1 nurse in the ER?!?!

[Mariposa2009, BSN, RN]

I live in upstate NY and we recently had a huge snow storm. Now, we all know what happens when there is bad weather, everyone calls out. Well my facility has huge issues with staffing as it is, and to top it off with bad weather--it's a mess. Any who, I work nights on a M/S floor and received a pt from the ER. When I was getting report from the ER nurse she told me that she was the only nurse working in the ER--WHAT!?!?! Does this happen often to anyone else? Or at any other facility? Is this legal? How is this possible? I have never worked in the ED or any ED so I don't know. Now, my hospital is not a small rural hospital, it's in a pretty busy city with approx. 400 beds. Is this normal???

[mentalhealthRN]

Never heard of that. I am in Upstate NY as well and know the city ERs are short as well. I would think they would have to bring in agency. But then again maybe they couldn't find agency either.

[linearthinker, DNP, RN]

Probably atypical, but not unheard of. 15 years ago I did some prn in a hospital that had no physician (or NP or PA) in house. I was the only nurse in the ED with a ward clerk who was also the person who had to prepare morning breakfast trays, lol. I assessed pts, began protocols and called the doc in to see the pt when labs we re back. We saw an average of 6 patients a shift though....

[littlemammanurse, BSN, RN]

It sometimes in the hospital in my town when there is bad weather.They will either take nurses from off of other floors to help or they will run the ED with just one nurse.It is dangerous to do, but unfortunately you have to do what you have to do

[ocean waves]

Hello. Regarding your question of "is this legal", there are usually guidelines for safe unit staffing and safe nurse to patient ratios, however in a crisis situation such as terrible weather I agree that "you do what you have to do". I have experienced working during very snowy weather when I was told at the end of my shift that I was required to stay and keep working because other workers were still trying to fight the icy roads to get there! In crisis situations, many nursing managers pull the few nursing staff who arrive at work (and who are actually needed for care of more stable patients on their assigned units) to work in critical units such as emergency rooms. Hard stuff! Best wishes!

[Altra, BSN, RN]

Is this legal? How is this possible? I have never worked in the ED or any ED so I don't know. Now, my hospital is not a small rural hospital, it's in a pretty busy city with approx. 400 beds. Is this normal???

Normal, no. Desirable, certainly not. But there is no illegality about it, as no U.S. state other than California mandates by law a ratio of nurses to patients. Individual facilities may have union contracts which also contractually require certain ratios, but if no one shows up to work ... who exactly are you suggesting be charged with what crime? The hospital's only alternative in the short term, until alternate staffing arrangements could be made, may have been to close the ER, which certainly does carry legal baggage re: EMTALA.

[canoehead, BSN, RN]

I worked for several years at a 7 bed ER in Maine that staffed only one RN overnight. Eventually we got a secretary for the overnight shift as well, but otherwise it was me and the maintenance man. He would direct traffic, answer the phone and make sure lab results got on the right chart, while I did patient care. Our manager also said we could call the EMT base for more help, but usually if it was busy they were out bringing me more patients, not available to help. the trick was prioritization and having enough experience to be confident in your assessments. We could call someone from M/S for a code or intubation, but they had their own work too.

In the case of a multi trauma I would call my maintenence guy to the ER and tell him who I needed and he would make the calls to M/S, EMT, and the covering doc. I would cover the ABC's and get IV access. Then we had an EMT for airway and compressions, MS nurse to record, and some would be OK to give drugs. The doc would direct care and I would kind of oversee to makesure the person with the right skills got assigned the tasks they could do, and of course I'd be filling in whatever patient care holes were left.

[Belle Epoque]

If an ER is critically understaffed they should either close some inpatient beds and pull nurses to the ER or they divert some non-urgent cases to a different ER, or a combination of both. Yes folks this does happen believe it or not as I worked for such a place. Working under such unsafe conditions - for both patients and staff - is NOT an option.

[darlink]

Even in California with the nursing ratio law, if there is an emergency situation like an earthquake (we don't have blizzards here), the hospital just has to write to the state and tell them why they couldn't meet the ratio.