Hospital Intensive Care Units

Nurse managers should consider patient needs, level of education, expertise and work satisfaction before dictating the number of nurses-to-patient ration (Murray, 2017). Reported by Martin (2015), the risk of mortality can be decreased by 50%. Starting with the nurses, a large amount of workload can bring fatigue, inadequate sleep, employment and increase in calls-out which leaves nurse managers to make changes to assignments. This takes times out of the resource nurse shift to focus on redistributing patient, in turn, causes a delay in starting their plan of care. As an aide, there have been times at Meritus where a nurse calls out and the resource nurse at least spends an hour with the outgoing nurse communicating with the staffing office to ask for a float pool nurse. On the other hand, outcomes such as “pneumonia, shock, cardiac arrest, and urinary tract infections are directly related to low nurse staffing” (Martin, 2015). On the stroke medical-surgical unit, sometimes there is one aide for 28 patients. Some of these patients need turning every two hours, incontinent or bedrest, but it is difficult to attend to all of them on an hourly rounding base and provide adequate care to each of them. At one point, a new graduate nurse was given seven patients to care for. According to Meritus nurse residency program, new grads can have up to six patients on a medical-surgical floor. One can only imagine how overwhelming that can be for a new nurse. To help prevent these poor outcomes from occurring, strategies to improve nurse staffing can be utilized by

Patient quality of care becomes severely compromised without adequate staff availability. Low staffing not only affects the patient, but the nurse providing care as well.

Chest pain is one of the most common causes for referral to emergency departments (ED), accounting for several million visits annually (Goodacre et al., 2005). In the given scenario, the call was made by the wife of the patient reporting complains of chest pain. She described that her husband is having a constant pain in the left side of his chest and upper arm and that he was having shortness of breath and wasn’t able to talk to the nurse himself. The patient hadn’t been to his HCP for eight years. During the conversation the patient started breathing easier and his wife was asking if they could go to the urgent care not right now but on Monday morning, which is almost two days after. The time of the scenario is Saturday evening.

The United States health care system cumbersome and complex; however, there is opportunity to transform the health care system. By providing seamless, affordable, evidence based and patient centered care that is accessible to all, United States will improve patient and community health outcomes. Nursing is the largest sector of the healthcare field and without a doubt has an essential role in addressing the United States health care system crisis. Care within hospital and community settings has become more complex. This requires nurses to make critical decisions associated with care for sicker, frailer patients and work with sophisticated, life-saving technology. Nurses are also being called upon to fill primary care roles and to help patients manage chronic illnesses, thereby preventing acute care episodes and disease progression.

Nurses can contribute positively towards improving all spheres of healthcare based on our knowledge, expertise, experience, and education ( Balalden & Foster 2014). Nurses can make a major contribution in promoting and shape effectively health policy.

Registered Nurses play a big role when it comes to patient care in the health care system. They use a systemic, dynamic way to collect and analyze data about a patient; we call this the assessment process (The Nursing Process, ANA, 2014). As a nurse you are not just seen as a caregiver, you are also seen as an advocate for patients who need to be cared for. We as Nurses have responsibilities such as knowing the laws, EMTALA, HIPPA, ADA and so on. Each of those laws gives us the guidelines of what we are expected as nurses.

I found that a few of the reasons that patients were held in the ED was because of lack of staff on the ICU and the lack of beds that are available. It was a constant issue while spending time in the ED that there was never any beds on ICU and if there was, there was not enough nurses. This is a problem because of not enough staff or the hospital not wanting to pay overtime. It never made much sense to me why it was ok for a nurse in the ED to have one critically ill patient needed ICU, a trauma and then three other patients with other illnesses but it is not okay to give a nurse on ICU more than two patients. It is not safe for the patient or the nurse that is put in that situation. The ED found that after the patient is admitted, they should be out of the ED and in ICU within at least 1-2 hours, anytime after that was putting the patient at risk for poor healthcare outcomes. I found that over a week period, the average time for the 4 patient’s that were held in the ED for a long period of time was 19 hours which is way to long when considering the hospital is striving for only a couple hour wait between transfer.

Soleimanpour et. al (2011) explained that patient satisfaction is an essential component in the Emergency Department (ED) because it is the entrance for patients to receive their initial treatments. The most important and single possible cause for ED patients’ flow problem is the availability of inpatients beds (Peck et. al, 2012). The American College of Emergency Physicians (ACEP) (2011) explained that the primary cause of ED overcrowding is boarding; which was defined as holding patients in the ED after the admission had been completed due to unavailability of inpatient beds. Lutheran Medical Center faced this problem and in his paper will discuss analysis of the problem, determination of possible quality lapses, identification of performance measures, designing and evaluation of the interventions and reporting of the results.

Staffing shortages is a serious issue affecting Licking Memorial Critical Care Units. This problem has been the subject of many staff meetings although a clear resolution has not been identified. Methods such as offering bonuses for overtime have been trialed to increase staffing have not yet been able to defuse the situation. Current employees feel they are unable to keep up at the current pace they are working and this can lead to resignations which adds fuel to the current problem. In order to provide the best possible care to our patients and improve staff morale a new approach to this persistent problem needs to be implemented.

Since the first days of nursing school, nurses have always been taught to advocate for their patients. Standing up for them when they have no voice, assuring that they are receiving the proper medication in the proper dosages, and maintaining their humanity in their final hours. In 2010 the Institute of Medicine called for nurses to engage in health policy and lead in transformation of the US healthcare system (Institute of Medicine(IOM), 2010). It has been years since this report and the government is still lacking nursing representation. In the words of Abood (2007), The current health care environment...challenges both nurses and patients who are often caught between the cross currents of cost constraints and access to appropriate quality care (p.1).

inflow of patients is higher than the available beds. You are treating an elderly man who is breathless and cyanosed. While you assess whether he has chronic obstructive pulmonary disease or heart failure, he becomes drowsy and starts gasping. You quickly intubate him with some difficulty, prolonging his period of hypoxia, and put him on ventilator support. You then get a phone call from a senior consultant in the hospital that an important social activist is about to arrive with chest pain and will need to be admitted. You are directed to

All of the samples were convenience samples of patients who survived a stay in the intensive care unit, questioned anywhere from 8 weeks up to one year later post discharge. All studies used questionnaires, interviews, and reviews of the patient’s charts for interventions. The results of the studies were not the same for all patients.

Nurses are known as the heart of health care. Being a nurse is a demanding job that requires commitment, but does not lack rewards. A fact stated by the American Association of Colleges of Nurses claims that “Nurses comprise the largest single component of hospital staff, are the primary providers of hospital patient care, and deliver most of the nation 's long-term care” (“Nursing Fact Sheet”). With many roles throughout the healthcare system as a whole, nurses are a large, very important role that interacts with every other part of the health care system. They have great qualities that not everyone has. They are highly compassionate, caring, professional, diligent and understanding individuals. A nurse experiences people at their worst and still care for patients in a way that no one else would. All these honest points prove that nurses are the most important members of the health care system because, nurses spend the most time with patients, nurses are the managers of patient care; they are teachers and are great with conflict resolution.

Critical care nursing is a roller coaster ride. It has a lot of surprises throughout the day and you never know what is around the corner. Our Critical Care Step-Down Unit here at the Davenport Hospital has a capacity of 30 beds (6 private and 12 semi-private rooms). 2 West accommodates a variety of patients, such as adult postsurgical, trauma, seizures, renal failure, and myocardial infarction patients. This unit provides care for patients that have been discharged from an Intensive Care unit, but they are not stable and require a high level of monitoring before they return in a general medical surgical floor. Lately our unit has been struggled with staff shortage. It has been weeks that in the day shift there are only 3 registered nurses and each of them provide care to 6 or 7 patients. Based on the hospital protocol policy nurse-to-patient ratio in a step-down unit must be 1:4 or less at all times. In addition, I am designing this written proposal to seek approval of hiring a new critical care nurse in 2 west step-down unit. The above proposed nursing position will definitely benefit both the unit staff and patient population. The nursing shortage can easily lead to nursing burnout such as fatigue, injuries, and dissatisfaction. Also, nurses that work in such conditions are more predisposed on making mistakes and medical errors. This proposal will definitely benefit the patient who are being treated in this unit as well. According to Huber

As a Hospitalist NP, the patients that I admit for our group are not critically ill. Most times, the conditions for which are they are admitted warrant an admission, but they are treatable conditions. If the treatment is successful, the patients are discharged within two to four days. If they decompensate during their hospitalization, a rapid response code is called. Their disposition