ER nurses advice

[RNCCRN]

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?

[ern91]

After 14 years at a Level 1 trauma center in a major medical center I went to a "slower paced"community hospital. At the trauma center was the team approach. Up to 50 pts with 4 nurses and 2 cnas.Sometimes there was an extra nurse who did the admissions and discharges but that nurse couldn't do all of them so the other 4 helped with that as well as pt care. This was also a teaching facility so we had the added responsibilty of making sure the residents did no harm. Thter was never a limit to how many pts would be in this area. If the acuity warranted it, they were brought straight to the pt care area after triage. The trauma and critcal medicine were also sqeezed in after stabilization in major rooms. There was no primary nurse, we all took care of all the patients . I did this straight out of school as a gn I might add. Pt's stretchers were touching, no curtains that worked, males and females side by side in a huge ward called The Holding Area. I can remember pulling pt's stretchers out into the main corridor so I could get to the bedside to do pt care.I just THOUGHT I got my butt kicked . Now I have 4 patients at the community hospital and I am the primary nurse with 1 tech for 17 rooms. I do everything myself for my 4 pts from start to finish and i come home more frustrated and tired than I did many nights when the team took care of those 50 pts.There are many different ways to make this type of nursing safe. I'm sure other nurses in this facility can help you with that. I never saw a nurse get into trouble that used good nursing judgement, critical thinking skills and followed all the policies and procedures.The nurses I knew over the years that got into major trouble ,whether it be legally or with the facility would have gotten into trouble anywhere because they just did the wrong thing, no matter what.

I wish you much luck. Send me a pvt email anytime, RNCCRN

[nursemoons14]

I worked in a relatively small Emerg where this was in effect but i can't imagine it at a large trauma centre. I didn't realize how unsafe it was until I came to a hospital where you actually do your assignment and help out here and there when needed. Im glad i got out of that type of care when I did, you really have to trust who your working with, which i didn't and i was a new grad

[SDS_RN, RN]

We are not using computerized charting yet but we will be in May and from what I understand of it if you do something in that patients room you will sign in your ID and chart on what you did. It is then documented as to who does what. We also do not assign patients who ever is available takes who comes in the door and we usually tag team and it works well for us. We are a huge team play facility and I guess I would prefer it that way.

[Mechi]

I have the same problem you have sometimes but even though you are the primary nurse ,any nurse who touch that patient should sign their name and the intervention with the time and signature if not you should add and addendum before you leave your shift explaining your care if the chart is closed and the patient discharge look for the name and you closed it with an addendum note .If not write an incident report to risk management explaining the care of the patient and anything that was wrong in his care if you did not have the responsability with the care .It will cover your license.Let your manager know the problem you are encountered with the charting computer situation ,they should fixed the problem I am sure many nurses are facing the same problem and the liability of the hospital is in jeopardy. Many managers does not face the daily routine problems as the staff you need to initiate alternatives for corrective action to help the departament to be more efficient in legal documentation ,Do not be scared to bring it in a meeting .It is your licence first.

[crb613, BSN, RN]

We have computer charting, & we work as a team. Each nurse charts what they do under their own name. When the pt is dced all that took care of that person signs the chart. I am new to the ER, & new to computer charting. We do not have assigned rooms, but take them as they come through the door.

I work with some really good nurses, and there is no such thing as just one person having a bad night! I cannot tell you how blessed I feel!!!!