Monday, September 3, 2007

Staffing again...

ER Tech Dude makes a critical point about staffing in hospitals.

So I say let's spread out the overcrowding with each unit absorbing a portion of the ED overcrowding. Nurse patient ratios aren't a valid excuse when it comes to refusing a patient admit to the floor, the ED nurse patient ratios are out of proportion daily. What's acceptable for one department should be acceptable to all departments.

Hospital administration has to stop sending nurses home mid-shift because the patient population has fallen 1 patient under the arbitrary ratio number. They also have to be willing to call in additional staff or use a staffing agency when capacity is reached.

Other departments don't care about ED overcrowding not because they're uncaring, it's because as long as the patients can be housed in the ED, it's not their problem.

The solution to ED overcrowding is to get rid of the crowd. Admit and move the patient to the medical floor and watch how fast beds are found.

One flaw with the proposition is that regular floors aren't equipped the way EDs are. Try running a code on a crashing patient on a medical floor and you'll know what I'm talking about. Nurses and equipments on medical floors simply aren't equipped to deal with potential problems the way the ED is.

I'm not saying what's happening is right - having a "stuffed to the gills" ED doesn't sound safe to me either. I'm just trying to provide a different perspective.

At my hospital, my unit typically takes all overflows - even though we are the Surgical/Ortho floor. I've seen everybody up here - Medical, Tele, Gyne, Pulmonary, Oncology, Uro, Neuro ... hell, even the occasional peds patient (even though none of us up here are PALS certified).

The problem, I submit, is the recent shift in hospital admin views about unit census. The current theory is that to stay out of the red, units should be staffed as close to being "full" as possible. They figure this to be efficient - hence why they closed the Medical/Oncology unit in my hospital. Now not only do we see their medical patients, we see their oncology patients too. And on top of that, we take their overflow as well.

We nurses, of course, think this is stupid. "A nurse is a nurse is a nurse" is a fallacy - when you cram different patient populations in the same unit without adequate staff training to take care of them, patient outcome is going to suffer. A medical nurse cannot take care of my post-op knee any better than I can take care of her pneumonia patient.

Besides it being unsafe and all...

I do concede the point that unit managers need to stop judging scenarios based on some arbitrary "Staffing ratio" number. But this again, is a two sided story - those "numbers" are set by admin. Once again, admin wants to eat it's cake and have it too - they want to increase efficiency but look with evil eyes everytime staffing goes "over the limit".

Then again, this isn't exactly something new....

All patients don't come to the hospital through the ER. Many are electives. Some are direct admits. Floor nurses see patient dumping too.

ER Tech Dude, you have my sympathy and support. Let us see if we can change the numbers game...


Anonymous said...

Spook I agree with you whole heartedly with your post. I wasn't saying that patients should be shipped to the floors willy nilly, the should go the appropriate floor for their medical condition. If it came across as patient dumping I apologize.

People who believe a nurse is a nurse is a nurse hasn't been around a hospital in a long time. With all the specialties out there today it's impossible for one nurse to know how to treat all patients, anyone who thinks differently is misinformed.

I don't know what the answer is to the number juggling admin does. We have 2 perfectly good wings in our hospital currently used as storage, its obvious we have the need for the beds yet admin is refusing to reopen at least one of them.

Should we move back to the for profit hospital? We're all hoping that with the new owner and the move from non-profit to for-profit hospital that things will change. After all you can't make money if you're turning patients away.

I know wishful thinking.

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