Sick to death about poor staffing level.

[Djuna]

I realise US Emergency Departments are probably run in a very different way than a rural base hospital here in Australia but I would really like to hear about your staffing levels.

We see on average 70-80 patients per day, no fast track system, lots of GP cases and probably one third chest pain, fractures, traumas, MVAs, pneumonia, basically patients who need a fair bit of working up.

We tend to be very busy in the afternoon whilst the morning tends to be slightly less busy although this is unpredictable.

We have recently had a large upgrade of our department with 4 extra beds, 2 of these being holding bay beds. So we have 2 resuscitation beds, 1 paediatric, 6 holding bay and then cubicles for the Drs to see the walking, reasonably well patients.

Our staffing levels are 3 in the morning and 3 in the afternoon, 2 at night with one of those an EN who cannot triage.

Most of us are exhausted and feel 3 staff is simply not enough to cope with triaging and caring for holding bay patients and then helping out Drs with procedures, getting their drugs, etc.

How many staff does your department have during the day and at night compared with us?

[bill4745, RN]

20 ER beds, 5 fast track. 100 patients/day, just outside Philadelphia.

From 7am-11pm 6 RNs-1 in Fast Track with 5, 5 in the ER with 20 for a 4:1 ratio. A charge RN with no patients, and almost always a float from 7am-11pm, and 2 techs during that time.

[mmutk, BSN, RN, EMT-I]

30 ER Beds 6 RNs7am-7pm 9RNs 11am-11pm

10 Fast trackbeds 2 RNS 11am-11pm 1 RN 11pm-2am

(no trauma,mostly cardiac, resp, psych, OD)

[mom2michael, MSN, RN, NP]

8 bed, 40-50 pts per day. Rural nursing. No trauma, limited ortho. Lots of cardiac, resp stuff.

2 RN's 7-7

1 House Supervisor who works from ER 80-90% of the time

1 Paramedic 11-11

1 Tech

1 Admission Clerk

[littleRNthatcould]

20 beds (14 of which are cardiac monitored and 3 are Trauma/Code rooms)

5 minor care beds (only open during the hours of 1300-2100)

We see approximately 80-100 patients daily on the average with recent numbers up to 120.

For several weeks we have been working with 3-4 RN's, no tech and one doc from the hours of 7p-7a. During several nights it was not uncommon to have every bed full with several ICU admits, trauma's and the like on top of our usual load of CP's, Pedi pneumonia's and an entire lobby FULL to the brim with sick people needing immediate attention.

One night in particular we had 3 level one traumas, 10 ED overflow patients,(no admit beds for tele, ICU or step-down) all 20 beds full, 5 minor care beds full (URGENT cases, not minor ones) an additional makeshift 4 hallway beds. We had again, 4 nurses, no tech, one doc.

Our manager did not return our 4 phone calls or pages. Our Department Director did not return our calls or pages. Our administrator on call finally returned our call and refused to put us on diversion until the trauma surgeon basically threatened to pull his services.

When we did get put on diversion, to incoming ambulances only, it was 0400. When the trauma surgeon went off call at 0600, our adminstrator re-instated us at full capacity.

And as for me, I'll be starting a new job on Monday thanking the good Lord above that no one died.

[bigsyis]

20 beds (14 of which are cardiac monitored and 3 are Trauma/Code rooms)

5 minor care beds (only open during the hours of 1300-2100)

We see approximately 80-100 patients daily on the average with recent numbers up to 120.

For several weeks we have been working with 3-4 RN's, no tech and one doc from the hours of 7p-7a. During several nights it was not uncommon to have every bed full with several ICU admits, trauma's and the like on top of our usual load of CP's, Pedi pneumonia's and an entire lobby FULL to the brim with sick people needing immediate attention.

One night in particular we had 3 level one traumas, 10 ED overflow patients,(no admit beds for tele, ICU or step-down) all 20 beds full, 5 minor care beds full (URGENT cases, not minor ones) an additional makeshift 4 hallway beds. We had again, 4 nurses, no tech, one doc.

Our manager did not return our 4 phone calls or pages. Our Department Director did not return our calls or pages. Our administrator on call finally returned our call and refused to put us on diversion until the trauma surgeon basically threatened to pull his services.

When we did get put on diversion, to incoming ambulances only, it was 0400. When the trauma surgeon went off call at 0600, our adminstrator re-instated us at full capacity.

And as for me, I'll be starting a new job on Monday thanking the good Lord above that no one died.

Where was your Supervisor? Why didn't they come to help you? Could you not request an assist of somebody from another floor?

At any rate, I am glad for you that you are getting out of that mess. Better luck with the new job.

[wibobr]

Not much difference here. Staffing based on census. Usually not too busy in the AM so lower staffing than our afternoon early PM peak where are staffing is almost double from the AM shift then a steady degredation to the night shift. Sadly, politics, finances, etc etc are turning more and more to the ER for primary(clinic) care thus throwing all staffing plans right out the window. BIG frustrator right now with talk of more cutbacks coming and we see 45,000 yearly