ER downward spiral

[canoehead, BSN, RN]

We've lost about 75% of our experienced RNs, so most have less than 5 years experience. They work hard, but they just don't have the experience. Now we're having shifts with no charge nurse (no experienced nurses means no one has charge experience). We have 80-90% of our beds filled with admissions, and run the ER out of the rest of the department, with difficulty. Charge is in charge of unit flow, who can go where, and negotiating with the floors and EHS about taking patients. If we don't have a charge nurse on it, we get a huge clog.

There have been a few shifts I've worked with no charge nurse, and no flow. If I can take a patient I do, but waits are way too long for safety. Calling up the chain of command hasn't brought any results, other than "good luck." They are nothing if not consistent. whose *** is on the line if someone dies in the waiting room? the triage nurse? But what if she's holding a few criticals already, she can't do triage AND have an assignment sitting in chairs.

How can we go on like this? we are expected to give quality care to admitted patients, as if they are on the floor, but there are no windows, no phones, no tvs, nothing to distract folks, no common room, and no safe time to walk in the halls without being run over. Critical ER folks need immediate attention. PT wants to chat about an admitted patient's ability to walk (I don't care if my other patient is critical) and the docs pull easy patients out of the waiting room, then stroll the desk like hookers looking for a date willing to give meds and discharge. I don't want my name on the chart of a patient I don't know! Certainly don't want to do that 3-4 times a shift.

This is a vent thread. I know I'm crusty, but right now its me or no one in this ER.
 

[JKL33]

Sorry to hear this.

I am past the point where I would be willing to operate in a situation like that, despite always having loved taking care of ED patients.

This is utter non-sense.

I know you didn't ask for advice, but if you intend to keep throwing energy at this for now, just prioritize carefully and appropriately. I'm sure you are good at knowing sick from not-sick, and real emergencies from fake emergencies. Make sure you're putting your energy on the right priorities. Eg. PT is not a priority....and many others. That's what happens when this list of responsibilities gets too long; it is reality and if admins don't like it they always have the option of making it not necessary.

Hang in there ~

[canoehead, BSN, RN]

I quit last night, wrote my resignation letter and sent it. This past week we boarded 30 admits in a 25 bed ER. Last night I had five patients, then an ambulance patched in with a presumed stroke, GCS 6, and they wanted me to take that person too. I’m not doing it any more.

[canoehead, BSN, RN]

Since my manager got my resignation letter she wants a meeting tomorrow to “address some issues.” Hopefully they can’t fire me for insubordination after I resign. That would cut off a lot of other potential jobs locally.

Heard from a coworker that the y were holding thirty admitted patients in our 25 bed ER a day last week, and still running ER patients in and out of chairs in the hallway. My last shift we had no spot for someone to pee in private so we borrowed a room in radiology. Reluctantly though because these emergent spaces we come up with have historically become real once admin finds out. 

[CrunchRN, ADN, RN]

What a mess. You did the only thing you could do. Hopefully this will make them see change is needed.

[Adam D., ASN, RN]

As a newer nurse, just a year of experience, its sad to hear so many with so much knowledge and experience are leaving. I remember one day, about two months off orientation I was sitting on a step stool in the med room and one of the older ED nurses, with about as much experience as you asked me what was wrong. I told her I feel like a horrible nurse, and I hate leaving the admitted patients waiting sometimes hours before I'm able to get to them. I knew it was going to be hard but I genuinely feel like I'm doing a bad job when I come in and the patient has been sitting in their own filth for the better part of an hour.

I felt like I just wanted to disappear into the floor I felt so defeated that day. She said the past few years have been the worst of her entire career, and left the ED to work per diem and urgent care. The last straw for her was when the hospital made all the ED nurses sign a pledge that they would complete a full head to toe assessment and offer bed baths for all admitted patients, otherwise they couldn't come back to work until signing it. I left three months earlier than planned, exactly at 1 year. Still staying in ED but not at that *** place.

[canoehead, BSN, RN]

Since my last post my administration has reported me to the Board three times, two were dismissed without investigation, still waiting for word on the third. Locally I've been blackballed, would get a great interview, or even get the job, but once the my former employer made contact with my soon to be, the job would disappear. I worked at a coffee shop for a while just to decompress and make the mortgage. Right now I'm a travelling nurse while all this crap gets sorted. I said in my resignation letter that the ER was becoming unsafe, as my reason for leaving, and apparently someone needs to squash that rumor. There were NO disciplinary issues until I resigned.