ICU/IMC/9East?!

I've only been an RN for a year plus-a-few-months, but in my short experience on an acute care floor full of potentially non-acute patients, I have never seen a physician make a decision to transfer a patient to a higher level of care without nursing pestering them (for hours) about it first.

Why is that? Why does it take multiple phone calls, the critical response nurse, the charge nurse, and the floor manager to convince the doctor that someone with consistently critical potassium values for 48 hours might despite constant IV replacement might (read: definitely) need to be on telemetry? Why is the resident not concerned over the fact that my tachycardic hypotensive patient has had ZERO urine output in the foley since the night before? Is it not obvious that the patient floating in a lake of her own blood every hour with the most whacked out labs of all time requiring constant transfusions might need to be on a floor where the nurse doesn't have four other patients to take care of?

I can think of a few patients in particular who we got transferred to the IMC after hours of paging, re-paging, arguing, and putting all my other patients' care on hold, and in every single one of those situations, those patients ended up spending weeks in the ICU.

One of them is still in the ICU.

When I started I didn't have the confidence or the experience to tell these reluctant docs that I disagreed with them. I would have thought that they know better, and if they think this patient should stay on our floor, then the patient should stay. Now thinking about the handful of way-too-sick-to-be-on-our-floor patients I've dealt with, and how taxing it has been to get them transferred no matter how obviously necessary it was, I am wondering what would have happened had nursing taken the lazy/passive route during those shifts.

I don't say this to throw our doctors under the bus. We have great doctors where I work. Wonderful, smart, great doctors. I'm not saying they should just know when the nursing care involved becomes too much for a nurse taking care of 5 patients. How would they know that unless we speak up?

...But really? Why am I the only one concerned about these un-replaceable critical chemistries?

Are patients only considered critical once they are arresting from their critically low potassium levels? Because it's going to be harder to call you and have a conversation about this when I'm doing chest compressions.