ER nurses advice

suebird3 · Jul 16, 2006

welcome to allnurses.com! i moved your post to the er forum for more responses.

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[color=#708090]suebird

Larry77, RN · Jul 17, 2006

Wouldn't each interaction with the Pt by another nurse be charted under their name? If so I don't see how you being the "assigned" nurse would hold you liable for actions taken by other nurses. While we do not have complete computer charting in our ED (yet...is on our floors for years now), we often pick up the charts of other nurses, giving meds, dc'ing etc. We are required to sign for anything that we do with a Pt and therefor are liable.

zima60 · Jul 17, 2006

We do "zones" where each nurse is assigned rooms. BUT-all available nurses will help when critical patients arrive. One does the IV and lab, one the EKG and place pt on monitor and primary nurse gets history and charts. We may assist with giving meds but always tell the primary (and sign our initials on the chart order) She would then chart "cardiazem given by..." It works well in our group. Communication is the key.

JMBM · Jul 17, 2006

In our facility, teams of 2-3 care for 5-12 patients. Occasionally floats chip in and when one section is hammered, nurses from other sections will informally float over to help out, too. We do computer-sign in as primary on a patient, but each entry is under the name of the nurse performing the task. Yes, one nurse might assess the patient, another gives meds and a third discharges him. The methods has been roughly the same at other facilities I've worked in. Its hard to imagine any other way that would work, given the extremely rapid pace at which patient loads, acuities, and emergencies arise and change. If my two epigastric pains and a migraine patient turn out to be two cardiac cases and an intracranial bleed, I can't imagine my partner, who has three diarrhea cases getting fluids, sitting while I drown.

tridil2000, MSN, RN · Jul 17, 2006

I work in a Level 1 trauma ER, does anyone else work in an ER that has a team approach? Where there may be 4 nurses to 10 pts, and all the nurses take care of the pts. Even though you may be the primary nurse, other nurses are involved in their care as well. I am new to this type of nursing and haved worked in the ER for 10 years at other places where the nursing care was given by 1 nurse to a group of pts. I did not realize how much this would bother me in a new facility, but it bothers me ALOT! What is the legal ramications to this type of care? Sometimes you may be the primary nurse, and never lay eyes on that pt because someone else may have given the medications, and then later someone else has discharged them. Since it is computer charting, once you sign up for a pt your name will be listed as the primary nurse on that chart. I work in a University Hospital that is very legally conscientious, they review the charts for errors, but continue to allow this type of nursing. What is your opinion about this and has anyone had to deal with this type of nursing?

i worked at a hospital once through agency and this was how they did it. i relaly did not like it. sometimes someone has given a med and didn't sign it off.... so i always had to ask around if someone did it. with narcs, it was a REAL pia! i wasted more time asking if something was done or not.

another thing was the pt would ask me about something that the other nurse did and i'd have no idea what to say. i then had to 'bug' that nurse to go back bc they have a question.

docs don't do this. it is unsafe imo, and nurses shouldn't either.

joint commission should come down on this in their 'communication' criteria.

TazziRN, RN · Jul 18, 2006

I work in a rural ER, 6 beds, with two RNs and a tech on at a time. If we're lucky on busy days we'll have a third nurse. Team approach is how we do it because we don't have assignments: whoever is free does the triage, and when there is an order the first free nurse carries it out. One of us is the primary nurse but we help each other out.

crosstanya · Jul 24, 2006

i worked at a hospital once through agency and this was how they did it. i relaly did not like it. sometimes someone has given a med and didn't sign it off.... so i always had to ask around if someone did it. with narcs, it was a REAL pia! i wasted more time asking if something was done or not.
another thing was the pt would ask me about something that the other nurse did and i'd have no idea what to say. i then had to 'bug' that nurse to go back bc they have a question.
docs don't do this. it is unsafe imo, and nurses shouldn't either.
joint commission should come down on this in their 'communication' criteria.

I totally agree! This is unsafe and waste a lot of time. I prefer having my own patients and to ask for help doing a specific task or giving a med when I have too much going on. I also don't like to discharge someone else's patient. Patients always end up asking you something and you have to go back to the primary nurse to get more info.

You need a good charge nurse that can assign patients in such a manner that one person is not overwhelmed and someone else is sitting. Also, if you have good team work you will never have to ask for help when you get eg. a chest pain or a gunshot wound.

soliant12 · Jul 24, 2006

I worked at an ER near Reno and everyone pitched and implemented the pysicians orders if there was an order on any patient whoever was avalable just did it. It worked great patients were in and out in a jiffy and everyone was happy no one was overwhelmed and everyone lended a hand. Best ER I ever worked in. If it was a critical patient the nurse was assigned to the patient and that was his/her focus and if they needed something whoever was available pitched in.

I work in a Level 1 trauma ER, does anyone else work in an ER that has a team approach? Where there may be 4 nurses to 10 pts, and all the nurses take care of the pts. Even though you may be the primary nurse, other nurses are involved in their care as well. I am new to this type of nursing and haved worked in the ER for 10 years at other places where the nursing care was given by 1 nurse to a group of pts. I did not realize how much this would bother me in a new facility, but it bothers me ALOT! What is the legal ramications to this type of care? Sometimes you may be the primary nurse, and never lay eyes on that pt because someone else may have given the medications, and then later someone else has discharged them. Since it is computer charting, once you sign up for a pt your name will be listed as the primary nurse on that chart. I work in a University Hospital that is very legally conscientious, they review the charts for errors, but continue to allow this type of nursing. What is your opinion about this and has anyone had to deal with this type of nursing?

nuangel1, BSN, RN · Jul 24, 2006

i have also worked in ER with computer charting .again yes i was assigned nurse but other nurse would help like with iv.meds or d/c .in that case the nurse documents under his/her name .so i didn't worry about liability with that.in that er we were assigned pts as they came in not by a set of room numbers like 1-4.i have also worked and work in ER now that each nurse has a set room assignment .for ex 1234.as each pt comes in the charge nurse assigns the pt to the beds available.but we help eachother out one does vitals ,one does iv and labs ,someone charts on paper etc .yes we also sometimes d/c eachothers pt's to help with flow of dept. also we cover eachother for breaks and document in our own names anything we have done.my own preference is to get the ps assigned to random rooms based on acuity not on set room assigments.but either way there is always going to be a heavier assignment because pt's acuity changes and unforseen things occur.

dfk, RN, CRNA · Jul 30, 2006

i too worked in a level I with a team approach (2 RNs to each section)... this was coming from a level II with just primary nursing.. i have to say that the team approach was by and far much better IMO, and realized that things got done more promptly and i found myself not going home AS exhausted as previous..

no ONE approach will work for everyone, that's for sure !

jos11 · Jul 30, 2006

a team approach should always welcomed