Triage

[hmwaggs]

I work in a small hospital that staffs one nurse 24 hours a day, and an extra one from 1300 to 0100. There are 6 beds. If the OB nurse does not have a patient, she is expected to help out both the ED and M/S, but this of course is hit and miss. There is no triage, simply a waiting area. When the patients present, they ring the doorbell and we look at them. They are not checked in, vitals are not taken, and if we are busy they are asked to wait without anyone watching them. The only other staff is a unit clerk, whose only responsibility is to check the patient in after we room them. Our "great" new computer system has the nurses and docs doing all else. Although respiratory is there in the day and for paged out emergencies, at night we are expected to act as the "triage" nurse, charge nurse, respiratory therapy, pharmacy, ed tech, and housekeeping. We also do outpatient therapy. In the day, they do outpatient therapy, work meds and DOT physicals none of which are accounted for when staffing is considered. Recently, we had a pulseless patient present POV on the weekend, kitchen staff and housekeeping assisted with recording and compressions.....We were recently reprimanded for paging out for assistance and were told that ED standards require a 4 to 1 ratio. I explained that those standards are designed for ER's that have all the other resources and don't do ambulatory care treatments and asked for a protocol be in place. Needless to say, I was reprimanded and notified of lengthy wait times in urban hospitals. What are your experiences and comments? I am concerned with patient safety.

[PacoUSA, BSN, RN]

I hope you're prepping that résumé ... that's not a situation I'd want to try to fix.

Sent from my iPad using allnurses

[annie.rn]

I am not an E.R. nurse but this sounds terrible for both you and the patients. I would find a new job. Good luck to you. I hope something safer comes your way quickly :-)

[That Guy, BSN, RN, EMT-B]

Even when I was doing my rural access clinical ( Similar to what you describe ) there was always someone that would at least triage them and get them started on charting.

[hmwaggs]

Mike,

Thanks for your response. I am interested in the staffing that was done in the rural access hospital. If this hospital weren't closely associated with hospitals within 30 minutes that are much larger, than this would be considered a critical access hospital. I would like to find resources for staffing from other hospitals and recommendations from organizations such as the ENA and give a presentation of options. There will be a new DON hired shortly.

To address Annie and PacoUSA, in the meantime we are going to move closer to the larger facilities and I will be updating my resume. I've been a nurse for 10 years, just about done with my BSN, am a CEN, and have experience in surgery, ICU, ER.....I chose to work here when we moved here just over a year ago because it is closest to home and my husband already travels....I didn't want to be too far from my kids, one of the many sacrifices of parenthood :) However, I'd still like to initiate something as I have great coworkers and I am worried about the possibility of unintentional patient harm.

[level1]

Unsafe hospital, you should leave that place ASAP. Shame on them for reprimanding you, they must be idiots.

[Altra, BSN, RN]

Recently, we had a pulseless patient present POV on the weekend, kitchen staff and housekeeping assisted with recording and compressions.....We were recently reprimanded for paging out for assistance and were told that ED standards require a 4 to 1 ratio. I explained that those standards are designed for ER's that have all the other resources and don't do ambulatory care treatments and asked for a protocol be in place. Needless to say, I was reprimanded and notified of lengthy wait times in urban hospitals. What are your experiences and comments? I am concerned with patient safety.

You don't need anyone to tell you that the reprimand was completely out of line - I'm sorry that happened to you.

I work in an urban hospital with long wait times ... but a more accurate description is "potentially long wait times AFTER triage by a licensed nurse, vitals obtained, possibly some protocol treatment initiated, and a clinically-trained pair of eyes on patients who are waiting". And the resources to change things up if a patient's status changes. Not exactly an apples to apples comparison with your situation.

I have no respect for administrators who play fast & loose with people's safety.

[hmwaggs]

Altra,

That was exactly my point. I previously worked in a hospital with sometimes long wait times. That being said, vitals and a brief history were taken, protocols were initiated, and a triage nurse was there to watch and round on them. My DON "explained" to me that we can leave patients wait in the waiting room, that our small community is too used to being brought straight back, and then she told me our sister hospital (a Level II trauma center) and a hospital in Chicago have 2 and 8 hour wait times respectively. I think comparing this tiny facility to those is, like you said, comparing apples to oranges. I know those hospitals have an RN assessing and monitoring them while they wait.

My administrator is too used to the way things were back in the day....The ways that have changed because there were too many incidents. She retires next month, and I think that is her main focus now.

[Bobjohnny]

We've got a couple of critical access hospitals in our health system. The minimum staffing any of them goes to for the ER is 2 RNS, an EDT, 1 Doc & a Registrar. There is also a RT for the whole hospital (This includes the 12 Med-Surg beds). That particular facility has 6 ER beds and there are also 2 Swing beds that can be used for ER or Med-surg.

But a single RN, a doc and a registrar? That is absolutely insane, sounds completely unsafe if somebody comes in who is actually sick. I hope all goes well for you in the time you choose to stay at that facility.

[L♡vER]

How do you waste meds with 1 RN?

[hmwaggs]

We call the floor nurse or OB nurse. Also, the pharmacist has the HUC take some class and they are set up to waste if the nurses are unavailable. The same for verifying high risk meds, like insulin or drips....not sure about blood (knock on wood)

[sockov, ADN, ASN, BSN, CNA, LVN]

OMG! Where you located? So not Magnet! JCAHO?

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