NEED HELP regarding patient assignments in the ER

[babygirl0024]

I have been in ER NSG 18 years AND NEVER experienced this type of nursing! Small 15 bed hospital (not certified for Trauma), one nurse does triage, there is not a patient assignment, a patient is brought back by any of the 3 remaining nurses, placed in the "to be seen rack". once seen and orders are written the chart goes into a different rack of which any of the 3 nurses will pick up and do the orders, when d/c time comes any of the 3 nurses (which might not even know the patient) will d/c the patient. Does this even sound safe? I have never worked where there isnt some type of assignment. Where is the continuity and accountability? You ask if the patient in bed 8 has had the lasix and the response is "I dont know". Is this type of practice condoned by State Boards?

[BrnEyedGirl, BSN, MSN, RN, APRN]

I have never worked in an ED as small as you've described, but I have worked in an ED with "team nursing". We would have 8 rooms assigned to 2 nurses and a tech and all work as a group. This of course only works well with good team work.

I work in a large Trauma center ED now, and it isn't unusual for one nurse to triage, another one start the line and draw labs, another one get the EKG, another give meds etc. We do have room assignments but if I'm trying to get a pt ready for the cath lab my co workers will pitch in and care for my other pts. I can understand your concern about accountability, however in reality, if I have a critical one on one pt, I believe my coworkers have some responsibility to provide care to my other pts.

We do still have to have someone sign as primary nurse, this is really only a big deal when time sensitive tasks aren't done.

[AndyLyn]

Ours is similar in size, we have one nurse that does triage, and then 3-4 in the back. We do have assignments, tho. The chart can be picked up by any one of the nurses if there's a med or treatment that needs to be done, and we'll discharge each other's patients, too. The important part is communication, and keeping the charting up to date. Our pyxis also tells us when the patient last had "that" medication, so it's fairly easy to keep track of who still needs what.

[babygirl0024]

I understand the 1:1 and help in a critical situation. My prior experience is LVL I Trauma. I have just never experienced this type of laziness. When I was orienting today, I just stood around and watched .. one nurse do almost everything while another sat on the phone or computer. I am from the day of "team nursing" I dont remember it being like this. It was one did the assessment/charting, one did the meds. This is more of a free for all. One nurse gave meds to a patient she had no idea about. There isnt any type of patient tracking system/ not even a board. Perhaps this is not where I belong....

[canoehead, BSN, RN]

I worked in a 7 bed ER that was like the one the OP described. Usually as the work load grew we'd just naturally end up knowing more about some of the patients while the other nurse knew about the others. So we ended up with a fluid assignment. You need good coworkers to make this work. You also need to look around the dept hourly and take inventory on who is waiting for what, and make sure no one has been lost in the shuffle.

[rntim49]

to the op, why don't you just quit and save the facility the trouble of training you along with preventing another nurse from obtaining & appreciating having a job. I worked in a ten bed ED where I was the only RN in the dept for 12 hrs. That is right, just me and a tech. The tech was also leaving during shift to act as the EMT leaving me alone with a physician that covered the whole hospital, get the picture?

[DanaOatman]

it's called communication amongst your team members.. whoever is giving you the "i don't knows" is hugely dropping the ball!!

[Nomadnurse, L.P.N.]

"to the op, why don't you just quit and save the facility the trouble of training you along with preventing another nurse from obtaining & appreciating having a job".

Really? So if she is asking what we think about this, and is it safe, she should just "quit and save the facility the trouble of training you........"? Am I misunderstanding your meaning? if I am I apologize, but isn't the whole point of the all forums here to answer questions exactly like she has? Please don't misunderstand. NO Flame. But weren't you a little harsh? Again, if I have it wrong please straighten me out....

[Bumashes, MSN, APRN, NP]

I work in a 30+ bed ER and that kind of sounds like what we do. There are 3 main halls, and you are assigned to a specific hall with 1-2 other nurses (depending on day of the week and time of day.) We use team nursing as well, and since I'm new, it confuses the heck out of me. It seems like a first come first served idea. When a pt is brought back to a room, whoever is available goes and sees them. When an order is put up on the rack, whoever is available does the order. Same with the DC's. It all seems very haphazard to me. It works well, though, for my ER from what little time I've been there to see. But I can see the potential for a HUGE problem when their are lazy co-workers. Fortunately, I've been told that the truly slack RNs are run off pretty quickly by the staff, so the majority of those I work with seem to really work well together. I guess it all depends on the co-workers.

[nursej22, MSN, RN]

I don't work in ED (except was floated there once) but have been there a few times as a patient and with family. But our ED does seem to run this way. One nurse brings them back, tells them to undress. Someone else may draw labs/start a line. Another will give a med/treatment. Another will d/c or send to the floor.

When I get report on an admit the person giving report has often not seen the patient, they are just reading the chart to me. I know this because the answer to any question is "I don't know, I just picked this patient up."

[diane227, LPN, RN]

I have worked in three ED systems from a very large level I trauma center to a community hospital that was a level II trauma center. In each system nurses were assigned by areas or zones.

In the large hospital areas were: Major trauma and cardiac (2-3 nurses), medicine (2 nurses) surgery (2 nurses) minor medicine (1 nurse) gyn (1 nurse), and pediatrics went to an established pediatric ED except for trauma. When patients were stabilized in the major trauma/ cardiac areas they were either taken to the OR, taken to ICU or taken to medicine or surgery areas for holding at which time the nurses handed off to the medicine or surgical nurses in that area. Patients did not remain in the major trauma rooms unless they were waiting to go to OR or ICU. Patients assignments were rotated according to the yellow team or orange team. The patients had the appropriate colored arm band and the nurses were assigned to either yellow or orange teams so they would know which patients were theirs. Abdominal pains were rotated between the surgery and medicine side as was cellulitis. Doctors were also assigned to either the yellow or orange teams. We had two triage areas each with a triage nurse. The charge nurse was responsible for helping out and facilitating patient flow. This system worked very well for us.

In the smaller hospital, nurses were assigned by area: trauma/critical patients, major (which was the area where patients went where they required more monitoring), minor trauma, and then hallway rooms which included eye, gyn, isolation and some orthopedics. It worked very well. Protocols for triage to these areas were formulated and we had a charge nurse and triage nurse. The charge nurse was responsible for helping in any busy area. When we had patients in stretchers in the hall, they were assigned according to complaint. When we held patients in the ED in the major area that were waiting for ICU beds, those patients were cared for by an ICU nurse who would come down or was called in to take care of these patients. It was not uncommon to have ICU patients waiting in the ED for 3 or more days.