I'm curious about how other small hospitals staff when census goes through the roof.
I'm an ER nurse in a 25 bed hospital that has a 24-hr ER. The hospital does OB, med-surg and takes a few rehab type patients (swing bed or transitional care). My concern is not the ER, but the med-surg area. This past weekend I was turning patients over to the floor nurses who already had 7 or 8 patients. I felt awful knowing they were in over their heads, but we were backed up in ER and couldn't keep them.
My question is, how do other small hospitals deal with large shifts in patient census. We don't seem to have a contingency plan. When we talk to our director, she says staffing is based on average census, which is averaged over a year's time and is 12 patients. However when we are at top census, our patient number is 25. And we seem to be hitting our top numbers much more often lately. We have never refused admissions due to nursing staff availability, but I wonder if we should sometimes. (Our next available hospital is 60 miles away).