Unsafe assignments in the ED

[LeahJet, ASN, RN]

Just curious..... do you ever (on a regular basis) have to have more than 4 rooms in your ED? If so, how many?

I have worked in many ED's all over the country and they would close rooms before a nurse would have to take more than 4.

The place I work now...it's not unusual to have 6.

Would appreciate your input. Thanks.

[adrenalinjunkie]

We have 9 rooms in our small er, however at night from 2300-0700 there is only 1 nurse. We frequently have up to 6 or 7 patients at a time. I quess we just get use to it. Occasionally the nursing supervisor will come and help out if possible.

[jojotoo, RN]

Our staff are routinely out of 1:4 ratio. And we have a LAW in Calif. to back up those ratios. AND, our RNs are unionized! A shift rarely goes by that the staff aren't out of ratio for at least several hours.

[LeahJet, ASN, RN]

I quess we just get use to it.

But I'm not sure if getting used to it is such a good idea.

Unsafe is unsafe....whether you are used to it or not.

[traumaRUs, MSN, APRN]

Just curious - when you close the rooms, are the patients diverted to another hospital or just left to wait in the waiting room?

[LeahJet, ASN, RN]

Just curious - when you close the rooms, are the patients diverted to another hospital or just left to wait in the waiting room?

On the rare occasion that the shift just could not be staffed adequately, rooms were closed and wait times were probably increased. But it felt good to work at facilities that actually valued and cared about their employees.

[Spacklehead, MSN, NP]

Our initial starting assignment for 1900 - 0700 shift was 6 rooms. Sometimes we would have more added after 2300.

[Lurksalot, BSN, RN]

So fr I am pretty impressed with my ER. We self-assign, that is, triage places the patient info in bins labeled 1 thru 5, and the RNs then go over and take patients as we can. So, if I have a very heavy pt, say someone who coded, I might only have that patient. But if my code stabilises and I am under control, I can go over to the bin and pull out a 4 or 5 if I think I can handle it in addition to my code patient. It seems like everyone works together, and nurses see the triaged patients waiting and try to shuffle them in ASAP. I have yet to see the charge nurse have to "assign" a patient to anyone who was not willing. Sometimes the charge nurse will see a "1" on the triaged bin, and will grab it and start it, and then find another RN who can take it.

I heard horror stories about my ED before I came here, but in my limited experience so far it seems to work pretty well.

[RoxanRN]

Our ER (Level I Trauma - 18 beds in addition to 5 trauma bays) staffs based on historical data. The shifts generally start with 5-7 nurses. One or two are added at 0900, 1100 and 1500 (all 12 hours shifts). 'Additional duty' is assigned to a few nurses - 1 assists with traumas when they come in, 1 works in 'Fast Track' when it is open (generally 2300-0500 weekdays and 0900-whenever weekends) and 1 does triage (they are never involved in patient care after the initial triage).

Here, when a patient is triaged, their chart is racked. A nurse will place the patient in an appropiate room as soon as one becomes available according to the severity of illness and arrival (a CP arriving at 2030 will get in before a broken arm with no deficits who arrived at 1830). The nurses self-assign and are expected to do their best to keep the assignments even. Each generally cares for their own, but 1-2 others may get involved (completing MD orders, etc) if the primary is tied up with a serious patient.

[LeahJet, ASN, RN]

I am really impressed with the self assignments in larger ER's. When I worked in small ER's, we did this.

To be honest, I'm not sure it would work where I am. Out of so many nurses, we only have a couple of slow/lazy ones....but man, if they both worked on the same shift, it may get bad!

[andhow5, BSN, RN]

Where I am now (and tonight is my last shift there), the "normal" is usually 4-6 rooms (all monitored). However, there was a very LONG period of time where I'd routinely get 8-12 rooms (all monitored - 2 of which were trauma/code bays).

I'm going back to my previous ER, and the assignment there varies on acuity. Acute is 3, sub-acute is 4, and fast track is 7. We also get floated to our ER 24 hour obs tele unit (staffed only by ER staff) where you'll get 4 (small unit).

[LeahJet, ASN, RN]

Where I am now (and tonight is my last shift there), the "normal" is usually 4-6 rooms (all monitored). However, there was a very LONG period of time where I'd routinely get 8-12 rooms (all monitored - 2 of which were trauma/code bays).

I'm going back to my previous ER, and the assignment there varies on acuity. Acute is 3, sub-acute is 4, and fast track is 7. We also get floated to our ER 24 hour obs tele unit (staffed only by ER staff) where you'll get 4 (small unit).

Sounds like you made a good move!