How do you staff for surges?

  1. OK, ER nurses, I need some staffing info. We are a small ER in Wyoming, but we are the only ER within several hundred miles, so diverting patients isn't usually an option.... We are struggling with a quickly increasing population (coal mining, methane, oil, etc...). We are trying to find out how other ER's handle patient surge times (high census) as far as nurse staffing goes. We recently increased our physician staffing, which seems to have helped. As far as nurse-staffing, we are currently trying the "triage room" where a RN works 10A-10P triaging pts prior to registration, and staffing 3 RN's in the dept 7-7. We recently added an RN or Tech (EMT1) position from 1p-1a, but still we struggle. Sometimes we are way-stretched, others we are sipping coffee and bored as hell (the powers-that-be often visit during these times and don't see why we need better staffing/more $$, etc). We rotate through the 10-10's/1-1's. Some are burning out (the drug seekers/meth addicts don't help any here!). My manager is getting an ulcer!!! Any tips would be so appreciated- thanks!
  2. 5 Comments

  3. by   bill4745
    We just added and extra 11a-11P on Monday and Tuesday - our busy days. We also have on - call staff. They are paid a few dollars an hour if they guarantee to be called in for a specific 4 hour shift (eg,7p-11p) - they sign up for the shift in advance, and must arrive in less than 60 minutes from the time they were called.
  4. by   traumaRUs
    You first need to look at a study of your pt census, hour by hour, day by day. Then...add staff to heavy times. This may allow you to staff some 4 hour shifts for heavy times. I worked for 10 years in a level one trauma center where we saw 65,000 visits per year. Our busy time was 1500-0300 on Mondays and Thursdays. So...we staffed this heavy.

    However, the key to success is doing your homework with the research.
  5. by   wyowyome
    Thanks for your tips, I will pass this along to my manager. I do believe we decided our busiest times were 10-10 (triage times) and thus, we have the triage nurse and another nurse/tech come in at 1p, but I don't know if these were actual documented "high census" times, or just "what it seems to be". I like the on-call idea, and I do think we'd have to have a monetary incentive to be on-call, but it could possibly work, though upper management may have a fit d/t overtime hours worked? Maybe we could take away the extra afternoon nurse/tech and leave him/her as an on-call, but then we run into the nobody wants to work till 1am problem....... thanks again!
  6. by   TazziRN
    I feel your pain, I also work in a small ER. When I started there it was one nurse and one tech on per 12 hours, no matter how busy. Then it went to one nurse at 7a and 7p, with a second one from 11a-11p. Now it's two nurses per shift with a tech, and Fri-Sun there is an 11a nurse. When a busy day can be predicted (holidays, etc), a fourth nurse is scheduled as well. Otherwise we call the house supe and she comes in to help as needed.
  7. by   nursebrandie28
    :rollWell, in the ER i work at is an inner city busy ER. We have the usual 7a-7p and 7p-7a shifts, then we have a 9a-1p shift, 11a-11p, 1p-1a, 2p-2a shifts. this works out well because usually be the 2a person leaves, the ER rush is over. (usually, not always)