[edrn]

As I read down the board I continue to read about unsafe conditions and ragged nurses. I do not understand why we don't band together across state lines and just say no. We need standards of safe patient nurse ratios and appropriate equipment. Where I work the DON states she will not recognize any one group of nurses over any other for pay increases. ED is different and should be compensated. The State of New York recognizes our special needs by mandating 1 years nursing experience to even seek ED employment. Many other hospitals offer a critical care compensation. Although my facility does not offer this they require a two week critical care course to be employed in these areas. In addition I must maintain ACLS, ENPC, and TNCC that is not required in other areas of the hospital. I take on incredible libility since we see, evaluate and initiate testing prior to an MD eval., and even triage which patient the doctor should see first (even after the initial triage to the appropriate acuity area). In no other area of hospital nursing is a nurse acting without a dx or MD eval of a pt. We put our licence on the line constantly. Why are there non standards of care that limit pt numbers and make the hospital and not the nurse liable? I believe it's because we ddon't stop it. Imagine in this time of nursing shortage if every ED nurse said I will not work with more than 4 acute patients at one time and you will pay me for my expertise or we will seek employment elsewhere. We are a special breed and not every RN is cut out to run trauma and serious burns at the same time as monititoring a pediatric patient in DKA. Wouldn't a national ED RN union be nice. I would feel better to know someone would listen at the end of the day (eve or night) that it wasn't o.k. to put the 80 year old woman with explosive diarrhea on the bedpan in the hall all shift. That 52 hours this week was enough, I can't be put on-call again and 14 acute patients at one time is not safe nursing care. I would like the administrator on call to have to say yes to code red after an MCI (the quote two weeks ago was "patient safety is not criteria for code red"). Any thoughts?

[oramar]

I am not a ER nurse but I know enough of them to say that they have validated everything you say as true. It appears that a huge increase in the use of ED departsments has occured rather recently and unexpectedly and for the most part hospital admisistrators are too busy dealing with budget issues to pay attention. You must save your own life and do what ever you have to do protect yourself, once you have done this you can start to worry about the patients

[bluesgirl]

Yes sir:
to whom it may concern!!!!
Never ever do I want to work the ER--utmost respect and Kudo's to you who do work E.R.
I worked a "sub-acute unit"---was turned down for an ICU position because i am not certified---Can't tell you how many times I've coded a patient or prevented a code.
Dr. J.--asked me one time-- what can they do for him in ICU that you don't do there---- and I said they can give him one on one--- I don't have that privelage and I fail to see why I should do this without staff, equipment, IE artlines, Dr. on the floor--- at least you have that===
and yes--it's so wrong.

[HazeK]

Whew! You touched quite a few topics in your post!

Originally posted by edrn: . . .I continue to read about unsafe conditions and ragged nurses. I do not understand why we don't band together across state lines and just say no. We need standards of safe patient nurse ratios and appropriate equipment. . . ."

WE ARE COMING TOGETHER! Please come to the Million Nurse March discussion & review everyone's contributions! Please, join us in our efforts as we get it organized!

Originally posted by edrn: . . In no other area of hospital nursing is a nurse acting without a dx or MD eval of a pt. We put our licence on the line constantly. . . .

I beg to differ just a bit. Do check out your Labor & Delivery unit. If it is a High Risk unit, with a Triage Unit, the RNs there may very well be in the same "boat" you are! In my unit, RNs follow a basic, loosely writen protocol, but essentially initially diagnose & triage without MDs there to eval a patient. We are constantly asked to "labor the patient and get them delivered" using our nursing experience and judgements. (Thought you'd like to know that the #2-most-sued group of RNs is standing right up there with the #1 group, ED RNs!)

Your DON is probably of the "every nursing area is a specialty" mentality. It took years & a Unit Manage who really went to bat for us to get our "critical care" pay differential. Good luck getting yours...I KNOW you all deserve it!

Originally posted by edrn: [B". . .Imagine in this time of nursing shortage if every ED nurse said I will not work with more than 4 acute patients at one time[/b]

Our Triage beds are run with 3 patients per nurse...but you do have to take into account that each patient is at least 1mom:1fetus pair...& both can give a nurse "grey hair" & ulcers. I have refused to take care of too many patients...& if looks could kill from the Charge RN--my best friend! But, it was either give poor care and possibly end up with a "patient abandonment" situation...& maybe loose my RN liscense..............OR get fired for insubordination...& keep my liscense! (thank goodness, she rearranged assignments and NEITHER happened...whew!)

Enough from me.......Again, join us at the Million Nurse March discussion & website!




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