Why did we accept this patient?

 KalipsoRed21, BSN: Not sure when these patients were admitted. During the peaks of COVID in your area, there just may not have been any place to send them. In such cases, care by you on your floor is much much better than non existent availability at a overwhelmed hospital. And perhaps better than your own ED where people may have been dying in the waiting room for lack of staff to see. The most common cause of seizure presenting to a hospital is sub therapeutic on meds. In that case, on your floor you may be able to control attacks with benzos, keep the patient safe, and load anti-seizure meds during hospital course.

Hannahbanana, BSN, MSN: you said, "If that means calling EMS and getting them the heck out to a real hospital, that that should cover your behind. Document the heck out of it all." With respect, I would consider this a very risky action. This might be considered a transfer. Transfers are covered under EMTALA. If this were to retrospectively found to be an EMTALA violation, the hospital would be subject to investigations from the feds and probably the state. Also, the nurse could be personally liable for initiating the 'illegal' transfer. The fine associated with this action is $50,000 which is not covered by malpractice or any other insurance. 

12 hours ago, Hannahbanana said:

Please do correct me if I'm wrong, but EMTALA isn't designed to prevent an appropriate transfer to a required higher level of care.

That's true. There's no problem in properly executing a transfer to a facility that has resources the sending hospital doesn't have. However, the OP did state that in the latter case the hospital ended up not admitting the patient at their facility supposedly because of they didn't accept the patient's insurance. That is going to get dicey very quickly, especially if admin is going to stand around proclaiming that they do have the resources to handle the patient.

So the patient that was having seizures had never been on seizure meds or evaluated by a neurologist. We were unable to get her seizures under control and when she finally was seizing every 5 to 10 minutes we FINALLY transferred her. As COVID was not peaked in my area or the nearest city with a large hospital, I do not feel that was the justification for not transferring her. Unfortunately Hannah, while I agree that there is probably something in my nurse act to justify such action, there are no other job opportunities in this area and as I am the breadwinner for my family I cannot loose my job. There is always the argument that I or other staff I work with could loose our license for not doing best for the patient. But honestly what I have to say to that is nurses are the scapegoat either way. You stand up for the patient you will be fired and blackballed in your area, you choose to continue to work under crappy policy and practice and something happens, the very first thing they do is blame the nurse, fire him/her and then the board takes away your license for poor practice. Does upper management and CEOs ever suffer consequence for the poor policy and  impossible situations they create? Nope. They just have to resign early. Boo,***ing, hoo. I’m done trying to change the world for the better. I’m just going to support my family and hope for the best for everyone else.