New Grad ER Vent - page 2
I love working in the ER, I will be off orientation in 2 weeks after a 5 month orientation. I feel pretty confident in my abilities and I can roll pretty well with a busy team of 8 or 9 patients. ... Read More
Aug 8, '08Occupation: RN Specialty: Day Surgery, Agency, Cath Lab, LTC/Psych ; Joined: Feb '07; Posts: 894; Likes: 1,097Quote from JMBMVery good post. I can't believe this hospital actually has nurses that stay in the ER. They are either all new grads or travelers.I can roll pretty well with a busy team of 8 or 9 patients.
This isn't even a hard question. Eight or nine ER patients is too much for an experienced ER nurse to safely handle. Fifteen for a new grad verges on the criminal. Just think, you have all of 4 minutes per hour for each patient, assuming you do no charting, answering the phone or, heaven forbid, using the bathroom. If this is a case of institutional neglect of the ER, the only solution will happen when nurses vote with their feet.
After writing my response above, I decided to come back and edit it some. Your statement that you can "roll" with 8-9 patients stuck with me. Thinking one can handle 8-9 true ER (not non-urgent) patients is not a point of pride, it is a tragedy waiting to happen. Any nurse who thinks she/he can safely handle that many acute patients has simply never had their gastric bleed, septic grandma, wheezing kid go south in a hurry, let alone having all three crash at the same time - while you have six other patients to watch/treat. ERs that put nurses in that position are unsafe and nurses who put up with that load are courting disaster.
Aug 8, '08Specialty: Emergency Department ; From: GA, US ; Joined: Feb '07; Posts: 80; Likes: 42Everyone seems so shocked that ER nurses can have this type of ratio, but unfortunately I think happens more than you think. While 15 patients is waaay to many for a new grad or even an experienced ER nurse, 7-8 patients is not uncommon in some large ERs. The level one ER I work in has typical ratios of 1:7, with 2-3 usually being monitored rooms and the rest being hall spots. Critical care rooms are typically 1:4 and trauma is 1:2. Yes, it is not safe and it is very stressful, but it isn't unusual in large hospitals.
Aug 10, '08Joined: Oct '00; Posts: 8,772; Likes: 8,530Absolutely no way I would take 8 ER patients. No way.
Aug 10, '08Joined: Nov '07; Posts: 487; Likes: 581I guess I can't complain much then. We are assigned 3 patients at our 65 bed ER and are expected to help the team whenever possible. I can't imagine working in conditions some posters have remarked about. Maybe being a Magnet Hospital helps and the hospitals philosophy about customer service truly does work to the nurses benefit? We don't get hall beds, nor to we get patients that have been admitted for hours down in the ER boarding as the saying goes.) I work at a 900 bed Level II trauma center, rural hospital rated in the top 100 in the country consistently over the past 7 years, maybe even longer than that. I can't imagine being a patient at these hospitals posters are talking about. One has to wonder what kind of care you get when you do not see your RN but a few minutes in an 8 hour period. Amazing!
Aug 10, '08Joined: Aug '05; Posts: 17,042; Likes: 14,635Our nurse to patient ratio is 1:5, with a tech who covers the ER, but we're just a 15-bed freestanding ER. We very rarely have hall beds (when we do, it's more like "put the wrist injury on a chair over against the wall there"), or admission holds. Our holds go over to our main hospital's ER ... we hate to do that to the other ER, but we don't have the resources of an entire hospital; we're it.
We're Magnet, too.
There is no way I would want more than my 5 beds, especially as a newbie! I know my limitations.
Aug 10, '08Occupation: Emergency RN Specialty: 10 year(s) of experience in Emergency nursing ; Joined: Nov '06; Posts: 306; Likes: 115OMG! I'd DIE if I had to take care of 7-8 patients. The most we can get is 4 , but even 3 patients are hard to keep up when you're dealing with the really sick ones. God bless every ER nurse that has to take care of that many patients:icon_hug:.
Aug 10, '08Occupation: Emergency Department Specialty: Neuroscience, ED ; Joined: Jun '08; Posts: 70; Likes: 80It doesn't sound like your hospital does a very good job staffing (to say the least) if you have about the same amount of nurses with half the volume of patients at night. I would be very concerned about filling up rooms with non-urgent patients and having critical patients in the hallway.
Like most of the other posters, our ratio in the ER is one nurse = four rooms. I think your hospital is actually in violation of standards and that is not somewhere I would ever care to work.
Obviously an important question for anyone to ask when interviewing for a job in the ER (or anywhere) is: what is the ratio?
Also, shadowing for both a day shift and night shift will give you information no one can tell or (or what they don't want to tell you).
I did both and what they told me was accurate, so I accepted the position. Also, other nurses in my ER, even if they are busy, will help new grads with patients if they need it (for the patient's sake!!!)
Aug 10, '08Joined: Oct '06; Posts: 2,604; Likes: 3,897That is NUTS having 15 patients in an er. The max in the ER I work in is 4, you can take more if you want, but cannot be given anymore by the charge nurse if you already have 4 unless you are willing.
Aug 13, '08Occupation: Emergency Department Specialty: ER/Ortho-Neuro-Med-Surg ; From: US ; Joined: Sep '04; Posts: 11,171; Likes: 3,262On our "acute" side (non-Fast Track), we typically have 2 RNs + 1 Tech per 5 rooms. Of course, if you add the "hall beds", it rounds up to 8 spots per 2 RNs. Meaning, roughly a 4:1 ratio.
Of course, we are also a super busy Level II center (370 in pt. beds. Counting Track, we have 55 ED beds). It's not unusual to see volumes of over 300 pts/day on average (and it isn't even the "busy season" yet!)
There have been times when we've gotten slammed and I've taken care of 6-7 pts. But that was just for the pinch. I've been a nurse for a while now and still I find it overwhelming.
15 pts. is unacceptable. Like someone else pointed out - it's a disaster waiting to happen.
I can't imagine being a new grad in that spot.
Wow. Just wow...