I work in a small rural hospital. We have one RN, working each shift, around the clock. One LPN for 12 to 16 of those hours. A clerk for 16 hours. (From midnight to 7 or 8 am, only one RN, who is registering, triaging, treating.) We have 4 beds, with another 2 to overflow for minor stuff. We average around 35 patients/24 hours. We are in the process of adding another full time RN because our pt load is picking up.
The RN triages, juggles, treats RN requirements, & discharges. Our efficent LPNs get them in & out. We don't sit on them. Our physicians are staffed by an ER company. We expect the best out of our doctors. If they are incompetent or slow, the company is notified and they are no longer placed at our ER. We give out simple yes/no with comment section surveys, immediately upon discharge. They are anonymous and a box is provided. We do put the dates, so that we know who was working that day. This helps with providing backup for our complaints against doctors.
We see a lot of clinic stuff, unfortunately. Should we get in a bind. The nurses request help from ICU and MedSurg, if need be. If we start backing up, we call in the local backup MD. We try not to back up with long stay IVs. We ask for admission to MedSurg for observation. We, also, have a manager, who will drop what she is doing and help (even if she is at home). I guess what I'm saying is that everybody works together.
We rank among Columbia/HCA's top 10% for patient satisfaction.
We get them in and we get them out. Keep them informed, if they have to wait. Don't be afraid to step on your doctor's toes. If you are a competent employee and they know it, they'll agree with you. You have to work together!
Our policies, also, grant us permission to order x-rays or labs (within reason), when triaged, so as to speed up the process. Don't do anything outside of what your policies stipulate.
I hope I have helped. Don't worry, the combined UC/ER will work out.