Right now I am averaging 1:7+ (nothing less) and am getting very close to quitting. It truly is becoming unsafe since critical care patients requiring 1:1 are part of the mix.
I just had a CVA who got the order for tPA 5 minutes before the closing window cutoff time (docs/residents/students couldn't decide what they were going to do and how they were going to do it...) Thank God I did a decent assessment, asked questions of the family (since the docs weren't keeping me informed) and knew there was a confirmed time of onset of sxs, allowing me to prepare ahead of time and not be the one that was blamed if we missed the time frame for administration. The patient actually received the initial bolus with 1 minute to spare. Of course, in cutting it that close, the patient did not have any relief in symptoms. While this was occuring, I had 6 other patients that had no nurse. I notified the charge nurse that I was aware that hospital policy required 1:1 for the tPA patient and someone would have to care for my other patients. Her answer was that there was no one to spare and I would have to find a way to be in compliance with hospital policy, while not abandoning my other patients-since I was at fault and should have not prepared ahead of time and just let the time for administration expire.
After she said that to me, I decided I will be leaving this ED as soon as possible. I don't want to get into another situation like this again, so am I asking too much to find a place that has safe pt to nurse ratios and professional management?
What is your patient to nurse ratio? Is it manageable? Do you actually get some help from the aides or do they sit around reading the paper and give you that dirty look if you ask for help? If it is less than 5:1, do you need additional staff? I am willing to move or do traveling because I love emergency nursing, think I do it fairly well; but, hate having to risk patient lives and my license because of poor management, cost cutting of nursing staff while putting millions of dollars into the aesthetics of the buildings...
At the least, thank you for giving me this opportunity to vent.