Er Staffing

[NicoleRN07, RN]

i work in a busy ed, where we see somewhere in the neighborhood of 180 to 200 patients per day. we are getting ready to start pod nursing, and i was just wondering if anyone has experience with this type of nursing and how well it works. i work the night shift, so of course our staffing is not as good as it is on days and we typically staff 4 7p nurses (including charge nurse), 1 nurse til 9p, and 1 nurse til 11p. i'm willing to give it a try, but i just don't see how this method is going to work with that kind of staffing. also, i would like some insight on how other ers are staffed. do you have a triage nurse all night? does your charge nurse take a room assignment? i've been in the er for 3 years now, and since first starting the ed, things have changed so much. our staffing has been cut, leaving the charge nurse taking a room assignment and doing triage at times, and i was just wondering if anyone else was experiencing the same problems.

[RNinED]

I work in a small 7 bed ER where we see about 50-60 pts /day and we are also struggling with covering the busiest times by adjusting two 10hr shifts. one will come in at 10am and the next at 1300. We do not have a charge nurse and who ever does triage is supposed to help with pt flow. Would you describe POD nursing.

[widi96]

Wow. That staffing just seems wrong. I work in a 27 bed ER - we have a charge nurse, triage nurse, float nurse and the other nurses have three room assingments on the 'more critical' side and two or three nurses covering our clinic side (which has 10 rooms). The float nurse usually takes bad trauma's or codes that come in that require the immediate 1:1 care.

[MomNRN, BSN, RN]

Your RN/patient ratio seems kind of low to me.

I work in a small, level 2 ED - only 13 beds. A "busy" day for us is 80 pts.

On nights we have 3 7p RN's (that includes the charge RN who sees pts), 1 RN who leaves at 2230 and another who leaves at 2300. There is also a triage tech on all night. This position is an RN during the day, but usually a paramedic at night.

The coverage seems to work well, but there are always those days when you never have enough hands.

[widi96]

Our ER ALWAYS has a RN in Triage, plus a charge nurse who doesn't take patient's except for between like 3am-6am. We usually have five 6a-6p. A 8a-6p. A 9a-9p. A 10a-6p. A 10a-10p. A noon-midnight. A 3p-11p. A 3pm-3am. Then night shift has five 6p-6a, and a 6p-2a. They sometimes have a 1a-1p or a 6p-4a, depending on what else is staffed. We have a doc that comes in at 7a-3, a doc that works 9-5, a doc that does 3-11, a doc that does 5p-1a, and a 11p-7a. We also have what we call "triple" which is a doc that comes in every day from 2pm-10pm to do the clinic side. We have at least one secretary there at all times, two from noon to midnight. We have tech shifts that are 7-3, 12-12, 3-3, 3-11 and 4-12. There is always the 7-3, 12-12 and 3-3 tech, then the 3-11 tech works Monday through Friday and the 4-12 is extra coverage we have Friday, Saturday, Sunday and Monday. This is a 27 bed level II ER with an average patient load of a little over 100/day.

[neneRN, BSN, RN]

Work in a very busy (>130,000 pts/yr) Level II ER- we staff 15 RNs/7LPNs/5 techs/2 triage RNs every shift (separate pedi ER, don't even know how they staff) Our triage nurses ONLY work in triage (we don't rotate)-have 2 triage nurses 24/7 and add a third whenever we can with staffing. Charge RN never takes assignment; if we are shortstaffed, then charge takes an assignment and the supervisor acts as charge for the day (this is probably due to the way our charge position is set up; charge has to stay at charge desk all day to watch monitors/take EMS calls/take admission orders-they really aren't mobile). Are you talking about team nursing when you say pod nursing?

[NicoleRN07, RN]

Wow....that's a wake up call!! In less than a week, we will be moving in to a new trauma center with 8 more beds than what we have now, and will be left with the same staff. Right now, we only have 10 monitored beds, but once we move into our new dept, all rooms with be equipped with cardiac monitors!!! That means, I could potentially be taking care of 9 monitored patients.....just don't sound right to me. We are a Level III trauma center, but we do see quite a few traumas, approximately 3-5 per week, and it seems to me that staffing only 4 RNs is setting us up for some big mistakes. I can recall, (and probably will never forget), Thanksgiving night this past year, we were left with only 3 7p RNs, and no one on call, and I was unable to reach our Unit Director. We had a code come in, 5 minutes after the code came in, we got a trauma, (a MVC rollover, BP 80, HR 140, O2 sat 85% on NRB, and at the exact same time, a difficulty breathing sating in the 50s on a NRB. Now, that left 1 nurse to each patient, and ideally, we should have had at least 3 nurses with all 3 patients, 2 working, and 1 charting. Oh, and I almost forgot about the patient that had already been seen by the MD who called out numerous times complaing of CP for over an hour, and when we finally were able to check on him was having an MI. That was a bad night.....and DANGEROUS!!!

POD nursing, (from what I'm told) is where the dept is kind of divided up in mini ER's. There are supposed to be 2 nurses, 1 tech, 1 secretary, and 1 Doc or PA assigned to a POD, and we're supposed to function just like our own little ER, inside this giant ER. But, with the staffing that we have, our POD is going to be more like 1 nurse to 2 PODs, 2 techs for all the PODs, and 1 secretary for all the PODs, and the docs are just going to have to take whatever patient comes up next. I just don't see how this is going to work.

[nuangel1, BSN, RN]

i don't either and it sounds unsafe to me.

[ernurse1993]

I work in a 20 bed level II trauma center with an urgent care that has 5-7 beds. We will be seeing over 50,000 pts this year, we average around 150 pts daily, right now our patient ratio in the ED is 5:1. At times I find myself deciding what is more important giving nitro to the patient with chest pain, narcotics to the pt with obvious fractures from trauma, or starting blood for the gi bleed. I go home at night wondering what I didn't get done and should have, or what did I forget to tell the nurse taking over on my patients at the end of a busy shift. Management is finally looking at increasing staffing only because the doctors are starting to stick up for us and say enough is enough. What is the nurse to patient ratio in the hospitals others are working at???

[Miss1030]

I've worked in a 22 beds facility--3rd level trauma center--, (fairly busy with >100,000 pt a year, >1000 ambulances a month, ) with 2 triage room, 1 stab room (2 beds) observation room, trauma and pediatrics... we used to staff on a 3:1 basis, had 2 triage nurse during day and evening shift that would only do outpatients triage (at night, the nurse who as affected to minor trauma and ambulance triage also does all the outpatient triage) 3 floating nurses.... we were pretty well staffed.

Now I work in a small 7 bed facility and we are poorly staffed. Would you believe at night, there is only 1 nurse. No receptionist or anobody else. You carry your blood samples to labo yourself, you open your patients files, you do triage and floor in the same time and you clean your stretchers when the patient is discharged. Sounds safe for the patients? not likely....