ER nurses please help!

I am a new grad working in the ER

congratulations and welcome. :)

How many patients do you usually take care of at one time?

it depends. if i have simple things like toothaches, colds/flu type stuff, i may have 5-7 patients. however, my limit is 10. i won't take more than that. if i have MIs or respiratory distress, i may have 1 or 2.

Do they turn over fast?

the "fast tracker's" go relatively quickly. but again, it depends on what else we have going on in the ED at the time and if a doc is available to see them quickly.

Is it common for almost all of your patients to be there all night?

no, this is not common for all of our patients to be in the ED all night. we will sometimes have an ICU patient that we will hold if the ICU is full but expecting a discharge in the a.m. Other than that a normal stay for us is about 4 hours.

If you are not working in the trauma room/area (or what we call resucitation room), are you responsible for notifications on top of your regular patient load?

sorry, i don't work at a level I so i can offer no assistance here.

Do most of your patients get admitted? Do many go home?

again, it depends. some nights i end up with mostly fast track stuff. some nights (like wednesday :chuckle) all but 6 of my patients were admitted. 3 of those 6 were transferred out to either childrens hospital or the cardiac cath unit in the city. overall, i would say the majority of my patients go home.

I work in a 46 bed level 2 trauma center. On average I will have 3-5 patients, depending on the acuity. I would say 50-75% of our patients are admitted. Depending on the doctor, our average stay in the er is 4 hours can be longer if the hospital is full, or we have a pokey MD! Lately we have had overnight guests more than ususal. When traumas come in we deal with them with the rest of our patients, the charge nurse trys to get the nurse with the "lightest" load the trauma and the rest of us pick up the Trauma Nurse's other patients. The majority of our traumas come from out of the county and Eastern New Mexico so we usually have a decent ETA to get prepared. The level 1 trauma center is right across the street and all the traumas that occur in city limits go there,.....unless the patient requests us, or we have a "honk and drop" at the back door with a GSW. Good luck....and stay on orientation as long as possible, that is the best way to learn.

Number of patients: Pt numbers very according to acuity, our ER has three critical care rooms where it's one nurse to two pts (all codes, acute MIs, unstable pts go here), there are three other areas on our critical care side where it's typically two nurses working together for 5-9 pts, again depending on acuity. Our intermediate care area is one nurse for 4-5 pts. Realistically though, more often than not we also have hallway pts and this increases each areas pt load by 1-3 pts.

Turnover: depends a lot on which docs and nurses are working, as well as how backed up the bed situation is in the rest of the hospital; if there's no where for pts to go, things get clogged up pretty quickly. Once a pt is admitted, we hold them anywhere from 15 minutes to several hours waiting on a bed. Our busy season is winter and I've seen pts stay in the ER over 24 hrs on occasion.

Traumas: We have a trauma team- there are two nurses from the team assigned for trauma alerts each shift. One nurse works as a float until a trauma is called- she then assumes primary care of the trauma pt. The second trauma nurse works in one of the lesser acuity areas with another nurse, when a trauma is called, this nurse leaves her assignment to assist with the trauma, and then returns to her area when the trauma is somewhat stabilized.

Admissions: We admit everyone, LOL, that's what it seems like! We have a fastrack area separated from the ER, so we don't really see the minor complaints in the main ER.

i have worked in some really bad er's and some great ones

here are some stats on the great ones

generally never more than 4 or 5 patients - even when i had trauma side i would carry 5 patients

more patients now are being admitted than ever (older,sicker etc...)

i would say on a normal day at least 50% of my patient load is admitted

the others have a fast turnover rate if the nurses are using the protocols and doing their jobs (ex. ordering labs, starting iv's, urine testing etc...) some nurses are better at this than others...

hope this helped - all i can tell you is it will get easier and better w/ experience - you will learn how to prioritize and how to read your patients - be patient