How do you get assigned patients?

In our ER the nurses are trying to give management ideas on how patients can be assigned to them and the doctors to better attain the CA law of 1:4 ratios. Can you tell me how the patients are divided up/assigned in your ER? Thanks!

we all have assigned blocks of rooms. 1:4 ratios in CA??? I should never have moved!! we have 1:7 or 1:8 here in PA. Pennsylvania is always 30 yrs behind the rest of the world. :chuckle

yeah you'd think it would be great...but we're nowhere near getting this...on an average night I have 8 patients assigned to just me! Its sooo unsafe! but it is the law now for ER 1:4, I wonder when the state will actually start fining our hospital...it was suppose to go into effect on 1/1/04!

On extremely busy days/night, they try to use the 'block' system at our ER.

But on moderate days they usually use the who-has-the-fewest-pts.-right-now system, which leaves a nurse running up and down the hall.

They at least keep the trauma rooms (we have 2) assigned with one nurse per room, and never budge on that. If one or both of those rooms do not have anyone in them, that nurse helps out whoever needs the help.

We used to use the block system. Each nurse was assigned 4 rooms. Now they're calling it TEAM NURSING and assigning 2 or 3 nurses (Depending on staffing) to every 12 beds. We have 24 beds in our ED. We have been doing it for a week and it has been disasterous. Many mistakes are being made. No charting is getting done and better yet, sometimes there are 2 nurses charting on the same patient. It seems very unsafe to many of us and completely unorganized. Many of our staff are threatening to quit if management doesn't reevaluate the situation. I guess we'll see what happens. Then again, maybe not, I have printed applications to other hospitals too. Let me know if anyone else does it this way and does it work?

We have 2 nurses assigned to a block of 8 beds w/ potential of additional 3 more bds (hall beds-usually in play by 1100 most days). We divide as we want- odds/evens--block style-we try to keep our running at a minimum. This type of TEAM approach is supposed to help s cover each other for breaks... (as if that happens). Sometimes we have a float nurse who helps a lot--she may take the hall pts or just float from team to team helping out getting new pt's tucked in or transporting others out--

Anne

We used to use the block system. Each nurse was assigned 4 rooms. Now they're calling it TEAM NURSING and assigning 2 or 3 nurses (Depending on staffing) to every 12 beds. We have 24 beds in our ED. We have been doing it for a week and it has been disasterous. Many mistakes are being made. No charting is getting done and better yet, sometimes there are 2 nurses charting on the same patient. It seems very unsafe to many of us and completely unorganized. Many of our staff are threatening to quit if management doesn't reevaluate the situation. I guess we'll see what happens. Then again, maybe not, I have printed applications to other hospitals too. Let me know if anyone else does it this way and does it work?

ahhhh the old "team nursing" approach. Our ED just abandoned this approach after using it for several years. This structure of care does not allow for any kind of accountability. The strong nurses end up doing most of the work and the weak/lazy nurses get to coast along. Things were missed and no one was accountable for making sure they got done. When I first started working with this type of approach to nursing back in 1999, It was difficult to get used to. But I am glad we dont do it anymore. The one bad thing about our current total care nursing though is that if I have a really bad patient, I cannot leave their bedside to keep an eye on my 7 other patients, and usually my coworkers who worked team nursing with me, end up bailing me out and I do the same for them.

I just graduated in May and have been work ER ever since. We have a 25 bed ER (level 2 trauma) we are assigned 4 rooms in number order and sometimes a hallway patient since we have been so busy. Sometimes we have a float nurse who relieves for lunch and helps if you need it. Some days thats crazy if you get tied up in a code.

are you guys serious? This is scary!! At most, I have four patients. If I'm assigned to the "critical rooms" which we put most AMI's/Resp Distress pts I only have 3. If I'm in Fast Track, I have six. I cannot believe you guys have one nurse for 7-8 patients. How can you possibly give quality care? That is so dangerous!

7-8 patients?? I get that on a good night! Lately I have had at least 10-14 patients every night, and many of them sick. Its funny that I hear people saying that they get one or two patients in the hallway!! We have 2 hallway patients per room, plus all along the hallway down to the x-ray department. We do team nursing as well, we have 2 teams with 3 nurses per team (the 4th nurse leaves at 11 pm and since I come in at 7 pm, we dont have him/her for long enough!) and when the 11 pm nurse leaves we take over his/her patients on top of our own. They assign the patients from triage by giving nurse 1 team 1 the first, and then nurse 1 on team 2, ect. Each nurse has thier own patients on each team, and we divide the patients up at the beginning of the shift, but sometimes it winds up where you have like 12 patients and your teammates have like 4. If you have good people on your team they will help you out, but if you get lazy people, they will sit on thier *** while you sink. Acuity plays no part in patient assignment unfortunatly.