I'm a Swedish nurse and have worked in an ER for several years now, and am very curious about how the average non-Scandinavian ER works when it comes to patient flow and work stations.
Who is the first one to talk to the patient regarding chief complaint? Are vitals taken at this point or later on?
What different work stations are there in the ER?
How many patients can one nurse be responsible for in the main ER at any given time - i.e. nurse-patient ratio?
Is there a requirement for nurses to obtain a CEN?
Can ER nurses do procedures like obtain arterial blood gases, write X-ray referrals, etc?
How often are nurses required to chart a patient's vitals and status?
Does every patient who is in the ER at any given time always have a nurse who is responsible for them?
What are the main responsibilities of the charge nurse?
Patients who are to be admitted to the hospital - where do they wait if no beds are available and who is responsible for them during the wait?
Looking forward to and grateful for any answers :)
I am from NY hence the terrible ratios. The other nurses try to cover for you if they can when you have a code or critical come in. I'm sure our management would love us to have higher ratios but we run out of physical space in the ED with 9-10 patients each
once we max out people just wait, it's usually at least 2 hrs for a level 3 during busy times sometimes gets up to 8 hrs
I work in a very, very busy ER for the area I live. We see 85,000+ pts per year. We have 20 high acuity rooms (1,2, and complicated 3s); 24 rooms for level 3s and 4s but if triaged wrong, who knows, we could have level ones in this area. We also have 10 Fast Track rooms. During the day, we have two nurses in triage. One triages and along with a tech gets vital signs and EKGs. The other sorts to the correct rooms. We also have a mid-level provider in triage during the day that enters orders and occasionally treats a clinic-type pt from triage and discharges without them ever coming into the ER. That doesn't happen often.
In the higher acuity area, we have two or three rooms per nurse. Lower acuity is three to four rooms per nurse, with occasionally five rooms if the wait time is insane and we're understaffed. Mid-level providers (PAs and NPs) see most of the pts in the lower acuity rooms. If they turn out to be complicated they are turned over to a MD overseeing those providers.
We have a charge nurse who handles the radio and sorts incoming EMS pts to rooms. That's pretty much all the charge nurses do. They don't help with codes, they don't help with IV starts or staff conflicts. I've asked for help from a charge nurse with an IV before and got told: Well, you're **** out of luck! The job duties of charge nurses in this facility are completely different from anywhere I've worked.
I'm not going to lie: we're in a mess. Day shift has many nurses with 10+ years of experience. On nights, we're working with an average of about 3 years. I was a LPN for over a decade working solely in a smaller ER; RN-BSN now for about 6 months. On night shift, you're pretty much considered experienced if you have a year working in this ED. Our most experienced nurse has been a nurse for 3 years. If it weren't for agency nurses, we'd only have half the staff we need. The turnover is horrible.
I really like what I do here and could love this job, but there is a clique that runs the place. If you don't belong to the clique it is hard to get help or get questions answered. The clique nurses all want to be seen as "super nurses" and don't want anyone to challenge their status. I outgrew the need to be a super nurse a long, long time ago, but I would like help doing those things I wasn't able to due as a LPN, like hanging Diprivan or assisting with chest tube insertion. Just someone to stop me if I'm doing something wrong. If you ask a clique member for help, you eventually get it but not until you are ridiculed in front of other team members for not know how to do something. It does no good to talk to management as they are buddies with the clique members.
I think about leaving, but I would really like to stay here at least a year to get my experience. But there are days when I really feel like I'm back in high school. I'm over 40 years old and I left high school behind so long ago, it isn't something I want to go through again! I just want to take care of my pts the very best I can and leave at the end of the day feeling like I did a good job. There are lots of other issues too, like the missing communication skills many of the younger nurses lack, because of technology, I assume. We work in teams. I like to tell my pts what is going to happen, but when a team member comes in, grabs an arm, and throws an IV in with no warning, it makes MY communication look bad. When I take time to speak with my pts, I get complained on for being too slow. I don't know...are all bigger ERs like this? Are there always going to be cliques and staffing issues if the ED is large? I love learning the more critical aspects of ED nursing but some of the trade-offs are hard.
PAEMT
5 Posts
I am from NY hence the terrible ratios. The other nurses try to cover for you if they can when you have a code or critical come in. I'm sure our management would love us to have higher ratios but we run out of physical space in the ED with 9-10 patients each
once we max out people just wait, it's usually at least 2 hrs for a level 3 during busy times sometimes gets up to 8 hrs