Shouldn't that patient go the ICU??

[psu_213, BSN, RN]

So here is the situation from several months ago. Pt comes in with CC "SOB." EKG reveals A fib, HR in 130s. Pt given dilt bolus and drip started. Rate decreases--irregular between 90s to low 100s. BPs fine. SOB resolved with decreased in HR. Still in A fib. Pt ordered a telemetry bed with drip to continue.

I get a bed on a telemetry floor (that handles dilt drips all the time). While calling report, discussing the dilt and the VS, the nurse says to me "he doesn't sound stable, shouldn't he be in the ICU?" Well, this is the type of patient we send to telemetry floors all the time. I tell this nurse "he is in a fib, on a dilt drip and he his hemodynamically stable...our doc ordered a telemetry bed after speaking with his PCP and to cardiology." Having worked on a telemetry floor before, I realize that this nurse had the best of intentions. I have gotten train wrecks from the ER who quickly went from the telemetry unit to the ICU; it is no fun as the telemetry nurse, so I understand why she is trying to prevent a bad situation. The real issues I have is the note I read in the (electronic) chart shortly after this discussion, but before I took this pt to the floor: "Report from ED nurse. Per ED nurse 'patient is stable and does not need to be in an ICU.'" In addition to having never said that she did not need to go to the ICU (I may have implied it, but she wrote it as a direct quote), I just felt that it was not an appropriate thing to chart.

Anyone encounter a similar situation? How did you handle it?

[ChristineN, BSN, RN]

I find it an odd then to document cause it is not the ER nurses decision what floor pts go too. If she had documented "Dr. Smith says pt is stable and doesn't need to to to ICU" I would have less issue, cause the Dr would be the one who could write the order.

I hope you documented well on your end a good cardiac assessment as well as a good trend of HR and BP.

[Anna Flaxis, BSN, RN]

Besides being way uncool, this is not an appropriate entry for the chart.

Have you spoken with your manager about this?

[Guest219794]

I wouldn't worry too much about it.

She made an incorrect entry into a chart. Even if it was true, it was irrelevant to pt care. What on earth does it matter what your opinion is?

She made a bonehead move, in a lazy effort to cover her butt. If she was truly concerned, and motivated, she would have called the admitting doc, and advocated for a unit bed. And been turned down.

[Altra, BSN, RN]

This is the kind of nurse who believes that if the patient deteriorates 2 days from now from some totally unrelated s/s ... "see, I told you he should have gone to the unit."

As you have presented the patient's situation here ... I see absolutely nothing to warrant a unit bed.

[turnforthenurse, MSN, NP]

With the information you are presenting on this patient, I also agree that they do not need an ICU bed. I worked in telemetry for 2 years before moving to the ED and we took patients on dilt gtts all of the time. Besides, it's the doc's decision on where they want to admit the patient, not yours. The accepting nurse should know that. They were probably just trying to cover their butt in case that patient went south later on.

[lvnlrn]

In your shoes, I think I would have documented your report, as well as what you said in quotes. And then I would discuss it my manager to see what she feels, if anything, needs to be followed up with regarding the other nurse's charting. I can see why you are a little upset...it wasn't fair for her to put that on you. Like PP said, you do not dictate where this patient goes.

In my hospital, it seems like there is a little bit of ED vs. floor nursing going on. Wish we could all just lay off each other and realize we're all doing the best we can.

[bebbercorn]

I get this a lot when giving report to the floor, noooobody wants a new patient. Sheesh. I usually cover my bum with a note as pt is transferred up with pt mentation, heart rhythm and any gems that warrant additional documentation, like if there is a med/lab due within an hour, nurse threatens to call management, etc. Don't hate the player, hate the game.

[Larry77, RN]

If you knew the nurses name could you send him/her an email to ask why they charted what they did. Maybe you could meet for coffee and discuss both points of view? I'm sure she was covering her bum but to direct quote something that wasn't said is falsifying charting and maybe she doesn't understand that you were the one looking at the patient and if you had concerns about sending her to the Tele floor you would have brought those concerns up with the admitting doc.

I always think this type of approach helps the culture in your hospital much more then just reporting each other to managers.