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At Maimonides I have noticed over the years that as the PICU grew in size and
staff, more and more patients who would have been "floor" patients in the
past became "PICU" patients. As a result, the floor nurses lost their skills
to manage any truly sick child.
This ongoing process robs them of clinical skills and confidence.
In addition, the ratio of patients per nurses has changed, and a floor nurse
takes care of more children today that he/she did 10 years ago. So monitoring
sick children is a real issue.
As a result, when ever I want to admit an oxygen dependant child to the floor
I encounter a lot odf resistant from the floor nurses who are often panicked
that they may actually manage someone sick.
Here at Maimonides we have to get the OK from the PICU attending for any PICU
admission (we do not need the permission of the floor attending for the floor
admission). If there is a conflict we leave it to the Pediatric Director of
clinical operations to resolve the dispute).

Giora Winnik MD
Maimonides ,  Brooklyn NY

For more information, send mail to [log in to unmask] with the message: info PED-EM-L
The URL for the PED-EM-L Web Page is:
  http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html