LANA

I, too, work in a small rural hospital. 4 ER beds with 2 extra for minor, minor overflow (actually, pt rooms not in use by hospital). Have one MD & RN around the clock. One LPN comes in 12 to 16 hours of the 24 hours and one clerk to register 16 of the hours. Eight hours (night shift) there is only one RN, who registers, triages, wakes the doctor (if he is fortunate to be asleep), orders, treats, & discharges the patient or patients. If it is possible, we do the EKGs and breathing treatments. Will call respiratory, if the help is needed. Will start the IV and obtain blood, if the situation permits. Otherwise respiratory and lab will perform the jobs. X-ray tech is either staying in house or live near hospital for call ins (they have 30 mins to respond). They always respond faster in codes. We have a Meditech system. The nurse enters all the orders, unless she has a clerk available and has no time to do the job. We have computers in 3 of our 4 ER rooms. Lab prints out results to our dept. We are able to access all labs that the pt has ever had at our hospital, as well as X-ray reports, History/Physicals, visit histories, medication histories, etc. Also, linked with larger local Columbia/HCA hospitals, so as to obtain same info, if the pt was ever treated there. Absolutely, love MediTech! Upon discharge, we put our charges in MediTech, copy the charts ourselves or, if the clerk has time or is available she will help us. We make a copy of the face sheet, T-sheet, nurse's note, and prescriptions for our benefit. Kept in our station for quick access for returns. Only keep them for 6 months. We make a copy of face sheet & T-sheet for radiology and the pt's local doctor. Main chart goes to Medical Records. Copy of face sheet with drugs administered goes to pharmacy for them to charge. We put out our own supplies, including linen. We average 30 to 35 patients a day and are growing. Currently, in process of building a new ER and adding a new full time RN. We don't like working at night alone. At current time, at night, we are completly isolated from the rest of the hospital. Various employees will come and check on us & lend a hand. The local police will come and check on us. We have no security, other than cameras and a silent alarm necklace. In case of codes, we have buttons in the exam rooms that alarms in MedSurg. If you know your job, you only need a handful of employees for a code. If we get backed up with serious to critical, we depend on ICU &/or the ER manager (who is willing to come in to our rescue anytime). If need be another doctor is just a phone call away. Just set up your policies and utilize them. Hope I have helped.

I work in a rural hospital with 4 ER beds with 2 for minor overflows. We have one MD and RN staffed around the clock (a LPN & clerk 12 to 16 hrs/24). The MDs are sent to us from an agency. If they are extremely slow or incompetent, we tell our nurse manager, who promptly does something about it. We are fortunate in that she also will work one of the shifts, at least once a week (more, quite often), so as to get her personal opinion of the doctors. Our manager listens to us and our patients. We provide a simple yes/no with comment section questionaire upon discharge. It is anonymous, except we do put the date on it, so as to know who was working on that day. This has helped us more than anything. We have a box for them to place it in upon discharge. The questions have to be worded in simple terms. We ask such things as was the staff professional, was your privacy respected, how well was your pain controlled? Everything has a check off answer. This goes a long way in getting administration to sit up and listen. We ask no more from the doctors than we expect from ourselves. We don't put up with rudeness to our patients. (Sometimes we quietly & secretly cheer it when it happens to a deserving patient.) Some of the doctors get mad at us. If they don't like the rules, then we don't want them back. Our manager expects us to stand up to the doctors, if they are rude. If we don't write them up, then she comes down on us. If they are incompetent, then we call our manager, and, immediately, if it is life threatening. We, also, immediately call in our local ER Medical Director or local back-up MD. Our doctors know our competencies and know that we won't call for stupid stuff. Don't be afraid to stand up to your doctor for your patient's sake. If weren't for your patients, then you wouldn't have a job. Hope I have helped. Bottom line, you need documentation and a manager to back you up.