Med/Surg to ER: General work flow in ER at night

AZQuik · Dec 1, 2015

Thanks Roy, I like the idea of not having to page a doc and hope they return my call. Last week I had the misfortune of checking myself into our ER, thankfully all tests were good, and I got clean bill of health. They took about 3 hours to see me and the waiting room was always full some people took 6 hrs to be seen, guess the ER was full cause some beds were in the hallway. My ER nurse did not spend much time beside just getting basic info and starting my iv. I rather not be a patient in an er...like most people of course but it was good to get first hand observation.

I wouldn't go to the er without pay if I had a choice

justin100784 · Dec 1, 2015

First off as an ER nurse the first thing that comes into your head heads "what are maintenance meds?" very rarely are you giving these meds, and secondly if you are debating on giving meds or working on a crashing patient maybe ER isn't the right place. I have worked a level 3 and level 1 trauma center and they are all the same when it comes to flow (fast and unpredictable). Everything is fast paced and you never know what comes through the doors. One day can be all abdominal pain and cough while the next is all heart attacks and overdoses. this change can also be every hour.

As far as patients go lets break it down this way. depending on the level of acuity and the surrounding environment the average provider sees 2.5-3.5 patients per hour. a nurse is in charge of 4 rooms and they range in acuity. The hospital I work at is a 30 bed unit and sees 110 patients a day, now not all beds are open all the time due to some being trauma bays and critical bays. You get an average of about 20 patients a shift and where my hospital is located 1.5 out of 4 are admitted. charting is click charting to make it faster, but you also have to follow guidelines for ER based on acuity of the patient. Some require 1 hour charting while others (Stroke post TPA) is 15min charting. The more acute the more charting

Hope this Helps

Dragonnurse1, ASN, RN · Dec 13, 2015

I worked a little over 9 years on nights in the ER and many times I got to work to find that we had over 30 charts backed up, every room and every bit of wall space occupied and more patients coming in. We usually got them all out or upstairs by 5AM. On the fast track I had many occasions when my d/c's were over 25 patients. I also had several occasions where we turned part of the ER into a holding area and I held 4 to 5 patients waiting for rooms (sometimes we even discharged from the ER after 2 to 3 days.

On the trauma hall there were fewer patients but we prepped for the OR and often had unit patients there along with stabbings, gunshots and the occasional human vs train results. Oh I should not forget the snake bites and GI bleeds. In the Cardiac section we prepped for heart surgery, cath lab, did at least one emergency C-section on a mother that had been killed, held patients for organ harvest and even cracked a chest or two.

Every ER is different and each night is an adventure, you never know what is going to happen or what is going to come in. Nothing we can tell you will prepare you for what will happen. Pull a few shifts or float to the ER and see how you like it but make sure that you have your running shoes on.

turnforthenurse, MSN, NP · Dec 13, 2015

Every ER is different and you may see certain things more so at one ER than at another.

ER #1: 38 bed ER with 5 critical/trauma rooms. Level IV trauma center. In addition to your typical cardiopulmonary/CVA stuff we saw a lot of drug ODs and psych. We would get some traumas but they were mostly high-speed MVCs that we would call a trauma alert on but would usually downgrade. Very rarely did we get an actual trauma activation where we had to stabilize and ship out either to the military hospital (level III trauma center) or the other hospital that was a level I. There would be days where we would have every bed full (or some blocked off due to staffing issues) and have 20+ people in the lobby. Then factor in all of the patients coming in by ambulance. If they came for something like "I stubbed my toe" and were stable you bet I would send their butts to the lobby. I was not going to give up my only available bed for that. A majority of the patients we saw were level 3's & 4's. We averaged about 140-150 pts per day. No hallway beds. We did utilize a fast-track/results waiting area.

ER #2: 32 bed ER with 4 critical/trauma rooms. Level III trauma center. Didn't see a lot of drug ODs and not nearly as many psych patients as ER #1. I think the most I saw were 4 patients whereas at ER #1, there were nights where I had 12+ psych patients, ALL HOLDING. O_O I saw a lot of more traumatic injuries and gun shot wounds in addition to the high speed MVCs. Patients here were sicker than at ER #1. Most of them were level 2's with some level 3's. We averaged about 180-200 patients per day. We had hallway beds. We utilized a fast-track/results waiting area but the mid-levels (NPs/PAs) would also start seeing the sicker 3's and 2's in the front to get stuff started if we were completely full on beds. We also had a lot of admission holds - sometimes for 12+ hours.

ER #3: 24 bed ER, not a trauma center. We see a lot of spice/kush users. A lot of level 2's and 3's. We have a fair amount of psychs but still not as many as ER #1. We average about 160-170 patients per day. We have a fast-track/results waiting area. We have admission holds but not nearly as bad as ER #2. We also utilize hallway beds.

ER #4: 6 bed freestanding ER. We see 1-6 patients per day. Easy peasy and helps prevent me from getting burnt out at the regular ER. We do 23 hour observations if the patient meets the requirements.

ArrowRN, BSN, RN · Dec 24, 2015

First off as an ER nurse the first thing that comes into your head heads "what are maintenance meds?" very rarely are you giving these meds

Don't get stuck on that line, just asking bout the workflow, thats all. I do.have 4 years experience on ambulance I do know type of patients an ER gets cause I used to be the one bringing them in. As a nurse on the floor my EMT instincts kick in and I'm usually one of the first in the room for rapid responce and codes and even the charge nurses have said I handle things very well and I even got kudos from my nurse manager. Considering I getting older (almost 40) not sure if fast paced is right for me even though I good at it. Maybe I could do it for a couple years. Many 40 plus ER nurses out there?

AZQuik · Dec 25, 2015

38. No problems with the pace.

Dragonnurse1, ASN, RN · Dec 26, 2015

I started as a nurse in the ER when 3 months after I turned 40 and was still going strong when I was almost 49. The nurses I worked with were primarily older than myself. When I began I was the youngest nurse on nights. Our night charge was in her 50's. None of us were thinking of leaving and if not for the latex I would more than likely still be there.

Altra, BSN, RN · Dec 31, 2015

Many 40 plus ER nurses out there?

Hitting the big 5-0 soon. Some days are punishing on the body, but that would still be the case if I were doing the frequent lifting of med-surg.

No routine, no control. If this sounds like your idea of fun, come join us on the dark side. :smokin:

Editorial Team / Moderator · Jan 6, 2016

Considering I getting older (almost 40) not sure if fast paced is right for me even though I good at it. Maybe I could do it for a couple years. Many 40 plus ER nurses out there?

I will be 44 this year. I currently work and have worked with many ER nurses in their 40s, 50s, and 60s. And one very special woman who retired in her 70s. She was awesome!!