Why are unstable ICU/CCU pts on our med/surg floor?!

Daytonite, BSN, RN · Apr 7, 2006

It's the nature of the beast. We used to get patients with Swan lines, arterial lines and on dopamine drips with one of the older portable blood pressure monitors because we, of course, didn't have that computer technology built into our patient rooms! CCU didn't like getting postop abdominal cases, believe me, but if they had an empty critical care bed then that is where the patient went until a bed opened up in ICU. When I got into supervision I learned more about the bed control situation. When the units are full and ER needs to empty out into the ICUs, then ICU has to triage and dump to telemetry and stepdown units. As hospitals started closing up beds this practice got to be a pretty regular thing. One of our first shift tasks as supervisors was to assess how many open critical care beds there were or which patients could get bumped to telemetry first. We also had to know who could come off telemetry first and who could be transferred off the telemetry unit to a regular medical unit. I wasn't surprised when I started seeing telemetry units requiring ACLS certification of their staff. When I worked telemetry we all had to take a course in hemodynamic monitoring, know how to care for and trouble shoot Swan lines and arterial lines. We rarely had patients with them, but we were required to know about them. This is just one of the many reasons why I do not think telemetry is a place for new grads. To add specialized care on top of an already anxious situation for them with learning to handle telemetry is too much responsibility without proper training.

Cheyenne RN,BSHS · Apr 10, 2006

i remember that there used to be a time when patients with triple lumen cath cvc lines, trachs, peg tubes, foleys, ostomy bags, multiple drips and antibiotics with hyperal feedings along with complicated multiple wound care's were considered icu criteria.

technology has progressed rapidly and insurance companies impact the amount of monies that will or will not be devoted to direct patient care.

hospitals are being reimbursed less and less with rural hospitals closing at an alarming rate.

it would seem that medical need and acuity no longer decide where a patient is sent. factors such as the level of nursing care required to care for that same person are not considered way too often.

patients are not only being discharged earlier for not meeting in-hospital criteria, they are also being sent out onto medical floors faster. all this puts the patient at risk for more complications and the nurse at risk for stretching her license too thin.

i now have patients that not only have all the above mentioned technological attachments, but mrsa, c diff, or vre as well. patients receive anywhere from 10 to 20 medications each on morning medication rounds, but they will have heplocks with iv medications and required peaks and troughs when they are on vancomycin or gent. these are the nurses responsibility to collect on our unit as well! :angryfire

total care patients are the expected norm and a "walkie talkie" is the exception. patients are sicker now and being placed out on the "floor" when a decade ago they would be one on one care.

the patients needs have not changed, but expectations have. i don't know if there is even a way to change any of it anymore. it's scary being a nurse some days when you see all the potential errors and complications a patient can have. :idea:

NYNewGrad · Apr 11, 2006

FireWolf, I'm with you on that.

If once in every in 6 shifts I get a walkie talkie, then I'm happy. Norm is 6, and sometimes up to 8, total care pts with one tech. Out of the 6 pts, its expected you have at least 3 vent or trach collar pts that require the whole nine yeards. When one of these "stable" vents get critical, more often than not they're an ICU reject, since "we need the bed for pts with a better prognosis." So very often the real critical pts are stuck on our floor without continous monitoring. So yes, often our pts are just as critical as the pts in ICU where its one nurse to 2 pts, but here the pts dont have a great prognosis, or they're DNR, but family still wanting everything to be done.

I had a pt today who went real bad, started on Dopamine, hemorrhaging, getting blood, fluids open etc. and, you know what, I spent four hours in her room!!! What happened to my other pts? Took a peek at them, had others nurses help here and there. My NM spent a lot of time with me in the room. But bottom line they're my responsibility and this type of situation is normal. And from speaking to nurses in other hospitals, the situation is just as bad everywhere else in my area. This is the norm here.

So yes, we give meds, total care, suction, turn, hang millions of IVPBs, the K-Riders and Kayexalates, central lines and infusaports, CBI and PCA, etc. etc. times 6 or times 8 pts! Oh, and did I mention family?!? Family x6 or x8? Good thing we dont draw our labs..