available and 3 nurses who discharge up to 40+ patients per day. This is a major red flag and a huge no no to any nurse with phase 1 experience. We have ALL complained to management and expressed our concerns about the safety of our patients and these assignments being inappropriate especially as we don't have the capability to monitor these patients closely (patients are in a room by themselves until family arrives) and we are very busy constantly discharging patients back to back and physically can't be there to give those patients the close observation that is necessary. I've quoted ASPAN standards to my managers but apparently ASPAN relaxed standards significantly during COVID and they haven't issued new standards since which I'm sure they will do in the near future. But in the meantime it appears managers are using this COVID loophole to justify sending unsafe patients to our unit on a daily basis. BOTH of my managers have 20+ years of experience and much of that experience was in phase 1 nursing so I know that they know this is unsafe. I had a patient today who was far too sedated to come straight from the OR and complained of 8/10 pain on arrival to myself and the CRNA (did nothing to rectify the situation even after my request for her to do so and just left) when the patients family arrived they were reasonably upset to see their loved one this way and when I mentioned (innocently) that the patient came straight out of the OR and that explained her excessive sedation and pain they demanded to speak with my nurse manager. My nurse manager later told me "to be careful what I say to families" and went on to justify why the patient was appropriate to come straight to phase 2. But if the patient was truly appropriate to come to phase 2 in the first place then why would I need to "be careful" what I said to the family? She basically told me to lie/omit what I told the family to avoid upsetting them. If she truly felt the assignment was appropriate to begin with then there would be no need to watch what I say to them, this is unethical and not the way I believe in practicing, patients have the right to know and to make informed decisions about their care. My nurse manager even tried to justify the situation by saying "bypassing the phase 1 unit saves the patient money" and asked me if I were the patient would I want to be charged thousands of extra dollars to go to pacu? To which I replied "absolutely" and said " I could also save tens of thousands of dollars by having my surgery in South America or a third world country but I wouldn't do it because I would want it to be done safely and that that's why our patients come to us and trust us, so that it is done right". I'm at my wits end and so are my coworkers. And I'm not sure which steps I should take at this point. I've done countless incident reports and had private meetings with management about the situation (as have many of my coworkers) and it just continues to happen. How exactly should I escalate this situation? Who do I report these unsafe practices to? Joint commission, the BON, the medical board? I don't necessarily dislike my job and I love my coworkers so I don't want to leave but more importantly if I left I could save myself the trouble but these things would still be occurring and it's unsafe and unethical for me to not intervene because these things will continue to happen with or without me there. There needs to be a change for the safety of the public who trust us, and btw this isn't some small hospital in the middle of nowhere, I work for a very large hospital downtown in one of the major cities in the southeast. Any advice would be appreciated by myself and my coworkers who only want to do the right thing