prioritizing in the ER | allnurses

prioritizing in the ER

  1. 0 so this is my last week of orientation and I'm off on my own next week. I still don't feel ready, and was denied more request for training. To keep up I know something has to give. I'm ok w.maintaining speed when new pts come through the door. work them up, pass out meds, keep an eye out on the more acute ones but when i start out the shift with a pt load of 8 that includes 5-6 admitted pts who are waiting for beds in other depts that have have a never ending list of meds due in 2 hrs, getting their meds, requesting it from pharmacy, and passing them out takes forever to the point where I have trouble documenting, and taking on new pts. (and there's ALWAYS new ones. sometimes it gets to a pt load of 12-17 all at once) i have the worse urge to forget the relatively stable admits and hold off on the admitted meds which means they either get their daily meds at the very end or not at all. if they crapped out due to not being able to get their daily cardiac meds or seizure meds or me being inattentive i would feel awful but I need to keep up with my workload.....
  2. Visit  nycClara profile page

    About nycClara

    Joined Jun '10; Posts: 28.

    13 Comments so far...

  3. Visit  liveyourlife747 profile page
    0
    Wow! That seems like a lot of work! I work on the floor and the ED nurses rarely, if ever, start giving medications on admitted Pts. Our Pts med recs aren't even scanned until the pt is on the floor. I don't know how you all do it, but kudos to you and good luck!
  4. Visit  Altra profile page
    1
    Am I understanding you correctly that you have 12+ patients per nurse?
    prnqday likes this.
  5. Visit  Career Changes profile page
    2
    8-17 patients? Geez...what kind of ER is this? That seems unsafe to me.
    turnforthenurseRN and prnqday like this.
  6. Visit  hella_RN profile page
    2
    That workload just does not seem safe. If I'm being honest and if it were me, I'd run for the hills! I'm sorry but that's just how I feel. I usually get 3-4 patients max! And if I have a one to one patient, my team is usually good with picking up the slack for my other not so critical patients.

    As far as prioritization, I suggest that you stick to the basics and deal with airway first, breathing next, and circulation last. That's my mindset when I am at work. Regarding the other patients who are supposed to be admitted but being held in the ED because there are no beds available on the floors, shouldn't there be one dedicated staff for those patients especially if they are critical? That's how we do it in our ED. Maybe you can ask your nursing colleagues how they have handled this issue in the past? Just a suggestion. Good luck!
    canoehead and prnqday like this.
  7. Visit  nycClara profile page
    0
    yea 12+ doesn't seem safe to me either :/ were expected to be competent enough to care for 9-10 which I'm not at this point unless half are relatively stable. The 12+ number is due to the recent shut down of hospitals in my area in 2010 & hurricane sandy. we're also a 24 hr stroke center & trauma 1. We do have a trauma room that can hold 5 so they *try not to load the main ED nurses with trauma pts if possible. We have admit nurses on the floor but not enough. Most will take only 8-9 pts. I think I might have to talk to the night manager if at 11-10 I'm max out. So far my preceptors been helping me. Being new they should be ok with reassigning. And I probably have to cut my breaks shorter to catch up on documentation.
  8. Visit  emtb2rn profile page
    5
    If those ratios are the norm and they're not all esi 4/5, which doesn't seem to be the case, head for the door NOW. Incredibly unsafe.
    turnforthenurseRN, prnqday, Altra, and 2 others like this.
  9. Visit  amarilla profile page
    1
    I've only been in the ED a few months myself but agree with others that your ratios are outrageous! I'm not sure how much better you can be at 'prioritizing' if you're babysitting a handful of admits as well as *ten* or more new patients - there is only one of you and only so much can be done.

    If it were me, I'd start applying elsewhere and see what you can come up with. IMO, the experience isn't worth being stretched so thin. Good luck.
    Altra likes this.
  10. Visit  bubblzrn profile page
    0
    I don't think I carried that heavy of a load when I worked the floor. For ED, that isn't acceptable. It depends on the acuity level but still not safe. I don't know about you but I worked too hard for my license...I don't want to lose it to something like this. Plus we love in such a sue-happy society, I wouldn't want to lose my personal possessions either. At the very least invest in some professional malpractice insurance! (and keep that fact to yourself) Good luck!
  11. Visit  nycClara profile page
    0
    thanks bubblzrn, i have my on personal insurance as well as what the hospital offers.
    The pt load is overwhelming but i see everyone else being able to handle it. even if I learn to deal with this pace, i'd like to
    find another position elsewhere. for now im going to stay and apply stimultaneously to other openings at least till i'm off orientation. which is soon. what is the normal pt load for you guys? and how does everyone prioritize their load with the handful of admits and their laundry list of meds.
  12. Visit  bubblzrn profile page
    0
    Our patient load is anywhere from 1-6...again depending on the patient's acuity. And I think that with time you do learn how to handle a larger patient load, but the patient load you are talking about is too big for anybody. Mistakes will and probably occur multiple times. Burn-out would be a huge issue I would think. Glad to hear you have personal professional insurance. Most hospitals say they will protect you (the nurse), but if it comes down to losing millions of dollars vs losing a nurse...most hospitals will hang a nurse out to dry and let them take the brunt of the responsibility. I have heard hospital administrators call nurses "a dime a dozen". Protect yourself and your patients above all. If you are having to talk yourself into staying...you need to move to a different unit/company.
  13. Visit  rangerlil profile page
    0
    In my ER we never have more than 4 patients per nurse (except on breaks. {actually, the minor nurse may have 10 - 12 but those are usually fingers lacs, earache = walkie talkies}. Sometimes, it is 4 admitted pts with tons of meds, or a mix of new ER and admits. Something I've learned since I've started: one thing at a time. (yes, you might be doing more than one thing at any given time, but if you can prioritize and assess/give meds to the most critical pt.first, then go on to the next task). I can't even imagine trying to take care of 10-12 admitted patients all at once - that sounds like unsafe practice to me. If you go into a pts. room for any reason, do vitals, ask if they need anything else while you're in there (may cut down on call bellitis...)

    Good luck
  14. Visit  sofiamcclain profile page
    0
    Very unsafe! We have 4:1 ratio. You have to talk to your er director or don .also check your department policy and standards


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