What a great thread that speaks to me! I, too, have been an ED nurse for many, many years and know that my time in ED is coming to a close soon. I don't think this is just a summer problem and it will end in a few months. I think it is here for the long haul for a number of reasons. The economy in general is in shreds. Everyone is tightening their belt just for survival. Gas costs are up, food costs are up, taxes are up, so it is no surprise that health care costs are up, reimbursements are down, and cuts are being made at every level.
I work in a very busy ED 120,000+ per year. We are in better shape than others I have seen on this forum in terms of staffing. I really DO believe our ED management is doing the very best they can. They are not above coming in on holidays, nights or just horrible shifts to help out. They don't take patients, but will transport, start lines, make runs to the lab, and order pizza for us! But it is still very quickly taking it's toll on everyone.
At peak times, we have 2 triage nurses, 2 triage techs and a "greeter" nurse who does a quick screen to decide if the patient is appropriate for fast track, needs to go to the main ED quickly without triage, or can safely be triaged and wait for a room to open. We have 4-5 hour waits every evening with 40 or so in the waiting room at one time. These are the ones who are too sick for fast track but not sick enough for the main ED immediately, so they are our level 3 patients...urgent.
At any given time we have 8-10 trucks inbound with the sick and injured, or 1-2 helicopters on the way in or out. We are a regional trauma center so we get transfers from all local hospitals within a 100 mile radius. It never, ever ends.
The floors or ICU can say, "Stop, we have no more beds". We never have that luxury, and being a referral center, we can never go on ambulance divert. The psych issues are becoming more and more of a problem and a danger to staff and other patients. We can't get psych patients transferred many times for days or a week. We have to staff extra police and security just for them, plus additional staff as sitters because of the danger they present. We are seeing more and more homeless with huge medical, psych and of course social issues. We can't send them anywhere, so we are the end of the line for many of them, their last resource, and we are stuck.
Then, you have the "real" ED patients, i.e. MI's, traumas, strokes, general medical, orthopedic or surgical patients. Even with a 3:1 ratio on the acute care side with no available floats, it is a scary place to work. When you are tied up with a critical ICU patient who is not going to surgery or cath lab, you can't get out of the room to even admit your MI patient, or your new drug overdose. Oh, and your "stable" drunk hall patient who is there to sleep it off, but doesn't! He wanders in and out of patient rooms looking for something to eat.
Then the mother of the bratty febrile kid gets mad at you because you won't blow up gloves for the kid to play with! AGGGGGG! Lunch?? OK, in my 12 bed pod, I have my 4 patients, 4 patients of the nurse who went to lunch, and the 3 patients for the nurse who had to go to special procedures with her critical patient. Then they ask you to hold the charge phone while the charge nurse goes to a meeting!!
No, I don't think this is a passing problem that will be resolved anytime in the foreseeable future. What will healthcare "reform" bring? More nurses, less patients?? I don't think so. I pray for those going into the profession, I pray for those of us still in it and mostly, I pray for our patients, current and future who are getting less than they need.
After 38 years of acute care, primarily ED nursing, I'm ready to sit in a cubicle in an air conditioned environment, be around people who bathe everyday, and talk to people on the phone about their insurance coverage and if their particular ailment is covered. I will miss the patients, the other staff who share the "we're all in this together" battlefield attitude, the great ED stories, the adrenaline rush and the exhilaration of making an immediate difference in someone's life. I will miss the gratitude of the child who was afraid, but I was able to soothe their fears, the little old lady who recently lost her husband and came to the ED after a fall who gives me a kiss on my hand for taking care of her wounds, the raucous pizza dinners in the break room with those who understand, but I just can't do this much longer.
To all those new, fresh faced new grads who read these forums and ask, "Am I cut out for the ED?" I can only answer, "I certainly do hope so!"