Published Feb 1, 2006
jabdab
2 Posts
Hello pacu nurses... Question for all...hope it makes sense...
I have worked in the pacu for almost 4 years and love it....except... on may occasions our hospitals 16 bed icu will be, as they like to call it, capped at 12. So when our icu does not have enough staff the 2 or 3 pt in the pacu must remain in the pacu overnight. Our call nurse is then mandated to come in and work 11-7 along with another pacu nurse. We are both taken off the next day but then the unit is short 2 rns. We have 10 ORs and do about 50 cases a day.
This happened again last night. 5 times this month. My manager says its happening all over the country! Anybody have the same situation?
Thanks for reading
DutchgirlRN, ASN, RN
3,932 Posts
I have worked in the pacu for almost 4 years and love it....except... on may occasions our hospitals 16 bed icu will be, as they like to call it, capped at 12. So when our icu does not have enough staff the 2 or 3 pt in the pacu must remain in the pacu overnight. Our call nurse is then mandated to come in and work 11-7 along with another pacu nurse. We are both taken off the next day but then the unit is short 2 rns. We have 10 ORs and do about 50 cases a day. This happened again last night. 5 times this month. My manager says its happening all over the country! Anybody have the same situation?Thanks for reading
Where I work they keep bumping ICU patients up to the floor as needed. There has always seemed to be a patient or 2 or 3 that when asked by the doctor could be bumped. The unit goes on diversion if not able to take anymore patients due to lack or beds or staffing. I think your situation is not totally unreasonable except for the fact that it is happening far too often IMO. I wouldn't like it. I signed up for days not nocts!
RosesrReder, BSN, MSN, RN
8,498 Posts
Charity, RN, APRN
129 Posts
When I first started in PACU over 10 years ago, our head of anesthesia would not allow a surgery to start unless that patient had an ICU bed waiting for them. The surgeons would literally have to scrub out, go to ICU, and find a patient to transfer. Ah, the good old days...
Of course, I remember walking into a unit with 4 ICU patients, ORs still running, and 2 nurses on the schedule...(The call to the patient comment line regarding me said: "get that girl some help!")
Our PACU is a bit different. We staff 24/7, so no call to worry about. One big help is that our ICUs recover their own patients. (using ASPAN's standards, just like us).
Yet we still have problems. ER wants to admit to us, instead of holding for an available ICU bed. A surgeon will refuse the assigned ICU bed because he or she wants the patient in another of our ICUs (we have 4). Policy clearly states that a surgical patient should go to the first available ICU bed while waiting for a bed to become open in the appropriate unit. (Neurosurgery usually). But the room will call out with little or no warning about the "change in plans" and there they are. What can you do?
Our solutions?
1. A diligent and supportive manager and medical director. Strict admission criteria. Adherence to ASPAN staffing standards. Shut down the ORs a few times because PACU is busy playing ICU and see how fast ICU beds open up.
2. Coordinate with ICU and bedboard/admissions prior to surgery to facilitate transfers. This may not seem like a PACU job, but it makes our jobs easier.
3. Get ICU to recover their own patients. If they never come in the unit, they can't be there in the evening...
4. Keep on the docs. Use money. We charge by the hour. One 24 hour stay in our PACU is approx one WEEK in an ICU. Let them explain THAT bill to dear Mrs. Smith...
suzanne4, RN
26,410 Posts
Cases should not be started if there will not be a bed available. PACU staff should not be utilized like that as a back-up because the ICU is short. The big issue will occur when those PACU nurses start to quit.
I like Charity's suggestions.
sharann, BSN, RN
1,758 Posts
It's so sickening when this keeps happening.
The solutions provided by Charity and others above are great. We make it a priority to let the surgery manager know when this is happening and we let them know that if we run short because of holding ICU, then we will stick to ICU patient ratios and will stop accepting OR patients when we reach ratio. THIS usually gets the ball rolling...
kvl
1 Post
We are having the same issues in our hospital. Actually the entire area I live in is experiencing this same situation. What we've done is work with the Clinical Administrator (house supervisor) and the surgical services manager on call to arrange for an ICU nurse and tech or 2 nurses to staff for that patient in PACU. That way we do not have staff shortage for PACU. The problem is there is not always a nurse from ICU to cover this situation. It is not ideal, but the call nurse or a volunteer from the PACU staff stay and the manager on call comes in to staff. Hope this helps.
amnesia
54 Posts
Cases should not be started if there will not be a bed available. PACU staff should not be utilized like that as a back-up because the ICU is short. The big issue will occur when those PACU nurses start to quit.SOOOOO... TRUE!:angryfire Burns me up that they continue to do surgery when there are no beds to transfer the recovered patients to!:angryfire Lately our haospital has started sending patients with a high BMI and with history of OSA/CPAP to a monitered bed (similiar to telemetry but includes SaO2 monitering as well). Well, lets just say that the demand outweighs the supply, and we get bottlenecked in PACU holding them. This is in addition to all the ICU overflow we routinely keep. I should say we do have a very good manager that is involved and proactive, but the medical staff always WINS out. This is a growing problem that seems to be nationwide. Where will the MADNESS stop?
SOOOOO... TRUE!
:angryfire Burns me up that they continue to do surgery when there are no beds to transfer the recovered patients to!:angryfire
Lately our haospital has started sending patients with a high BMI and with history of OSA/CPAP to a monitered bed (similiar to telemetry but includes SaO2 monitering as well). Well, lets just say that the demand outweighs the supply, and we get bottlenecked in PACU holding them. This is in addition to all the ICU overflow we routinely keep. I should say we do have a very good manager that is involved and proactive, but the medical staff always WINS out. This is a growing problem that seems to be nationwide. Where will the MADNESS stop?
SFCardiacRN
762 Posts
Our charge RN and E1 anesthesiologist will not allow an ICU case to start until a bed (read RN!) is available. Usually, the surgeon/resident will just transfer an ICU pt. to TCU. There are enough emergencies and unexpected cases needing ICU without squeezing in elective ones.
Mayotski
15 Posts
I just had my 24 hour duty Thursday last week. I was the 2pm-10pm nurse and our SICU then was a full house. There was no one to relieve me, I have to cater to 2 SICU patients and 2 PACU patients alone w/ a pull out, I have no choice but to extend my shift until 6am the next day. But guess what? I am also the 8am-4pm nurse the next day. Can you imagine how tired I am the following day?
The thing is, this is not the first time and we're only 3 nurses in the PACU. According to our admins our area doesn't require additional staffs (which is bull BTW) coz we've got all the help we got. Well, goodluck to us all.