Critical care patients in emergency room

[diane e]

hi good morning. My daughter is a new grad. She landed a job in a very busy emergency room by Los Angeles airport. Staffing is for patients to one nurse. I have a question and a concern. They gave her three patients and the fourth patient was intubated and a propofol drip and a Cardizem drip. I have been a nurse for 34 Years. I worked mainly in a busy trauma center in Southern California where we had lots of intubated patient and on many drips but we were not given three other patients. My concern is how safe is this for the patient number one and for the nurses license number two and is this acceptable by the California state board of nursing. Being a new grad she doesn’t want to make waves but I have concerns and if anybody out there could enlighten me to this practice I would really appreciate it thank you

[Wuzzie]

Not uncommon when I worked ED. I'd have a critical patient and 2-3 stable patients. Not ideal but we made it work and all the patients got good care. Is she still on orientation?

[diane e]

No. Thanks for response

[Wuzzie]

1 hour ago, diane e said:

No. Thanks for response

Well, that's a lot for a new grad to handle depending on what her other patients are and how stable her critical patient is. Teamwork and appropriate patient mix is key in situations like this.

[Corey Narry, MSN, RN, NP]

Based on California's mandated nurse to patient staffing law, your daughter shouldn't have 1 critically ill patient and 3 other non-critically ill patients. The rule for ED's is 1 nurse to 2 ICU level patients or 1 nurse to 4 patients who do not meet ICU or trauma criteria. Trauma patients are 1:1. However, ED's are highly dynamic units in terms of patient intake, flow within the ED, and dispo. This can make it tough to stick to the ratios as the law dictates.

I'm sure there are ED's that have a hard time sticking to the rules at times and there are also those that plainly violate the rules all the time. If it's a pattern and it concerns you or her, ratio violations are reported to CA Dept of Public Health and not the Nursing Board. Facilities don't really get fined for violations, instead, a letter is sent asking to correct said staffing ratio violations. I imagine many facilities have received such letters.

It's best if she works in a hospital with a union. In those hospitals, nurses are advised to express disagreement with the assignment, NOT refuse the assignment, and fill out an Assignment Despite Objection form. A pattern of staffing violations can be dealt with by the union in meeting with the hospital administration.

[diane e]

Thank you for responding . I will pass this on to my daughter. It is a for profit hospital. I may be old school nursing where the patient came first. The events that she has shared with me are so unacceptable. Also unsafe for patients and staff.She is trying to be a good patient advocate, and a compassionate new RN.

[OUxPhys, BSN, RN]

2 hours ago, diane e said:

Thank you for responding . I will pass this on to my daughter. It is a for profit hospital. I may be old school nursing where the patient came first. The events that she has shared with me are so unacceptable. Also unsafe for patients and staff.She is trying to be a good patient advocate, and a compassionate new RN.

Well there is your problem right there. She works for a for-profit hospital.