Covering 1:1’s in the ER

[Ryan William]

Hey guys! Reaching out for some guidance for the ER I work in is having a ton of trouble staffing PCAs/ER techs to cover the rapidly rising number of behavioral health one to ones we have. How do your ERs do it without overstaffing? We’re an inner city ER that sees about 60k patients annually, and as you can imagine, we can go from zero psych patients to 4+ in an hour. We utilize staff from the inpatient floors when available, but more often than not it’s left to us. Anyone have any ideas? Not only are our ER techs getting burnt out from sitting on one to ones every single day but the nurses could also use the extra set of hands that they’re losing in their busy assignments. Thanks!!

[JKL33]

On 12/6/2020 at 8:17 PM, HiddencatBSN said:

The OSHA issue is that the RN station is considered a “patient care area” and that there’s potential fluid exposure there and with how many patients or residents try to hand me urine or lab samples at the RN station instead of leaving them in the room (or giving me an opportunity to grab gloves)....LOL. 

I know what it all stemmed from.  OSHA addressed this way before it came on my radar, although that hasn't stopped administrators from still making it an issue even in the past 3-5 years.

https://www.osha.gov/laws-regs/standardinterpretations/2006-05-17-1

OSHA's 2006 letter, which is an easy Google hit, includes this point blank comment:

 

Quote

An employer may determine that a particular nurse's station or other location is separated from work areas subject to contamination and therefore is so situated that it is not reasonable under the circumstances to anticipate that occupational exposure through the contamination of food and beverages or their containers is likely. The employer may allow employees to consume food and beverages in that area

 

That is why I say that there is a lot of unthinking interpretation of regulation and then there is also purposeful (disingenuous) misinterpretation when employers want to do things for their own reasons. This is one of those issues that has since been easily solved with measures other than saying no one may have access to water in the work area--after enough staff carefully/professionally provided rebuttals.

But yes, I understand that handling of ED patients with psychiatric complaints is a big deal. Not all of them should or do require 1:1 attendance though.