In over your head with a critically ill inpatient?
Call for help if needed
More and more, emergency nurses are being put in a dangerous position when caring for inpatients, says Deborah M. Dixon, RN, MSN, APN, ED educator at Summa Health System in Akron, OH.
"Our biggest challenge is all the hands-on care that critical care patients require," says Dixon. "Normally, an intensive care unit patient has a 2-to-1 ratio. We don't have staffing for that. It is a struggle for our nurses. We have to think outside the box in how to handle some of those patients."[A list of immediate interventions done by ED nurses for admitted patients is included.]
Procedures that ED nurses don't normally do, such as invasive care monitoring or arterial line setups are covered during mandatory skill labs held annually. "The topics change every year, depending on the needs of the department," says Dixon. "Last year's skills lab covered intraosseous insertion, chest tubes and autotranfusers, and Level 1 rapid infusers."
However, there are times when ED nurses ask for an intensive care nurse to help. "This is rare, but we have said on occasion, 'We've got these patients down here, and we don't feel comfortable treating them. Do you have somebody you can send down to help us?'" says Dixon.
On one occasion, a critical care patient required invasive care monitoring, and the ED lacked the necessary equipment. In addition, none of the ED nurses was up to date on the use of Swan-Ganz pulmonary artery catheters. "We had to call somebody to set it up," says Dixon. "The ED is not the place for putting burr holes in somebody. But if it's going to be done here, you at least need someone that has done it a few times."
If a large number of admitted patients are being held in the ED at St. Vincent's HealthCare in Jacksonville, one of the PRN nurses who care for patients in the telemetry or intensive care units might be called down and assigned to the patients in the ED instead. "We make that decision depending on how many patients we are holding," says Diane Fox, RN, BSN, CEN, clinical resource coordinator for the ED. "If the determination is made to send us a nurse, that frees up a nurse for us and keeps our flow going."
[Editor's note: Fox can be contacted by phone: (904) 308-5020. Fax: (904) 308-5050. E-mail: [email protected].]
More and more, emergency nurses are being put in a dangerous position when caring for inpatients, says Deborah M. Dixon, RN, MSN, APN, ED educator at Summa Health System in Akron, OH.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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