New Grad ER Vent

[EMTSNA]

I love working in the ER, I will be off orientation in 2 weeks after a 5 month orientation. I feel pretty confident in my abilities and I can roll pretty well with a busy team of 8 or 9 patients. Recently we have been too crazy and busy. Management has implemented a new triage system designed to get patients out of the waiting room and into the treatment areas as fast as possible.

I did an AM shift today and by 2pm I had 15 patients. There were no inpatient beds and the patients just kept coming. Before working as an RN in this environment I had no comprehension of the level of stress that a person could maintain for 12 hours. When things get that busy really sick patients start slipping through triage and ending up in the hallway.

As I said I really like the ER, but I don't want to lose my license. I know everyone is going to say get the heck out, I think I'm going to switch to night shift as soon as I'm off orientation and see how that works. I rotate days and nights now, and that side of the world seems a little bit more sane.

Thanks for listening

[RunnerRN, BSN, RN]

I know you said you don't want to hear that you need to get out, but YOU NEED TO GET OUT OF THERE! I don't care what shift you're working, any ED that is willing to throw 15 pts at a new grad is no where I'd want to work even with 20 years ED experience. Take your orientation and market it to another ED in your area.

[Dolce, RN]

I did an AM shift today and by 2pm I had 15 patients.

Thanks for listening

I think you have answered your own question. This is completely unsafe. I wouldn't take an assignment of 15 patients in any acute care setting, let alone the ED! I know it looks bad to quit so soon after being hired but you can tell the next facility you interview for what the situation was. Most reputable ERs have a 4:1 ratio.

[bopps]

that is unsafe and if i would be looking for another ED job somewhere else. as a new grad myself i can understand what u are going through. the max patient load i have had though is 7 at one time in the ED and i felt unsafe. there are other EDs out there dont put up with that u will burn out.

[kpyers32!]

Yikes. I interviewed for an ED position and now I'm wondering if I know enough about the reality of ED. Just to clarify, are you saying you had 15 patients at the same time? YIKES, or did you have 15 pts. in and out by 2pm....I guess that sounds a little less scary. thanks!

[mom2michael, MSN, RN, NP]

Wow, I hope what I'm reading is you've had 15 total patients by 2 p.m. and that you haven't actually been putting your license on the line caring for 15 patients AT ONCE.

I've never had more than 5-6 patients at once....and that was a freak thing. Most of the time, I have 3-4 and "maybe" 1 hall bed. I've work at 3 different ER's (1 full time, 2 PRN) and it's the same at all of them......we are staffed so we don't have more than 3-4 rooms at once.

Even at my full time job now where we have 8 beds plus a hall way bed, we have 3 RN's in there plus a medic. I may be "invovled" in all 8 beds in some way or shape or form.....but I have help from EVERYONE there.

I have on the other hand cared for 15-20 patients by 1400 before....that's not unheard of in my rural ER settings where 90% of what I see on a daily basis is "clinic" type stuff. But there is NO FREAKING WAY I would even care for 15 "clinic" patients at once.

If you really, truly are seeing 15 patients at one time you need to get out and I mean, run. I'm not even sure I would even step back in that ER. That is unsafe on so many levels and loosing your license is probably going to be the least of your problems there.

Good luck!!!

[MrsCannibal]

As much as you might want to work ER, or you don't want to "be a quitter", I think that for your own sanity, your license, and the safety of the patients, you really need to look elsewhere for employment. Not only is this hospital putting you in danger, it is putting the patients at risk also. Don't let yourself burn out before you have even started! Good luck!

[Blee O'Myacin, BSN, RN]

Our ratio is 4:1 - if there are holds, we have agency in to take care of them in the beds while we do the best we can with stretchers and chairs in the hall. Sometimes we have to start having a PA screen patients in the waiting room, but we never have to work in such unsafe conditions.

Sure, there are times that if I have 3 out of 4 patients just needing to be discharged (I'm waiting on the doc to get the paperwork done because she's still got 7 charts in the rack and 40 in the waiting room) - we'll take a 5th patient, but that doesn't happen too often.

Last week we had all of our 32 beds taken up with holds. Luckily, the nurse managers from the floors are now taking a turn at being the "holds supervisor" and amazingly, we are starting to be able to move people out of the ER quicker.

I'd find myself a new job if I had to take 15 patients.

Blee

[scattycarrot, BSN, RN]

15 patients at once not only puts you in danger of losing your licence but also, of potentially having to live with a patient dying on you because you couldn't look after them and having to deal with that for the rest of your life. Trust me when I say, no job is worth that amount of stress. I watched our unit try to deal with that as a whole when a visitor came up to one of the nurse and said.'that patient doesn't look very well' and that was because he was dead and no-one had noticed. His named nurse was swamped as we all were and no blame was placed on her but she had a vERY hard time dealing with that incident. It didn't take me long to get out of that place as quickly as I could.

[EMTSNA]

Point taken,

I did indeed have 15 patients at one time, and this happens occasionally at this facility although 8-10 is more of an average. What gets me is that this is a big name regional trauma center that regularly wins awards for it's excellence, mostly the ICUs. I don't understand how the ER can get shafted so bad. I look at other nurses who seem so adept at balancing the chaos, and think if I just get a little quicker and more efficient, with experience I could be that good too.

The night shift gets about half the volume of days with about the same amount of staff, so there is a lot more support. All the other ERs in the area have pretty insane volumes as well so I don't know how much better off I will be switching hospitals locally. On the other hand I could head upstairs to one of the units.

[mmutk, BSN, RN, EMT-I]

WOW 1:15 pt ratio, is that legal??!?!

Hey PM with the name of this hospital, I frequent TRAUMA centers and deff don't want to end up there.

[JMBM]

I can roll pretty well with a busy team of 8 or 9 patients.

This isn't even a hard question. Eight or nine ER patients is too much for an experienced ER nurse to safely handle. Fifteen for a new grad verges on the criminal. Just think, you have all of 4 minutes per hour for each patient, assuming you do no charting, answering the phone or, heaven forbid, using the bathroom. If this is a case of institutional neglect of the ER, the only solution will happen when nurses vote with their feet.

After writing my response above, I decided to come back and edit it some. Your statement that you can "roll" with 8-9 patients stuck with me. Thinking one can handle 8-9 true ER (not non-urgent) patients is not a point of pride, it is a tragedy waiting to happen. Any nurse who thinks she/he can safely handle that many acute patients has simply never had their gastric bleed, septic grandma, wheezing kid go south in a hurry, let alone having all three crash at the same time - while you have six other patients to watch/treat. ERs that put nurses in that position are unsafe and nurses who put up with that load are courting disaster.