435 pounds of why is this patient here?

My shift today started with me coming in to a 435 lb patient sleeping in a hospital bed that nurses had to borrow from one of the units upstairs. She was simply too big to fit onto one of our gurneys. There was nothing about this patient's presentation to grant a resuscitation bed but given how heavy (both physically and in terms of workload) this patient was, she was assigned a spot in the resuscitation room. Out of all the areas in our ER, resuscitation room has the smallest nurse to patient ratio. It's usually one to two patients per nurse.

This woman has been recently discharged from our hospital after being admitted for a whooping two and a half years. She hasn't spent even two weeks in the nursing home when the staff there decided they could not cope with her care and jumped on an opportunity to send her back to us. Their reason for calling 911 was that the patient had a decreased level of consciousness. She did not. True; she wasn't as active as some other people might be, and spent most of her time in the bed snoozing. True; she had sleep apnea and stopped breathing for a few seconds here and there, but then again, it didn't come as a shock given her weight. But there was absolutely no change in her baseline presentation to grant a visit to ER, let alone being admitted to the hospital.

Couple of hours into my shift (and after a great amount of collaboration between clinical nurse specialists, physicians, social workers, and ER management) it was decided that this patient was going to go back to the nursing home since her medical condition did not change since her discharge a couple of weeks ago.

Never before did I get so much pleasure out of calling a nursing home to inform them that we were sending their patient back. Mind you, I do understand how much it takes to take care of patients like Ms. K. This is one of the reasons I would never work in a nursing home or any other long term care setting. I just don't have what it takes to do that kind of nursing. But it frustrates me to no end when nursing homes literally dump their patients on ERs as soon as they feel overwhelmed and tired of taking care of them. That's not what ERs are there for. We are not there to give long term care RNs, RPNs, and MDs a break.

When two EMS crews arrived with the bariatric stretcher in tow I paged for all the available staff to come to resuscitation bay 3. Did I mention that we don't have ceiling or any other sort of lifts in our ER? It took six nurses and three paramedics to transfer Ms. K onto the EMS stretcher. As soon as they rolled through the sliding doors of the ER and out into the crisp winter morning air I felt lighter. About 400 lb so. I could go back to taking care of patients who actually required emergency care. Well, some of them did. Majority just didn't feel like waiting in line at a walk in clinic.