Long waits up to days is not unusual in Canada in ER depts. We can't get the patients to the wards because there are no avalible beds not that the medical or surgical staff will not co-operate. What this amounts to is another in patient unit. The problem is ER dept were generally only designed for short stay and lack the beds and other equipment resources to care for all these ER admitted patients. In as much as possible we use every avenue to improve conditions ie bed utilization, documentation,staff meetings, staff meetings with the other depts, OH&S, lobbying managment like dogs without bones for non nursing support like clerks, aids and social workers. We have found having a social worker in ER very helpful. The biggest stumbling block is getting the nurses to take the time to write things down or document. Once the get mad enough then they will usually have more motivation to try and work towards solutions. I hope this may be useful to you.:)