Published Apr 8, 2014
So I moved to a new city because my husband got a better job there. I'm indifferent about the city but I absolutely hate my new job. The ppl seem nice but the way the department flows gets to me. I'm trying to figure out if my old job just spoiled me or if there really is a problem with the new place. Here goes.....
me: ER nurse with BSN, CEN, BLS, ACLS, PALS, and TNCC. And four years experience.
old job: level 2 trauma center in big city. Nurse patient ratio of 3:1 standard, but up to 4:1 in main ED. 5:1 in ED Obs. Spectra link phones for each nurse assignment. Notified of new patient by phone whether coming from triage or from EMS. Monitor tech works radio, flow coordinator or shift supervisor assigns bed, then monitor tech calls RN with quick repot on incoming pt and ETA. No nurse gets 2 patients at the same time unless you have the last 2 open beds, if so trauma nurse checks in one patient. 6:1 patient ratio for techs. RT in department. 2 overnight docs. 47beds in main ed, 10 in Ed Obs. 2 triage RN.
new job: level 4 trauma center in big city that's smaller than old city. Nurse :patient ratio 4-5:1 standard but up to 6:1 including hallway patients. Walkie talkies for communication. No notification of new patients assigned to rooms. Monitor tech watching monitors and recording cycled vitals from monitor. Ems beds assigned by charge nurse. Triage patients assigned by triage nurse. Any clinical staff answers ems radio. Normal to get triage patient and ems walking to your rooms at the same time. 6:1 patient ratio for techs. RT not assigned to ER, covers whole hospital. 1 overnight doc. 17 beds, 9extra open during peak hours. No ED Obs. 1 triage nurse.
Does either of these places sound like your ER? Was my old job just a rare situation? I feel miserable at the new job, how long would you give it before you decided to leave if you were in my shoes? Can anybody tell me what it's like in south florida (Palm beach county and south)? I'm really trying to adjust...I keep telling myself it will get better, but by the end of each shift I hate it more? As far as pay, they're both the same give or take a few cents. I'm wondering if it's just the culture in the new city because my husband is in a completely different industry and hates his job too....and were both usually very easy to please. Help me figure this out!
zmansc, ASN, RN
My first question would be do you feel like you are able to treat your patients safely? If you are having issues with the safety of the patients, then I would not hesitate to bring that up to management and if not satisfied with the changes, give my notice. I would be tactful in how I did that, but I would also be firm if it involved patient safety and my license.
Assuming you feel like the care being provided is safe, then I would suggest one of two paths depending on how approachable management is:
1) Approach management with a set of issues and solutions that you think would improve the flow and improve the patient care. I always suggest having this in writing so you have had a chance to formulate your ideas. Evidence to back up your suggestions is always a plus as well. If you have co-workers who also share your concerns, getting their buyin on your suggestions would be a good step prior to approaching management.
2) Look for another position that is able to show you they are not as bad or worse in these issues before you turn in your notice.
I would always suggest option #1 first. Even though many have a fear of approaching management, if done right it almost always turns out better than they expected even if the problem isn't solved to their satisfaction.
Thanks zmanc. As far as patient care, I feel like I can take care of my patients, but they aren't getting my absolute best. By that I mean, I'm still very careful with meds and thinking critically about the patients situation, but when it comes to the simple things of taking an extra two minutes to listen to a story ms soandso started while I was starting her IV, I can't. I feel like from the time I walk in to the time I clock out each minute is full of stuff. As far as management I just kinda feel like I might be too new to bring up this type of stuff. At the same time, I want things to improve as soon as possible. This is why I'm trying to get a feel of what other ERs are like so can recondition my mind if the problem is me.
In my experience, every ER is different. It's very difficult to compare one to another strictly in terms of patient ratio because so many other factors come into play, such as what software is being used, how critical the patients are, how much support staff do you have, etc.
I have to say that your past job sounds like some people at the top are really using their brains, and that's really the way it should be at all emergency rooms. It's not uncommon for me to get two ambulance patients at once, and the only real reason for that to be happening, is because no one at the top is thinking ahead and coordinating patient flow.
Personally, and I'll probably offend a lot of people by saying this, I think the problem is that ER's should not be run by nurses who do not have higher education in management and a proven track record of success in previous management positions.
emtb2rn, BSN, RN, EMT-B
Personally' date=' and I'll probably offend a lot of people by saying this, I think the problem is that ER's should not be run by nurses who do not have higher education in management and a proven track record of success in previous management positions.[/quote'] Ahh, but then there's the old conundrum of how do you get management experience if you don't manage?I can also get squads & triage pts at the same time. Almost always d/t lack of communication up front.
Ahh, but then there's the old conundrum of how do you get management experience if you don't manage?
I can also get squads & triage pts at the same time. Almost always d/t lack of communication up front.
Ahh, but then there's the old conundrum of how do you get management experience if you don't manage?I can also get squads & triage pts at the same time. Almost always d/t lack of communication up front.
I agree, I actually think my ED's management team is top notch, and they are RNs w/o previous mgmt experience who work very hard to learn and improve their mgmt skills on a regular basis.
Communication is the key for not swamping a nurse. We had a new triage nurse swamp one nurse they other day, and we just had to have a teaching moment. It will probably happen again, because when someone is new they do stupid things. But, in general we flex to figure it out.
I'm glad you feel like your giving safe care. I've worked at places where I don't think they give safe care, and I had to quit because I wasn't going to do that to the patients or risk my license being in a situation like that. It just wasn't worth it to me.
In that case, I would suggest that even if you are new, you still can bring up proposed solutions to problems you have identified if you do it right. I would try to get buyin from others who have been there longer, identify solutions as well as problems, and write up your suggestion so that it shows that your intention is to help improve.
Each ED is different and so I think that maybe you should give yourself some time to adjust to your new surroundings. You mention that you want to maybe move further south. The ER that I work in there is a patient ratio of 4:1 but at night that tends to change to 5 or 6:1. It has 16 main ed beds and 6 fast track beds. There is one over night doctor and then a mid level that leaves around 3:30 am. The fast track usually closes around midnight or whenever the last patient gets out, then everyone waits to be seen in the main ed. I have worked both night and day shifts and I prefer days. I am curious to keno if you are in central or northern florida? I am looking to relocate up there.
Yea your old place sounded great, the only ER I ever worked at (which I hated every minute of and left after 7 months) if I had 4 open room omg watch out. No mercy. I would get 2 direct beds at the same time and then 30 mins later a new pt and 20 mins later another pt. the stress was off the charts, the turn over at the place was very high.
Your first one is so similar to my job that I wonder if we're at the same place. I'm traveling now though and am finding that I was SPOILED at that job!
On the question of how long, I would give it at least 6 months, if not a year.
Where I work:
2 triage nurses if fully staffed, with EMT if fully staffed. If not enough staff might have 1 nurse 1 EMT or just 2 nurses. At worst, just 1 nurse & no one to greet incoming pts.
Beds; 20 in main ED, 10 more in obs (also for psych/ETOH), 2 trauma/code bays (3rd level), 5 beds in fast track. One nurse in fast track, 1:3 in highest acuity level area in main ER, 1:4 in moderate, 1:5-6 in obs.
2 docs & 2 midlevels during the day (until 11pm), 1 doc 1 midlevel at night.
Anyone takes EMS radio calls, triage nurse assigns beds to external pts, charge assigns to ambulance, so it really depend on how good the triage and charge nurse are individually, and how well they work together. Not rare to get 2 pts at same time, sometimes ambulance & triage, a lot of times multiple triage pts come into assignment at once. Rarely is there an extra nurse with now assignment just helping around with ambulances.
Help with criticals is not anchored by any protocols or hard rules, really depends on who you're working with.
EMTs 1:6 if staffed, but could be 1:8 and even 1:12.
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