Emergency room RN minimums in Texas

[starsky3501]

I can't seem to post this any where else. I am trying to get my hands on some state minimum requirements in the state of Texas for the number of RN's working in the ER. Everything I have ever heard is that there is a state mandate minimum of 2. Can anyone point me in the right direction that provides documented proof of this?

Thanks.

Starsky

[Altra, BSN, RN]

If your facility has recently been surveyed, you should have a contact for further questions/clarification. Send them written communication, email or actual letter, requesting direction regarding the regulation.

Poor labor relations never benefits anyone, least of all patients. Here's hoping you can work constructively with emergency department RNs at your hospital to address concerns regarding productivity, patient safety, and compliance with state and other regulatory requirements.

[wyosamRN]

If these nurses are on 12s, are you making some provision for them to have time to eat, or just chalking that up to more wasted time? I suspect you are going to be very popular here. 2 is a common sense minimum, based on requirements for double verification. Most facilities (and probably the inspectors you mentioned) require independent verification of many medications by two RN's. That becomes difficult to maintain if a nurse has to come from another part of the facility (where they are also probably minimally staffed). But by all means, figure out exactly how you can meet the absolute minimums in terms of staffing, then also be sure to complain to the staff that they aren't meeting patient satisfaction goals. Sounds like an awesome place to work.

[psu_213, BSN, RN]

Most facilities (and probably the inspectors you mentioned) require independent verification of many medications by two RN's.

I had forgotten about this. In my ED, I can't think of any medications that require a "double check;" however, with some meds it is nice to have another set of eye to make sure I have programmed the pump correctly, drawn up the right type/dose of insulin, etc.

Blood, however, takes independent verification in every institution.

[Esme12, ASN, BSN, RN]

That is correct, the state surveyors are the ones that said the hospital should have a minimum of two - which we actually have 3 but are planning to go down to two. There was no write up but they couldn't point me to anything that said two. Naturally every time you drop the number of scheduled RN's they start losing their mind. So if the state surveyor says two I want to be able to point to the documentation that says two when my RN's are losing their freaking mind. They are used to having three so they have facebook and texting time and now they actually have to do more work. Sheez... nurses! haha

Are you a nurse?

You are right Texas has no real staffing minimums. Your facility should have a staffing plan that reflects your staffing pattern. What the surveyors were saying for your patient population/census you need 2 nurses to safely practice and care for patients. There are times 2 nurses are necessary to verify a drug, like insulin, heparin or blood. If one nurse needs to accompany the patient to CT scan you cannot leave the patients unattended without a RN or if there are two simultaneous codes you must have 2 RN's available. who do you have assigned on nights to do watches? I would also consider non licensed personnel for other tasks like transporting the patient to and from radiology or the floor when the patient is not monitored.

If the RN's are facebooking and texting as a former manger/director of an ED I suggest that you as the apparent manager/director to appropriately manage your staff. It is important to remember that there is some down time in some emergency departments it is the responsibility of the manager to see that it is used in the most effective manner.

[TheCommuter, BSN, RN]

That is correct, the state surveyors are the ones that said the hospital should have a minimum of two - which we actually have 3 but are planning to go down to two. There was no write up but they couldn't point me to anything that said two.

The state surveyors who stated that the hospital should have a minimum of two nurses in the emergency department should be able to produce documentation, in writing, of this regulation (if it really is a regulation). However, state surveyors sometimes pull official-sounding information out of their butts without anything to support their statements.

I assume this is a smallish critical access hospital in a small town or rural area with an ER that doesn't see much traffic.

[360jRN]

Is browsing allnurses considered wasting time?

[TheCommuter, BSN, RN]

Is browsing allnurses considered wasting time?

I wouldn't think that browsing Allnurses is a waste of time. Then again, my opinion is biased toward Allnurses.

[psu_213, BSN, RN]

What the surveyors were saying for your patient population/census you need 2 nurses to safely practice and care for patients.

Watch out! We are straying into the land of ratios.

[OldDude]

No or No and/or No.

[NurseOnAMotorcycle, ASN, RN]

That is correct, the state surveyors are the ones that said the hospital should have a minimum of two - which we actually have 3 but are planning to go down to two. There was no write up but they couldn't point me to anything that said two. Naturally every time you drop the number of scheduled RN's they start losing their mind. So if the state surveyor says two I want to be able to point to the documentation that says two when my RN's are losing their freaking mind. They are used to having three so they have facebook and texting time and now they actually have to do more work. Sheez... nurses! haha

I personally think it's a fantastic and wonderful idea to go onto a site with almost a million nurses and tell them about how unreasonable, stupid and lazy they are. I think you should amplify your returns by also going onto a site for police and telling them how all they do is eat donuts and oink.

I continue to be impressed and amazed about your sagacity in laughing at them. You are clearly a wonderful and caring administrator who puts patient safety above the bottom line.

I can't wait to some day be a patient at your hospital with only 2 nurses knowing I am safely in the hands of continuously diminishing number of trained and monitored personnel to take care of my ability to breathe.

And by the way: they are not your nurses, jerk.

[OBigdog26, MSN, RN, NP]

^sarcastic much

Sent from my iPhone using allnurses

[Nonyvole, BSN, RN]

Can't offer written proof, but it's common sense to have at least two nurses in an ER at all times.

Unless you're not down with patient safety, proper medication wasting (can't see a doctor willing to sign into the Pyxis just so that they can witness a nurse wasting the remnants of a narcotic), proper medication administration (insulin and blood both require a co-signer for administration at my facility), or keeping staff at your facility.

You can also look up what the accreditation agency for your facility says. Same with the federal government. Just because the State of Texas doesn't have anything written doesn't mean that there aren't numbers somewhere.

And have you asked the nurses why they object to dropping to two nurses? I highly doubt that it's because they'd be losing time for texting and Facebook...