When every bed counts

Nursing team helped critical ED census by taking inpatients on observation unit. “We looked at each other and said, ‘Okay, let’s do this.’”

It was one of those nights when UI Hospitals & Clinics was experiencing a critically high inpatient census combined with an overloaded Emergency Department (with 53 patients and counting). At the same time, the seven-bed 7JPP Medical Observation Unit had an unusually slow night with only one patient during the evening shift change. That all changed quickly when a group of nurses decided to help out the Emergency Department.

Sarah Owens, RN, and Doug Swanson

Sarah Owens, RN, charge nurse on 7JPP, began talking with house operations managers (HOM) Stephanie Flores and Emma Englehart, as well as the E.D. navigator Kristina DeVore to send up more observation patients. They started to discuss the possibility of opening up the unit to inpatient care—a first for them.

“We were lacking certain supplies, because most patients under observation, for example, don’t need equipment such as IV pumps or poles, sequential compression devices, or patient-controlled analgesia (PCA) pumps that inpatients often require,” explained Owens.

But at 11:30 p.m. that night, it was decided that 7JPP would take non-observation patients from the Emergency Department, as inpatient census was about to max out.

Time was ticking

The shift on 7JPP was ending soon for unit clerk Katrina Jackson, so they also needed more staff support to keep the unit open. That’s when Doug Swanson, psychiatric nursing assistant from 3BT, saved the day.

“When he came in, I was so excited to see him, I was like, ‘YES!!! We got DOUG!,’” Owens says with a laugh. “We’ve worked with him before and knew he was a very good worker. All of our aides are fantastic, but he’s worked across this entire hospital, and there was no one better for this job. It was perfect.”

Their team was on mission: to convert their observation unit to an inpatient unit in under an hour. “We just looked at each other and said, ‘Let’s do this,’” recounts Owens.

Swanson went room by room to map out what was needed for each patient, and then proceeded to rush across the hospital to find the necessary supplies and equipment. After several trips, he came back with everything they needed. Environmental Services also helped out by quickly cleaning each room.

All of the rooms were ready in just enough time, when final approval came to start taking inpatients, at around 12:30 a.m.

A successful night

“We were just solving one problem at a time,” says Swanson. “Being part of the solution is what makes me proud to work here.”

Throughout the night, the team successfully discharged one patient (thanks to some help from SNICU), admitted seven new patients (three observation patients and four inpatients, which filled the unit), and continued to triage for more observation admissions.

“And the cherry on top,” Owens explains, “Was when Sara Caven from administration came up to personally thank us and for what we had done. That was very thoughtful of her and meant a lot to us.”

Caven later commended the team on how selfless they were throughout their shift.

“They worked together, collaborated with other teams, and tapped into their resources,” says Caven. “They truly put the needs of the patients first and created a safe and effective solution that supported not just their unit, but the entire organization that night.”


  1. We hear “can’t” so many times, even when it might benefit patient care. . . it’s nice to hear a “can” story.

  2. Bunk! I know just how creative you can be! to see that you were a part of this doesn’t surprise me at all!!! Con

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