Doing Double Time in the ER

[Chiaramonte]

Looking for some creative solutions re a precarious working situation...

I work in the ER at night in a community hospital that sees an average of 50-60 patients a day.

Our nightly census is averaged at 10-20 patients. Acuity level ,of course, varies but even though we are not a trauma center, being rural, we stabilize until the trauma patient can be flown out.

My dilema is that on each shift there are 3 RNs staffed except on nights. Usually there is a lone MD working each shift. This usually is not a major problem except when a certain husband and wife MD team work together on the floor. They are not only disorganized but when I come into my shift it looks like someone has kicked over the ant hill. People are scampering and running around trying to complete their care. It's busy and 3 nurses are leaving the mess to this lone oncoming RN. I have an EDT and an occasional Paramedic available to help when he's not busy.

I am told when I ask my manager to schedule another RN on the nights there are two MDs working and I am told there are not enough RNs to staff that way. They keep telling me that I'm doing a great job and being that I am a well seasoned- experienced RN that they made the right choice in hiring me for this position.

I keep hearing " Hang in there, things will get better" But what does that actually mean?

I love the job and the people I work with. I go home frustrated every morning these two are on because they can't seem to coordinate all their orders and once you think you're ahead of the game, they add just one more order and just one more...and then you add a conscious sedation procedure to the mess...wow...I am exhausted thinking about it!

I have told them repeatedly that it is an unsafe environment even when I do double time to stay ahead of the game. My husband, who is also an RN on a different shift in the ER can sympathize but the only solution he can come up with is to quit.

I hate to do that because it is convenient to be part of this hospital community that is only 3 minutes from home.

Thanks in advance for any help!!

Tired RN!!

[canoehead, BSN, RN]

Been there.

Just take your time and make your own priorities. Don't allow them to interrupt you in the middle of one thing to do another unless it is an emergency. Make them write all their orders down, no "by the way" verbal orders. Inform the dancing duo that you are one person with two hands and you will get there...eventually, and that they are welcome to do uncomplicated discharges themselves (if that is possible).

Accept that patients will end up waiting longer the night this crew is one, but in the name of quality care and your sanity. It's a fair trade off. Encourage them to write up complaints about the wait and maybe you'll get some help. I'd recommend you briefly put your request for extra help in writing as well.

[veetach]

I have also been there. I used to work in an ER very much like you describe. It was all fun and games and no one could justify 2 RN's on night shift until one of our nurses had 2 cardiac arrest patients come in within 5 minutes of each other one night!! One was a trauma code and one was POV.

The hospital realized how dangerous this was, thank goodness and immediately increased our RN's. This is a scary situation. Good luck.

[CCL"Babe", BSN, RN]

Similar situation until we had a house fire - 5 paitents- 2 pedi codes, mother in resp arrest tubed on vent , father with smoke inhalation. Same time drug overdose came in became unresponsive and ended up tubed. I was at home, but got called in in time to take over one of the pedi codes until the transport unit from CHOP could arrive. We never ran one nurse a night after that. I had done it solo before that, never liked it, never thought it was safe. Unfortunately both pedi cases eventually died. Mom signed out AMA. Over dose made it. Some jerk in the waiting room almost assaulted me because we did not take him in for his bloody nose that had stopped bleeding two hours before. Thankfully this hospital no longer exists.