tele/step-down nurses pulled to ICU

I work in a community hospital on a telemetry/step down unit-not really sure which you would classify it under. We do drips-cardizem, dobutamine, dopamine, amiodorone, nitro, insulin-pretty much everything except for levophed. The majority of our patients are cardiac or pulmonary-AMI, sepsis, CHF, COPD, pneumonia, PE.

Anyway, I was just wondering if at the hospitals other nurses work at in a similar capacity to mine, if you are ever pulled to the ICU? Our ICU is grossly understaffed. Just the other night, there were 10 patients in the ICU (15 bed ICU). I got pulled there, and the assignment the charge nurse made out was that 1 nurse had 2 patients, 3 nurses had 1 patient, and I had 4 patients. I clarified that all these patients were ICU patients, and not overflows from my regular unit or from med surg, then I kindly told the charge that this was not an appropriate assignment, and that I was not able to take 4 ICU patients. She tried to convince me that the assignment was appropriate-that the patients were not on vents, that they were the lowest acuity patients, that they should be patients on my unit, but that was just "a matter of how the order was written." And I repeatedly told her I would not accept the assignment, if they were so low acuity then they should request the doctor to write an order to transfer them to my unit and I would gladly care for all of them. Eventually, a nurse who was supposed to be going home said that he would stay over and I went back to my unit.

So, do any of you get pulled to the ICU? If so, what kind of assignment is assigned to you? 4 patients with vitals every hour and who knows what else is way too much for any nurse, in my opinion.

In my unit we'll on occaision get step-down nurses as 'floats' when we're under-staffed. We make a point to give them the 'easiest' (least unstable??) patients and never force them to care for anyone out of their ability/comfort-zone.

There are also times when we'll have patients who are stable and up for transfer (or should be). In a staffing crisis we've had 3 of these patients to one nurse (never 4!)...but we (the staff) are very resistant to this and it's not done often.

Anyway, i kinda understand your anxiety about caring for 4 patients...but not so much because these patients are more difficult or becuase they're in an icu bed as opposed to a step-down bed (does location change their acuity?)... My biggest concern would be that inconciderate or *bad*, or *stupid* managers can see this as a precedent and continue this *potentially* unsafe/dangerous arrangement.

I'm in a small rural hospital as well, but we get it the other direction -- we call it the "ER miracle"

Pt comes in, doc says they need ICU, no additional nurse to staff the ICU, so...

(((miracle happens)))

you're suddenly better and can go to tele/ICU stepdown.

We've had nurses pulled to ICU, but they only get the patients with floor orders - i.e. the ones who are hanging out in the unit until a bed opens up on the floor. Usually they are patients that would come to my floor anyway, so it's not that much of a stretch. I don't think though, that they get 4, but I may be wrong.

Tom

i have been pulled to ICU before as being short and had worked on tele/pre/post cath floors however in my hospital there are obviously times were there are not enough beds for the icu patients and then icu/ccu patients overflow into tele beds - so there are times when you have those patients on the tele units when you know they are more critical, so on top of the usual tele patients you may have 2 that are more critical and really it seems as though those 2 take up most of your time as some ICU nurses have a 2:1 ratio instead you have tele and you have a 4:1 or even 6:1 depending on the staff so....alll in all you have in these situations 2 potential ICU patients, then your 4 tele you have to take care of ---

but also i think that you did the correct thing by telling the charge that you were not comfortable in accepting the patient load/cases - very responsible to take action - ive seen nurses that do not say anything and run around flipping out because they know they should have said they were uncomfortable