Question

You are the house supervisor in an acute care hospital. Most of the of the units are full. The ED request 2 admissions to the step-down unit. The floor with appropriate and empty beds has only 4 RNs on duty for this 30-bed unit with a census of 20 patients. The charge nurse (one of the 4 nurses present) tells you that they can’t safely admit any more patients. You currently have no more float pool staff and upper administration has already said no to closing the unit for admissions at this time. What should be done? What is the ethical dilemma? How does this impact patient care? What possible solutions are there for this situation?

Answer 1

If possible tell the ED staff to delay admission so that the nurses atleast can settle the other patients. If it is possible just be with them support them help them and also convince them to take admission. If it is not possible received the patient from ED because the patient should not suffer due to less staffing. Check the patient vitals, physical examination and check for bedsore by self.

It is not fair to over load the staff which will make them stressful. At the the same time the patient should not suffer in any situation. This is the ethical dilemma.

Assigning more patients to a staff will result in poor patient care. When a patient is admitted in the hospital the patient will be confident that the nurse who is assigned will take care about him very well. For example if the nurses is allocated with 8 patient incase of 5, she will busy, she will be giving poor backcare, poor bath etc.

Now there are only the best solution is to reassign the nurse for example if a nurse is having 2 critical ill patients and a bedridden patient. Split the critical ill patients to other two sisters and assign 2 patient who are not too sick and assign the new admission patient to the nurse and helping the nurse.

The patient should not be the sufferer