[bill4745]

We have 1:4, with a float RN, charge RN, and two techs (0700-2300) with a total of 20 pts. Sometimes, we even have 2 floats.

[loricatus]

Originally Posted by bill4745

We have 1:4, with a float RN, charge RN, and two techs (0700-2300) with a total of 20 pts. Sometimes, we even have 2 floats.

Notice you are in PA. I have a PA license----Do you need more staff????
I am quite serious because I was just notified that the landlord put the house we are renting up for sale (during mid-lease). Seems like I'm going to have to move anyway.

[bill4745]

Loricatus-I sent you a personal message. We have openings.

[mom2michael]

One facility I work for - 1 RN and 1 tech 24/7 with an overlap RN that works 11-11 - we see an average of 30 patients a day. We have no set ratio. We do our own triages and then just everyone pitches in and does what needs to be done for each patient as we bring them back.

2nd facility - 1 RN to 4 patients - with 2 float RNs (11-11 and 3-3) that pick up the slack and take trauma or high acuity patients, help with meds, d/c and getting patients admitted. We also have a charge RN that doesn't take patients unless necessary and a triage RN that can help in a pinch. We have no tech though. We have 12 rooms there - see around 100 patients a day.

[Kinky Slinky RN]

1:4 ratio is almost unheard of in my ER. Tonight I had up to 10 patients alone and it was fairly slow... About 4 of the 10 of my patients all at once had ankle fractures. One went straight to OR. Another case was to go to OR shortly after the first one. I had a few admitted patients. One patient had the worst clavicle fracture I have ever seen. It can definitely become unsafe but thankfully I work with a great group of people and we all watch around and help each other out. In this ER, prioritizing is a must.... realizing which patients are truly sick is essential.

On our trauma/surgery portion of the ER, we have hard bed assignments so max patients you will have is between 6-12. However, on our medicine portion of the ER, you may have 2 RNs to 20patients easy.. If we are short staffed, it's possible you can have all of those 20 patients on your own. If it weren't for the fact that all of the RNs pull together and help each other out, our ER wouldn't be as efficient as it is. It can be scary at times, no doubt. We hardly have techs at night and if we do, they are typically transporting patients to the floor. We do have phlebotomy and EKG on the medicine side which makes our job SO much easier.

Although it's crazy and sometimes can be unsafe, it is a practice we deal with daily. My hospital is a huge teaching facility so thankfully we have someone keeping eyes on the patients most of the time, whether it be interns, residents, or attendings.

For our patients that go to the ICUs, we have one nurse to those patients. Typically one nurse to 3 ICU admits.

It's crazy... In fact one of my good friends refers to my ER as an "orangized chaos," and that is exactly what it is... but it works =)

[AndiERRN]

My ER has a 1:4 ratio we have a floating charge who is very willing to jump in and help and take over a team when needed. You should have been 1:1 with a tPA pt and if your co-workers and charge weren't willing to jump in and take over your other patients and then help with the tPA you are in the wrong place.
I have found a job that is supportive and amazing but it's taken alot of work and frustration to get here, but I'll never leave.
I work north of Atlanta at Northside Hospital. www.northside.com There are 3 campuses and all are growing. They have a local traveler plan where they pay you for gas millage and pay for you to stay in a local hotel, all within walking distance. We have one RN who actually flies in from Maryland! (look on the web site under careers and then benefits and then programs and then local traveler.)
My advice? just keep looking and find something, somewhere else where you are supported and appreciated. Experienced Emergency Nurses are too hard too come by and we need you... Don't give up!
AndiERRN

[Medicine Eagle]

Get ready for a shocker, I worked Christmas Eve in a level I Trauma woth 4 nurses total! That included the Charge Nurse and triage. We thought we were going to loose our mind. Talk about unsafe. Esp. considering that Christmas Eve is not only high MVC time but also attempted and successful suicide time. We were called the gun and knife club. It was baddd. On top of that Administration refused to allow us to go on diversion until 30 min before day shift came in. I had a pt that only needed report called, and after the night we had the day shift nurse refused to call report. The day shift Charge Nurse backed her up and chewed me out and demanded that I call report. I have no idea how many pts I had at the same time that night because there was no time to count them.

Also I have rarely worked in an ER that had a set nurse to pt ratio. I have had as many as 9 or 10 pts going at the same time. Some serious some not. I was working a severe trauma when the charge nurse (I use that term loosely) started yelling at me that my other 2 pts had bed and I needed to call report to the floor. Keep in mind that in the ER, we have pts for a short time comparetively speaking and that any ER nurse can generally pick up a chart and call report on a pt s/he has not given care to. That place was crazy but I loved it. With the exception that the cliques were really bad and the politics sucked. All things considered I would still go back. I had the best Nurse Manager I have ever worked with. Some of you may know her. Helen Sandkhul RN is the best ER Manager hands down. She is the only manager I have ever worked with that would come in to the ER in scrubs ready and willing to help if we needed it usually. Never see that anywhere. Frequently we were so busy that the nurses would raid the saltine cracker supply in desperation. Either that or run out to the vending machine for a candy bar. However, you had to be desperate to do that as in a blood sugar of <50, B/c if the pts waiting saw you do it then they thought that they were waiting while we had a great big old candy bar party going on instead of seeing pts.LOL Or that is how they acted anyway. Sorry about the rant. As a floor nurse with up to 15 pts at a time, I did not understand the ER nurses urgency in giving me report on a pt that I had no time for. I did not understand I figured the pt already had a nurse, couldn't it wait? I did not know that the ER charge nurse, pt, pts family and the ER doc were all up her butt to get that pt to the floor to open a room. I think it would do everyone alot of good to just follow an ER nurse for a shift and for ER nurses that have not worked a floor or ICU to follow those nurses for a shift. Then maybe we would all be a little kinder to each other.
Tired Brave Heart