You are the ward manager in charge of a busy short stay 18 bed surgical ward. You currently have 16 patients on the ward who are awaiting surgery or recovering from very recent surgery. You have 2 staff nurses who have been allocated 8 patients each, one staff nurse is off sick. During the busy shift, the bed manager for the NHS Trust in which you work, rings to inform you that they wish to transfer another patient, Mr Smith, onto your ward. Mr Smith is recovering from a fractured neck of femur following a recent fall at home and underwent surgery to repair the fracture the day before. He is considered to be moderately dependent at present and has not commenced mobilisation as yet.
You inform the bed manager that you currently have a staff nurse off sick, so you have no extra capacity, and that the nurse to patient ratio is already at the nationally recommended limit, being 1:8. You also inform her that the patients you do have are in need of a high level of care due to the nature of their individual needs, both preoperatively and postoperatively. There is also no other nursing assistance available to you, due to high sickness levels throughout the hospital. Although you do have two spare beds, and you would like to take care of this patient, you feel you do not have the resources to do so safely, without placing your existing patients and staff at risk of harm. The bed manager becomes hostile in her manner, refuses to accept this explanation and informs you that as you have an empty bed the patient should be transferred over to you anyway, as there is no room on the other wards due to patients waiting to be transferred from Accident and Emergency department.
What should you do?
This issue was created by Vanessa Peutherer, VX facilitator, UK
It is proposed that you continue to refuse to accept Mr Smith onto the ward on this occasion