As I read down the board I continue to read about unsafe conditions and ragged nurses. I do not understand why we don't band together across state lines and just say no. We need standards of safe patient nurse ratios and appropriate equipment. Where I work the DON states she will not recognize any one group of nurses over any other for pay increases. ED is different and should be compensated. The State of New York recognizes our special needs by mandating 1 years nursing experience to even seek ED employment. Many other hospitals offer a critical care compensation. Although my facility does not offer this they require a two week critical care course to be employed in these areas. In addition I must maintain ACLS, ENPC, and TNCC that is not required in other areas of the hospital. I take on incredible libility since we see, evaluate and initiate testing prior to an MD eval., and even triage which patient the doctor should see first (even after the initial triage to the appropriate acuity area). In no other area of hospital nursing is a nurse acting without a dx or MD eval of a pt. We put our licence on the line constantly. Why are there non standards of care that limit pt numbers and make the hospital and not the nurse liable? I believe it's because we ddon't stop it. Imagine in this time of nursing shortage if every ED nurse said I will not work with more than 4 acute patients at one time and you will pay me for my expertise or we will seek employment elsewhere. We are a special breed and not every RN is cut out to run trauma and serious burns at the same time as monititoring a pediatric patient in DKA. Wouldn't a national ED RN union be nice. I would feel better to know someone would listen at the end of the day (eve or night) that it wasn't o.k. to put the 80 year old woman with explosive diarrhea on the bedpan in the hall all shift. That 52 hours this week was enough, I can't be put on-call again and 14 acute patients at one time is not safe nursing care. I would like the administrator on call to have to say yes to code red after an MCI (the quote two weeks ago was "patient safety is not criteria for code red"). Any thoughts?