I, too, work in a small rural hospital. 4 ER beds with 2 extra for minor, minor overflow (actually, pt rooms not in use by hospital). Have one MD & RN around the clock. One LPN comes in 12 to 16 hours of the 24 hours and one clerk to register 16 of the hours. Eight hours (night shift) there is only one RN, who registers, triages, wakes the doctor (if he is fortunate to be asleep), orders, treats, & discharges the patient or patients.
If it is possible, we do the EKGs and breathing treatments. Will call respiratory, if the help is needed. Will start the IV and obtain blood, if the situation permits. Otherwise respiratory and lab will perform the jobs. X-ray tech is either staying in house or live near hospital for call ins (they have 30 mins to respond). They always respond faster in codes.
We have a Meditech system. The nurse enters all the orders, unless she has a clerk available and has no time to do the job. We have computers in 3 of our 4 ER rooms.
Lab prints out results to our dept. We are able to access all labs that the pt has ever had at our hospital, as well as X-ray reports, History/Physicals, visit histories, medication histories, etc. Also, linked with larger local Columbia/HCA hospitals, so as to obtain same info, if the pt was ever treated there. Absolutely, love MediTech!
Upon discharge, we put our charges in MediTech, copy the charts ourselves or, if the clerk has time or is available she will help us. We make a copy of the face sheet, T-sheet, nurse's note, and prescriptions for our benefit. Kept in our station for quick access for returns. Only keep them for 6 months. We make a copy of face sheet & T-sheet for radiology and the pt's local doctor. Main chart goes to Medical Records. Copy of face sheet with drugs administered goes to pharmacy for them to charge.
We put out our own supplies, including linen.
We average 30 to 35 patients a day and are growing. Currently, in process of building a new ER and adding a new full time RN. We don't like working at night alone. At current time, at night, we are completly isolated from the rest of the hospital. Various employees will come and check on us & lend a hand. The local police will come and check on us. We have no security, other than cameras and a silent alarm necklace.
In case of codes, we have buttons in the exam rooms that alarms in MedSurg. If you know your job, you only need a handful of employees for a code. If we get backed up with serious to critical, we depend on ICU &/or the ER manager (who is willing to come in to our rescue anytime). If need be another doctor is just a phone call away.
Just set up your policies and utilize them. Hope I have helped.