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Like I said, where I work floor nurses are not allowed to give IV fluids off pump. They can give a bolus at 999, no problem. Ultimately yes, if a patient is crumping so that a bolus at 999 is truly not enough, that patient requires far more monitoring than a floor nurse can give. They may have nine other patients (I once had twelve). They may not be certified in ACLS or experienced in telemetry. That patient requires monitoring and possibly intervention not only during that time period but also afterwards, and floor nurses do not always have the ability to do that. That's why you couldn't pay me enough to go back to the floor. My patients are trainwrecks, but I only ever have one or two.
ETA: My hospital system is implementing sepsis criteria that requires admission to ICU if a patient was hypotensive at any time. They found that when patients were hypotensive but stabilized with IV fluids, often later they crumped, triggered a Rapid Response event, and were transported to ICU in crisis.
Interesting...
Unfortunately, the demand for our ICU often exceeds the supply. As a result, our floor nurses have become fabulous at managing patients that would be better suited for a stepdown. Also, all of our RNs are required to be BLS/ACLS and experienced in telemetry (tele is distributed through the entire hospital). And with so few ICU beds, hence the strict criteria for admission. If they respond to the bolus of fluids, then they are not considered hemodynamically unstable. But of course, the standards are different at every hospital.