staffing

  1. I have a question re: staffing in other ER's... I work in a level 2 trauma ER in a big downtown. In the winter, we run our rears off, but in the summer we slow w-a-y down. (I left at 2200 tonight, and we had 21 pts. in the book for the day). Some days, though we see 40+. The patients that we do see seem to be pretty sick; not a whole lot of fast track kind of patients.

    What administration is doing to us has been to cancel our unit secretary (normally only works 12-8p anyway), and cancels the "middle" rn (either a 12-8p or 11-11p shift). I should mention that we have 13 beds in the unit. This leaves one dr. and 2 rn's..and that is it! The 2 rn's have to be rn/unit clerk/everything. We think that this is unsafe, #1...plus we have been told that there "is no on-call pay". So what they have done in the past is call us at home and say, "we don't need you now, we will call you if we need you". Welllll....we have finally, I think, come together as a group with this no on-call pay. We now tell them to cancel us for the entire shift. We are hoping that somehow (maybe someone will die, isn't that awful ) that this will help get them to realize that they should be paying somebody on-call pay...just in case. What we are wondering, is whether or not other ER's pay on-call pay, and what that pay scale is. We refuse to sit at home, and wait by the phone all day just in case they need us. Our unit director is new, and she just plain stinks. She doesn't stick up for the nurses at all. We have complained to her that this is unsafe, and nothing comes of it. We have had nurses float to us from affiliated hospitals who have even written letters to administration telling them it is unsafe, and nothing comes of it. The Dr.'s stick up for us, and they have complained to admin. multiple times...and nothing has happened. We have actually resorted to "taking our time" "to hell with them, I am not going to bust my a** if they don't care about us" The morale is pretty crappy. Two nurses is just really not enough, given our pts acuity. We can't be triaging, and running downstairs to the pharmacy while we are taking care of putting orders in the computer, and then carrying out those orders ourselves! I am rambling...any suggestions? Is on-call pay out of the ordinary for ER's? or is it just our cheap hospital? Any thoughts, any suggestions welcome. BTW I have applied for a transfer to one of our sister hospitals (same owner), but with much better staffing than our own. On the evening that I oriented they had seen about 65 pts by 2300, had 6 rn's, 2 dr.s, a 24-hr. unit secretary, 2 registration clerks, a PA, a tech, and a resident. What gives?
    •  
  2. 7 Comments

  3. by   OC_An Khe
    Fisrt of all they shouldn't be canclling any one. Do they pay firemen only when they fight fires? Call pay is an alternative and not out of line for an ER but if you were hired for x number of hours a week you should be paid for x number regardless of census. At our facility we can not be cancelled, at least the RNS CAN'T.
    Last edit by OC_An Khe on Aug 31, '02
  4. by   kaycee
    I work in a similar size ER with similar pt. load. On 7-3 there are 3 RN's a tech and a secretary. On 3-11 3 RN's a tech and a secretary. There is also a registration clerk. 11-7 goes down to 2 RN's and a secretary that also acts as the registration clerk. We always have 1 doc.
    Your situation sounds very unsafe. If you've exhaused your attempts to change things then you should get out of there.
    As far as on call. If I am not paid to be on call I would not do it. We staff the ER the same all the time regardless. It's the nature of the beast, sometimes your balls to the walls and sometimes you're sitting. We don't have on call and we never call anyone off.
    Sounds like an accident waiting to happen there and I would get out before it does!!!
    Good luck!!
  5. by   Uptoherern
    I am orienting to the sister hospital (closer to home, I might add) on friday...if all goes well, I am outa there (with license intact)
  6. by   teeituptom
    Howdy yall
    from deep in the heat of texas


    Good luck Dianne, hope it gets better. We slow down in the summer also, to about 140 pts a day. Then they send nurses home too, just in time to get creamed by a fresh batch of arrivals. And try to get one of those nurses to come back in after they have been sent home, dream on. see it happens in larger ERs also. of course after I have been sent home early, I am less than inclined to come back also. I usually do however, Because I like money, and feel somewhat responsible. Or am I just a glutton for punishment. They call and say this and this and this just hit us. And I think do I really want to subject myself to that. I usually do, but I can think.




    doo wah ditty
  7. by   AZEMS
    DIANE I HEAR YOU!!!!

    PHOENIX ER NURSING IS ALMOST THE SAME EVERYWHERE.
    THE THINGS I'VE SEEN AS BRAIN STORMS OR STREAMLINING ARE JUST RIDCULOUS WAYS OF AVOIDING THE NEVER ENDING REALITY.

    HIRE MORE NURSES AND ASK THERE INPUT...AND LISTEN!!!
    TO WHAT THEY THINK IS A GOOD SOLUTION TO THE PROBLEM.

    WHEN I FIRST STARTED I WAS ACTIVE IN COMITTEES AND THE CHANGE PROCESS. BUT TO NO DISBELIEF THE WAS NO RESOLUTION OR ACTION TO OUR IDEAS.

    I LEARNED TO ADAPT AND RIDE OUT THE STORM WILL MICRO MANGING THE BATTLES.... ONE AT A TIME .

    AFTER A WHILE MOST THINGS LATER SEEM TO SETTLE DOWN AND RETURN TO ITS UNORGANIZE CHAOS BUT WITH RESOLUTION OF ONE OR TWO PROBLEMS THAT ONCE EXISTED. VOICE CONCERNS BUT DON'T TAKE THE WIEGHT OF BATTLES AND FIN THE ENVIRONMENT THAT LETS YOU DISCUSS CHANGE AND GIVES YOU FEEDBACK.
  8. by   ernurse728
    I am not sure I can really give you an answer to your question? First of all we never cancel anyone....we see about 250 pts/day. We each have 4 pt's..there is a triage nurse for the pt's who come in the front door...and a triage nurse for the ambulance who takes care of 1-2 pt's. We have a seperate Fast track area that holds 12 patients and staffs 2-3 RN's...sometimes there is a secretary and a tech and sometimes not. we also have 3-4 techs for the main side of the ER and a unit secretary for each side of the main ER. The # of MD's varies for the time of day...usually 2-4. There is also a charge nurse and after 12noon there are usually a float RN or 2 roaming around. AS far as on call pay goes...we don't have it b/c we are never on call. It sounds to me like there needs to be some major changes going on where you work! Especially if you fell your acuity is high. Best thing I can say is get the he** out of dodge!
  9. by   Uptoherern
    I start at my new er on wednesday.... Our wonderful full-time secretary just put her 2 wk notice in also.. So they will be out a sec. and a flexible evening shift rn. I think they are starting to squirm. The secretary basically told them she can't live her life without a dependable salary...way to go! Now they will be scrambling to fill the secretary slot with an rn until they can hire a secretary. And they are an rn short. I wish more would quit.....management does not seem to hear, but actions speak louder than words.

close