Monday, September 12, 2005

The Tyranny of The Bed!

The most frustrating aspect of emergency nursing is trying to get patients up to their floor after they've been admitted. Back in the old days, when the ER called to say they were ready to bring a patient up, they came up right then, whether you were ready or not. But it seems that things have changed. Getting admitted patients to their rooms has become fraught with obstacles, delays and much gnashing of teeth. Over the years I have discovered that it is really no one's fault. Every problem in admitting can be related to.......THE BED!!!!!!!Here are the top ten reasons why:

1. THE BED is not in the room. No one knows where it might be or when it will be returned.
The hospital "orderly" will be sent to look for it.

2. THE BED still has a patient in it. No one knows when this patient will be discharged or
why it was reassigned while still occupied.

3. THE BED is not clean. Housekeeping was called "half-an-hour" ago, but no one knows
who called and no one knows why they haven't answered their page.

4. The nurse assigned to THE BED is at lunch.

5. There will be no nurse until 7:00 pm for THE BED. Please hold the patient in the ER for
the next three hours and no, there is no one to come in early.

6. The admitting doctor wants to see the patient in the ER, not in THE BED.

7. The nurse can't take report because she is at THE BED of another patient.

8. The floor can handle only one transfer to THE BED at a time. The other four patients
waiting for their version of THE BED will have to wait.

9. The hospital is full. Each room has someone in THE BED.

10. It's Change-Of-Shift and there is no one available to help put a new patient in THE BED
Never mind that report was recorded an hour before shift change and only requires the presence of the oncoming nurses.

As I've always said about ER, "The longer you stay, the longer your stay!" When you think about it, ER is the only department (with the obvious exception of Labor and Delivery) where you have no control over when your patients show up. In our world, THE BED is eternally ready.....


9 Comments:

At 9/12/2005 07:05:00 PM, Blogger Dr. Deborah Serani said...

OMG, your post is so true. My Dad has been very ill and had aneurysm surgery and we needed to take him back to the ER two times in the last month. I feel like you overheard our conversations with staff!!! My Dad was in the ER 8 hours on the first ER visit and then 10 at the second before a bed was assigned, and that was with the surgeon calling ahead to make the transitions easier. Sheesh.

 
At 9/12/2005 07:48:00 PM, Blogger B said...

I feel your pain!

 
At 9/12/2005 08:34:00 PM, Blogger Gypsybobocowgirl said...

I think you really struck a nerve here...this is a daily battle in my hospital. In one of my finer moments, I got written up for going to the floor and cleaning "The Bed." (I didn't apoligize for that one).
When I worked the floor, it wasn't an option to say no the the ED. I can't pinpoint where and when it changed, but there has definately been a culture shift.
I hesitate to say it, but I think in trying to teach nurses to be more assertive, we've taught them to be more assertive with each other (and less cooperative), and I often see that assertivenss applied to make the nurse's life easier, not to advocate for the patient. Bummer!

 
At 9/12/2005 10:22:00 PM, Anonymous Catherine said...

At a major HMO in Northern California, it's just as hard, if not harder, to attain an ER BED, which can be seen as the heir to THE BED. I've written about this in an earlier rant here that I called ER Cash Cow. ER visitors are triaged, pay their $50 co-pay, and have been known to wait for hours without ever seeing an ER doctor, thus never achieving the ultimate ER status symbol, the ER BED. It took me two ER visits spread over three days (with a so-called short appointment with a primary care physician (PCP) and blood tests sandwiched in between) before I was whisked away to the bed behind ER curtain #1. And frankly, it took two hours on the second visit to achieve that, even though by then they knew my hemoglobin level was 5.8. My PCP could pull no weight to get me seen any faster. Having attained the ER BED, it took 10 hours (and two of the three units of blood I needed) before I made it to THE BED. I was able to keep ownership of THE BED for three full days and two nights before being discharged. I have to laugh, though, as the second night and third day turned out to be a waste, as the hospitalist in charge of my case failed to schedule the test I was supposed to take on the third day and I wasn't discharged 'til that evening, too late to give THE BED to anyone else.

You're probably wondering why I just didn't see my PCP in the first place. Well, I tried, but was told by the Advice Nurse that my symptoms were such that I couldn't be treated by the PCP, that I'd have to go to the ER. After 4 hrs in the ER, I left . . . and used the HMO system against itself by scheduling a short appointment via their Web site, thus going around the dreaded Advice Nurse.

After five long and frustrating months, things eventually worked out (though my hemoglobin dropped from a high of 10.8 in May back down to 7.9 in September). I finally got the surgery I needed to fix my bleeding ulcer, but even then, I was only able to call THE BED my own for less than 24 hrs before I was discharged. Makes me wonder if I was just being forced to "pay back" the lost bed time from the end of April . . . naw, they wouldn't do that, would they?!

 
At 9/12/2005 11:27:00 PM, Blogger Kim said...

Catherine, I believe every word. I think it depends a lot on the hospital and department, too. The larger, busier hospitals can be hell to navigate. That's why I work in a smallish community hospital. Large enough to have resources and small enough to be fairly human. In fact, many of our patients are supposed to go elsewhere but they will come to us instead. I hear so many stories similar to yours, it's very depressing.npr

 
At 9/12/2005 11:30:00 PM, Blogger Kim said...

I don't think it would be so bad if the gurneys in the ER were more comfortable but those things are horrible. I joke with my patients about how we should get Temperpedic gurneys.

 
At 9/13/2005 02:53:00 AM, Blogger Fly Over Drew said...

I have to say Kim you gave me two flashbacks tonight. A) I laugh as I sit here at 4:30 AM surfing due to insomnia and B) the "bed" has longevity. I was a Respiratory Therapist (RRT) for 5 years working nights in Trauma/Neuro ICU and thought I had forgotten about these days. Although much like yourself I don't regret my experience - changed me for the better, more grateful. The insomnia is a gift from working nights but then again I think my bed will ready in "30 minutes". We used to joke that they were metric minutes and they lost the clock!

Best

 
At 9/13/2005 06:28:00 AM, Blogger kenju said...

The few times I have been in a hospital as a patient, I have never seen a housekeeper who worked well enough to be worth his or her salt. Perhaps there is a way to motivate them to work faster?

 
At 9/13/2005 11:36:00 AM, Anonymous Catherine said...

Kim -- I agree with you about the ER gurneys, they're really uncomfortable. Each should come with its own auxiliary rubber donut . . . or better yet, a "gelly" donut! But maybe that's one of the only ways that ER docs and nurses can tell if you're still alive, by the amount of squirming you do to relieve the pressure on your numb buns!

 

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