Ridiculous? Or not?

morte, LPN, LVN · Apr 16, 2010

involve the media and JACHO

greenfiremajick · Apr 16, 2010

If you're going to prove your case, don't let them catch you posting to All Nurses while at work.........................

I'm in Alabama very near Birmingham. I work in a very busy ER (30 beds, 200-275 pts q 24) After a year of no wage increases the hospital decided that they had enough money to give us all merit raises. I now get an extra 75 whole cents an hour. What they didn't tell us was that in order to get the merit increases they were cutting staffing in both the RN and tech roles. Needless to say tensions run high in the ER anyway but now patients are having to wait longer periods of time before their "stuff" gets done. Patients and families are upset, yell at us and some of us are finding it hard not to fire back.

We've had so many complaints that the bigwigs did a survey and all the charge nurses go to this meeting. The survey was done in the general area that we serve. People were asked things like... how long do you think you should have to wait after the call light is pushed for an answer... less than one minute was the answer. If there is something that you needed like pain medication, help to the toilet how long do you think you should have to wait? FIVE minutes!?! Do you think expectations run a little high?

I'm usually in triage so when people are having to wait up to two hours just to get to me they are usually rather upset. I try to do a little patient education on average wait times etc. But what I'd really like to do is to step into the waiting room and say something like... Seriously people, if your belly has been hurting for 3 years then it really can probably wait till tomorrow when you can see your own doctor!

Oh, I forgot to mention this... the same bigwigs will no longer allow the ER to go on diversion. I've got 16 people waiting to get to a bed and 10 ambulances have shown up in the past hour alone, anyone besides me see a problem here? We recently had an EMTALA violation, the doc got canned and a nurse was demoted, can no longer be in charge. We all had to reaquaint ourslves with EMTALA via the computer. My personal opinion is that not being able to go on diversion can be an EMTALA violation. You have to be able to provide "adequate" care of the patients you have and with our numbers being up while staffing is down, I don't think we can. What do you think?

netglow, ASN, RN · Apr 16, 2010

It's not like this kind of thing isn't happening in ERs across the country. Don't think she has to go undercover or nothing.

greenfiremajick · Apr 16, 2010

It's not like this kind of thing isn't happening in ERs across the country. Don't think she has to go undercover or nothing.

No, not undercover....But if she's going to prove her case that they need more people and that they don't have enough time to do what needs to be done to provide good "customer service" to patients, then it would be a bad thing if the IT admin could pull up activity and show that while she is at work, she has enough time to post to a nurses forum/board, don't you think?

IT pulling that info isn't hard, at all....

BornHealer · Apr 17, 2010

LilgirlRN,

I definitely have empathy for you. I too worked in a busy intercity ER/Level1Trauma Center. It's a tough situation and nothing will ever change unless the Staff and the Administrators work together. This is what ultimately had to be done at our ER. Nurses had to start thinking like Administrators and Administrators had to start thinking like Nurses in order to bring the whole situation into view. For example: Administration biggest concern was the Budget (How they could get the most done for the least cost) Then they were not too happy when they started getting cited for violations from JCAOH, OSHA, etc. (Hey, crunch the numbers -- "X" amount of nurses can't be in two or even three places at the same time) Critical Care patients must have an RN with them when going to CT Scan or other transports -- So, who's caring for the patients left in the ER, while his/her nurse is away on a transport? Also, it was noted that the number of staff injuries (slip & fall, back injuries, etc.) rose significantly, after nursing staff had been reduced. OK We made our point-- it's better to have more nurses in the ER -- The fact remains -- There's only so much money to go around. We all expect a pay check at the end of the week. The number of patients coming to the ER is constantly rising, as are the nunber of those without insurance. Something has to change. These are a few of the positive changes we made. We started a "Fast Track System". All the non-urgent adult patients (U.R.I.,U.T.I.,Suturing,Sprains,Closed Fx.,etc.) were immediately assigned "Fast Track". It was covered by an RN & Physician away from the main ER. It was quiet and many times pts were seen within minutes & then D/c'd. Children were seen in Peds Clinic -- Both opened 8AM to 8PM. This did help greatly with improving our ability to care for our pts, while trying to get by with a shrinking budget. That's not to say that everything is perfect now. It's a work in progress and more innovative ideas will have to be tried. Good Luck. :nurse:

dscrn · Apr 17, 2010

Don't know if your hsp had Unsafe Duty Assignment forms...if they do, get yourself a stack of them. Might be some extra work for you to fill out, but basics of unsafeness listed, also that supervisor was made aware. You keep a copy for yourself (in your locker, so as not to infringe on any pt confidentiality stuff. If, God forbid, an legal matters arrive out of lack of care,at least you will be able to remember what was going on-however long ago it happened. Good luck...supervisors can become cranky about this-at least you went up the chain of command...

solneeshka, BSN, RN · Apr 17, 2010

Why do you think she was posting from work?

greenfiremajick · Apr 17, 2010

Why do you think she was posting from work?

From this sentence she included with her post:

"I've got 16 people waiting to get to a bed and 10 ambulances have shown up in the past hour alone, anyone besides me see a problem here?"

Bamaeyes · Apr 17, 2010

Good luck. We all feel empathy for your situation.

**canoehead, BSN, RN** · Apr 17, 2010

From this sentence she included with her post:
"I've got 16 people waiting to get to a bed and 10 ambulances have shown up in the past hour alone, anyone besides me see a problem here?"

I don't think she was posting from work, just giving an example.

BrnEyedGirl, BSN, MSN, RN, APRN · Apr 17, 2010

I think this is happening everywhere. I work in a similar sized ER, 4hr waits are fairly common et holding pt's for rooms upstairs really throws a kink into the whole system. We also have a "fast track" and have started to pre treat as many pt's as possible from triage so that when they finally get back to a room most of their labs/xrays etc are complete.

I agree with a previous poster,...when bad things start happening those in the suits upstairs will start listening. Chest pains who don't see a triage nurse for an hour,..stroke like sx waiting an hour. When things get that backed up bad things are going to happen,....just hope it isn't on my shift!