ER staffing question

[ERNurse752, RN]

I'm curious as to how your ERs do things...

It's common in my ER when we're short a nurse, for the shock room nurse to have all 3 shock rooms, plus 3 monitored rooms, and sometimes 1 treatment/minor room.

The other night, I had 3 pts holding in the ER d/t no beds; 2 chest pains r/o MI, and 1 postpartum mom who'd gotten dc'd a few days earlier after being on the vent for 10 days b/c of developing ARDS after delivery, back in the ER with a big DVT...on a Heparin gtt, needed MSO4 Q1hour, RA sat 88%...

Those weren't bad, but they were busy pts...and then I got a shock room pt that had a subarachnoid hemorrhage, and took up all my time from then on. Head bleeds can't hold in the ER, but there weren't any ICU beds, and no step down beds to kick somone down into, so she stayed in the ER a good 5 hours before going for her cerebral angiogram and then to ICU...

My point is...it seems really dangerous to have 3 shock rooms and 3 monitor rooms, when you can potentially have 3 critical/unstable pts plus 3 others that may not be doing so hot themselves...

Luckily in this situation, the charge nurse helped out on the other 3, and the ICU coordinator came down periodically to check on how the head bleed was doing, and to answer my questions...but it really could have been a cluster *&$!

The next night the same thing happened, only my shock room pt was a rupturing AAA...I wound up spending 1 1/2 hours in the OR hanging blood and pumping it into him...but that's a whole other story, hehe...

How do your ERs handle shock rooms/monitored assignments?