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

[Lunah, MSN, RN]

You are not usually medicating with things like insulin and heparin at a freestanding ER..... You transfer out. That's how. Narc is completed at shift change with two nurses. You need to be strong to be able to manage and not freak out but I never said it was safe.

Not the freestanding ED where I worked — those meds can be part of stabilization. But I have come to realize that my freestanding ED was kind of a unicorn among horses.

[chivon101]

Not the freestanding ED where I worked — those meds can be part of stabilization. But I have come to realize that my freestanding ED was kind of a unicorn among horses.[/

I not saying you can't give those medications. You said how can you give those medications with only one nurse when you need a dual sign off. I'm saying you don't, you give the basic ASA mg for chest pain then transfer out. Anyone that needs medication requiring a dual sign off should be transferred out anyway.

[Lunah, MSN, RN]

I not saying you can't give those medications. You said how can you give those medications with only one nurse when you need a dual sign off. I'm saying you don't, you give the basic ASA mg for chest pain then transfer out. Anyone that needs medication requiring a dual sign off should be transferred out anyway.

I worked in a freestanding ED that couldn't transfer without a bed assignment, which meant holding ICU patients, tele patients, you name it. That was were I first became proficient in dealing with vents, drips, etc. Not a typical freestanding ED — we had CT, x-ray, and ultrasound 24x7, but no RT or pharmacy. We developed very strong teamwork and multiple skills because we were it — there was no one else to call when you couldn't get that tough stick. I felt like that experience prepared me in part for what I experienced while deployed as the ER nurse with a Forward Surgical Team (FST) in the middle of nowhere! :) Like I said, probably not a typical freestanding ED, but it's the only one I have worked in. We did a lot beyond ASA and transfer, though we did try to get our transfers out as soon as possible. Usually the only time we did ER to ER transfers was with surgical patients or those needing an emergent MRI. It was interesting!

[chivon101]

I worked in a freestanding ED that couldn't transfer without a bed assignment, which meant holding ICU patients, tele patients, you name it. That was were I first became proficient in dealing with vents, drips, etc. Not a typical freestanding ED — we had CT, x-ray, and ultrasound 24x7, but no RT or pharmacy. We developed very strong teamwork and multiple skills because we were it — there was no one else to call when you couldn't get that tough stick. I felt like that experience prepared me in part for what I experienced while deployed as the ER nurse with a Forward Surgical Team (FST) in the middle of nowhere! :) Like I said, probably not a typical freestanding ED, but it's the only one I have worked in. We did a lot beyond ASA and transfer, though we did try to get our transfers out as soon as possible. Usually the only time we did ER to ER transfers was with surgical patients or those needing an emergent MRI. It was interesting!

Sounds interesting and extremely unsafe. So no, this is not a typical freestanding ER. So my comments are meant for typical free standing ER that always transfer out to a facility that is equipped to care for patients requiring a higher level of care. I've never heard of situations where you can't transfer out, at least to the ED unless they are on divert. County level 1 facilities in which Ive worked, accepted everything. Even if no impatient beds they were still sent to an ER with more resources and specialist who could still see them while in the ED. That seems to be skating a little too close to an EMTALA violation.

[Lunah, MSN, RN]

Our on-call specialists would come to our freestanding ED when the census was high and pts couldn't be transferred immediately. I suspect the difference with this ED is that it is affiliated with a hospital system and so pts who were sent out by ambulance to our primary hospital were actually considered to be admissions and not transfers. Weird set-up, I suppose, but the hospital system has a few of these types of EDs. They are frankly as capable or more capable than some of the community hospitals I have experienced! Definitely not a trauma center, though. Lol.

[TLSpaz, ASN, RN]

Sheez... management!

I side with the ENA, who supports a position that a charge nurse and triage nurse should not be counted in staffing. In a perfect world!

THIS! Most nights in the ER where I work, the Charge Nurse doubles as the triage nurse after 0100 or 0300 depending on when the last mid-shifter leaves. That leaves two RNs to work the floor. We are a small ER, but we aren't THAT small. We waste a lot of anxiety worrying about what we will do if SHTF.