Chronic Extreme Emergency Department Shortstaffing

Published

Our facility chronically leaves our ED shorthanded by 25% to 75% in Nursing staff. This leaves extremely unsafe staffing ratios, I'm talking up to 11, 12 patients to 1 RN; also our RNs often must do our own housekeeping, be security for violent events in the department, hold ICU inpatients in the department etc because the hospital does not want to pay for ancillary staff; all of this is in addition to our 4-12 patient load for each RN. Then when a patient complains that their wait was too long or if a bad event occurs, the hospital blames the nurses. I would write an occurrence report, but that goes to our Risk Manager who is also a blamer. Everyone else is afraid to address the unsafe nurse to patient ratios due to our Administration will simply terminate anyone who questions them. What is everyone else doing to stay safe in this kind of facility?

Up Vote Up Vote ×
Specializes in Emergency Room.

I gave 2 weeks notice and found another job. And while our staffing was horrible we didnt have over 5 patients unless we were in fast track. Being in that type of positon is not only dangerous for patients but you're risking your license.

Up Vote Up Vote ×
I gave 2 weeks notice and found another job. And while our staffing was horrible we didnt have over 5 patients unless we were in fast track. Being in that type of positon is not only dangerous for patients but you're risking your license.

Might be time for me to do that.

Up Vote Up Vote ×
If you do, LeftFlankPain, do you want to stay in the ED? What are your options? Home health and hospice seems to be a good transition for many ED nurses I know who were just done with the hospital setting.

I love the ED so I would still go there. It's our facility that has lost complete sight of the patient, relying upon extreme short staffing to maximize profits. It has become extremely dangerous to work there.

Up Vote Up Vote ×
Specializes in Pediatrics Retired.

Although it's been several years since I worked in the ER, this is the exact reason I finally quit. I worked nights in the only pediatric ER in a fairly large city. Nurses would move on and the hospital would delay, delay, delay filling the position or not fill it at all. Many nights there would only be 3 of us. In Texas, and I'm sure other states have a similar thing, a nurse can file "Safe Harbor" paperwork which informs the employer, and nursing board, the nurse believes she/he has been placed in an unsafe working environment but will not abandon the patients, i.e., leave the shift. I kept the paperwork printed and ready to submit during this time. After a grueling too many months I finally threw in the towel. Good Luck.

Up Vote Up Vote ×

I'm really tired of facilities, even the big shiny ones, being too cheap to provide adequate staff for the number of patients and their acuity. Especially in critical areas. To me, it all started when these facilities decided to "streamline" and use lean management to a fault. I don't understand why administration doesn't understand healthcare can not be run in the same manner one would run a bank, or any other corporate business.

In my facility, I have seen how scary being understaffed can be. Then when something goes wrong, administration blames staff. Why?! Unfortunately, I don't see the situation improving unless laws are passed or nurses take a very serious stand.

Up Vote Up Vote ×
Specializes in Pediatrics Retired.
I love the ED so I would still go there. It's our facility that has lost complete sight of the patient, relying upon extreme short staffing to maximize profits. It has become extremely dangerous to work there.

I was gonna say...Exactly! For the patients and nurses....the straw that broke my camel's back was a night where we were only three nurses and one tech. I was charge. In the span of 20 minutes we received 3 ambulances, 2 of which had 2 patients, ALL on backboards! So out of nowhere we have 5 patients on back boards and NO ONE available from the entire hospital to simply come monitor the patients until we could get them cleared from the backboards; including the house supervisor. NICE, very NICE working conditions. Real teamwork. Two week notice submitted at the end of that shift.

Up Vote Up Vote ×
Specializes in ER, Med-surg.
What is everyone else doing to stay safe in this kind of facility?

I wonder if we're coworkers.

I'm skipping breaks, charting the crap out of everything, and looking for a new non-hospital job, personally. I pretty much hear it's the same all over, and getting worse.

Up Vote Up Vote ×
Specializes in Emergency, Trauma, Critical Care.

Quit. Come to California. I work in probably one of the best staffed ERs in the country. We have float and transport nurses to make pt get safely to the floor. We have 1:1 for he super sick pts and no nurse ever has more than 4 pts even if they're taking care of the band aid and scrape pts. We all get an hour lunch (they combine our two 15s with it). I swear I've won the lottery. There are good places to work, you just have to go find them. Don't let a horrible place allow you to deal with low standards. The hospital will gladly martyr its staff if something happens.

Up Vote Up Vote ×
Specializes in ER.

I would be looking for a new job. Little staff, high patient numbers = future sentinel event. I would make sure I have , document those times you've gone to management regarding an unsafe environment. If you feel you can't go to your management, what about going to HR to file a grievance. If you feel that any or all of these measures will lead to your eventual termination, then I'd start to submit applications to other employers today.

good luck.

Up Vote Up Vote ×

If you are not getting the appropriate people to change things, then you need to move up the food chain. Start filling out incident reports after every shift. Keep copies, regardless of what RM has told you. You don't have to tell anyone that you have them. Keep them secret, in a safe place at home until you need them in court.

I would first get another job secured, then the fun stuff begins. You notify the CEO about the above working conditions. Inform him/her, that you have filled out incident reports of the above unsafe staffing conditions.

I would continue to move up the food chain, and arrange a meeting with the senior partner of the law firm that represents the hospital. Don't go alone, take someone with you. Go into very fine detail what is going on staffing wise, that you no longer work there because of these working conditions, and if there is a law suit, you will contact the Plaintiff's attorney, and testify on their behalf, and inform them that you filled out incident reports on these days, concerning whatever, and if need be, will go to the newspapers, concerning the above incidents.

You can also report them to your states, "Facilities and Licensing Division", the State Board, that licenses health care facilities. This is the hospital's version of the State Board of Nursing.

That should get some response.

JMHO and my NY $0.02

Lindarn, RN, BSN, CCRN, (ret)

Somewhere in the PACNW

Up Vote Up Vote ×

The facility has medical director or chief medical officer. Inform them of the situation in writing and keep a copy of any response.

Up Vote Up Vote ×
+ Join the Discussion