So for the past 10 months I've worked in the ED of a level 1 trauma hospital. To say the very least we are an extremely busy ED. We've had 3 hospitals just in this town close within the last 2 years which of course means MORE PATIENTS. We went from seeing roughly 90K patients in the ED/year to about 110k (as of the last estimate)
I'm relatively new to the ER and I love it, but with only 10 months in I'm already feeling burned out and am looking foward to doing one more year here and them I'm out. Not to mention the nurse turnover rate for this department is high.
It's the sheer volume of patients. It's just too much I work 12 hours shift and last night was a horrid shift. At one point I had 11 patients, including an ICU patient and a slew of extensive abdominal pain workups, plus and ETOH patient that was driving me and my other 10 patients crazy.
Then I get a call from the med-surg nurse upstairs asking me why I sent her a patient that was soaking wet with urine and why we nurses in the ED like to send them dirty patients. I just confessed and told her that I was drowning in almost 10 patients, plus an ICU patient, and that the last time I checked that patient he was dry and clean. Not to mention we have no nurses' aides in our ED anymore, they took them away, so between me and the tech (who is swamped with EKG's and Vitals signs to do) I have to stop and help the little old lady's and gents to the bathroom, give pt's bedpans, and change dirty diapers, and linens, and yes somehow try to prevent my psych, ETOH, dementia patient from falling out the stretcher
Then I have the doctors from the floors asking me to repeat this lab, place that foley, give this medication. Ugh. This is a 500 bed hospital, and almost all of the time patients in the ER wait anywhere from a few minutes (hardly ever) to hours before they get a bed. Which means that I can hardly get to caring for them properly before a get another 3-4 patients within 60 minutes from triage.
I asked my charge if I could somehow be skipped over for just a bit from triage, so that I could catch up because I had atleast 1-2 more patients than ever other nurse in the ED last night. Not saying they had it easy, in fact I didn't get any relief because the nurse to my right had 2 ICU patients (plus 9 others) and the one to my left got slammed from triage 3 patients back to back.
I got NO break last night, I wasn't the only one either. I literally worked 12 hours straight with only half an hour break and I barely even got to sit down at all! Right now my head, feet, and back are throbbing.
I love being a nurse, but I find myself getting colder. People just use the ER so recklessly (already the hospital is losing money and closing units) They don't want to wait, been sitting there for 15 minutes, and bark at you for a blanket, pillow, and a dinner tray. Sometimes I feel so used and abused.
I know the doctors work hard too, but some of them barely help you, or see that you're swamped but still want to know when x,y, z is going to be done. One resident told me the attending was upset because a certain pt didn't have their foley in yet???? well HELLO! someone could've told me that it was ordered and I'm sorry that is last on my priority list, I have people vomiting, screaming in pain, etc.. ! The Med-Surg nurse can insert the foley when they go up to the room. Sometimes I wonder where they fit in, in this whole ''team work'' (healthcare TEAM) we're all supposed to be engaged in. Don't get me wrong we have some lovely doctors who will actually start that IV, or give the morphine to a patient doubling over in pain, but the rest of them and don't even get me started on the surgical or internal medicine residents
And you can forget management, they think everything can be done! They told us that we need to do hourly rounding in the ER! What?
And this is the least of my worries, I won't even go into other things we are subjected to. No wonder nurses come and go here.
Sometimes I wonder if management sees this? Do they understand how hard we work?
One resident told me the attending was upset because a certain pt didn't have their foley in yet????
Don't set that precedent, especially with a med student, intern, or resident. Next time explain to them if they want the foley in now they are more than capable of doing it themselves and then direct them to the supply closet. If that answer is not acceptable to them, then it is not that pressing and it can wait.
Management sees it but does not care. It is all about the bottom line.
Management doesn't get to decide funding for nursing staff. They are told a number, and they have to hire based on that. If you want someone to improve staffing, it's gotta come from the CEO of the organization (if local, then him/her....if a corporation, the head cheese at HQ).
Absolutely incredible. You would have been busy as heck with half that load. When I'm overwhelmed I just say "I'll put it on my list," and do it when I can. I'm happy to have anyone ask about the way I prioritize. Two hands, two feet, and so long as everyone lives through the shift it's been a good day.
I rarely say this, but I would not stay in that job. Your license, health and livelihood are on the line.
Yeah ER nurses get such a bad rap, I'm not saying other nurses don't work hard, but we don't get capped, I've came on shift with 14 patients
I simply cannot believe having that many patients assigned to you, unless they were all fast track acuity 4 or 5. Seriously.
What kind of patients are these and WHY are you accepting care for these patients? Why aren't you sticking up for yourself at the very start? Tell your charge it's unsafe and you CANNOT have that many patients, period. Have them call the house sup, your manager, whomever...
I totally feel for you. I work in a level 2 ER, and I can totally see this happening. We do about 40-50k patient a year and I have had up to 10 patients during a shift including critical ICU patients. Typically however we have No less then 4 patients and a average of 5-6 at a time. and I CANNOT STAND when your getting your a** kicked and you try to get rid of a patient to a floor who has not taken anyone ll shift and you get the old lines "my charge nurse is on the phone call back" "the nurse is on lunch call back" (lunch? I wish I could EVER say, Im on lunch come back later), "we are having a floor meeting, call back", "its been so busy here, can you call back in a hour" (sure I will just tell the ambulances to stop coming because I already have 10 patients)
or the myriad of other infinite floor excuses.
The floors need to realize that we are ground zero in the Hospital, and can have unlimited amount of patients that we cant turn away and its not our fault. Please stop getting mad at us that these patients exist and need to come to your floor. I think the Icing on the cake though (and this will be my last rant) is now in my hospital we have admission nurses,admission secretaries and a throughput coordinator. SO, when the patient comes to the floor, the admission is done for the floor nurses and ALL the orders are frequently picked up by the secretary for the charge nurse, so all the floor nurse needs to do is vital and assess the patient. Usually not even daily meds because if we dont do every daily med before the patient comes up the floor will cry
so sorry to hear of your daily dilemma, but for your own sake and your family, you cant run fast enough. there have been numerous studies that show how daily stress affects us negatively and physically. until nurses start standing up for them selves and stop allowing others to contribute to their workload as unsafe as it is, they will continue to abuse us in this fashion, nevermind the legal ramifications of such unsafe conditions! .....there are too many positions for nurses not to be able to pick and choose for our own satisfaction and needs.....get going...and pass the word.....
I had a night mare of a shift recently and might start my own thread. I work med-surg and I don't know what to tell you. Many shifts i run around non stop without peeing or even drinking any thing for 12 hours. seriously. here comes a bad uti....... its not always the short end of the stick in regard to assignments, sometimes everyone is as busy as I am. There are times i just want to start crying and i never cry. So that actualyl worries me when i feel tears come on. and drs on the phone. and everything is a priority to that patient and his/her doctor
I totally feel for you. I work in a level 2 ER, and I can totally see this happening. We do about 40-50k patient a year and I have had up to 10 patients during a shift including critical ICU patients. Typically however we have No less then 4 patients and a average of 5-6 at a time. and I CANNOT STAND when your getting your a** kicked and you try to get rid of a patient to a floor who has not taken anyone ll shift and you get the old lines "my charge nurse is on the phone call back" "the nurse is on lunch call back" (lunch? I wish I could EVER say, Im on lunch come back later), "we are having a floor meeting, call back", "its been so busy here, can you call back in a hour" (sure I will just tell the ambulances to stop coming because I already have 10 patients)
or the myriad of other infinite floor excuses.
The floors need to realize that we are ground zero in the Hospital, and can have unlimited amount of patients that we cant turn away and its not our fault. Please stop getting mad at us that these patients exist and need to come to your floor. I think the Icing on the cake though (and this will be my last rant) is now in my hospital we have admission nurses,admission secretaries and a throughput coordinator. SO, when the patient comes to the floor, the admission is done for the floor nurses and ALL the orders are frequently picked up by the secretary for the charge nurse, so all the floor nurse needs to do is vital and assess the patient. Usually not even daily meds because if we dont do every daily med before the patient comes up the floor will cry
that is all :)
we dont have admission nurses. hell, ona usualy shift we don't even have a unit clerk or aides. Sometimes we are swamped. not your fault, not mine either. if i am in the midst of stat orders on one of the patients i already have the er pt will have to wait. i don't care. i am sick of caring over it.
I don't understand why a med/surg nurse would call you and c/o a patient being wet/dirty when coming onto the ward? What is the big deal? On the ward, we just get the patient settled then change them. I've worked wards and ED so I know how busy it is. Tell the ward nurses THAT IS PART OF THEIR JOB.
In our ED it's probably a bit different because I am USUALLY the help. The RNs are SO grateful when we are there for them. It gives them just that little breather for a few minutes inbetween patients and they always say thank you. But sometimes I have had anywhere from 8-10 bed patients, plus the ones waiting for beds, which can be any number of people sitting and standing, plus the corridor patients in beds (waiting to go upstairs). And they all need VS/obs, blankets, need help with toileting/feeding and most are elderly so u have to stay in the toilet with them, etc. We have no aides in our ED, only RNs.
Can you ask the Drs to insert foleys if u get too busy? If the NUM isn't busy, ask her to do it. Tell ur NUM that patient care is being compromised. If u get criticised, just tell them ur prioritising your workload, like I do.
Sometimes you have to be a bit forceful with people who criticise you and tell them there is only so much you can do quickly w/out compromising patient care. I never, ever do meds fast, because that is when mistakes happen; I don't care who's screaming in my ear. And I explain this to the patients and they usually understand.
Looks like you may have to either get everyone together to complain, or just up and leave for another job if possible.
Could you even do 4 or 5 8 hour shifts instead of 12? It's more days worked, but then u get a bit of time for yourself.
And I tell you now, I would never not take my break. For one it's illegal here for someone who works 6 consecutive hours NOT to have a break, and I don't care how busy it is: you NEED YOUR BREAK; same goes with peeing. You have earned it. You may need to start being more forceful with management re this.
Complain to someone higher up the chain if that will do any good (probly not), otherwise dust off the resume and start looking for a new job (or take holidays if you can).
I work 12 hours shift and last night was a horrid shift. At one point I had 11 patients, including an ICU patient and a slew of extensive abdominal pain workups, plus and ETOH patient that was driving me and my other 10 patients crazy. 
from triage.
and don't even get me started on the surgical or internal medicine residents 
EmergencyNrse
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