CHUBBY

sallerella, As long as oyu're an experience RN and can "drop and run", agency may be you're best bet., I don't about Canadian salaries, but the payscale is lower in Baltimore than say, Pennsylvania or New York. Of course, the cost of living is less.

Unfortunately, the problem you're having is not umcommon. I don't have charge responsiblities in my present position (due to fact that I'm per diem, even though I have a significant amount of experience) but I have seen the shift charge nurse chewed up by "coworkers". I think people take personal offense to being questioned. They feel as though you're questioning their experience...sometimes it's justified, sometimes not. It's unfortunate that your Nurse Manager doesn't back you up or try to rectify the situation, but that's another issue altogether.

Cal, I understand the fiscal reasoning behind the crutches, but they certainly can't send someone out the door with a simple/nondisplaced fx without crutches..that's malpactice. How do they they justify fx sans crutches? The fire department deal sounds great. I always tell people not to throw the crutches out, either return them or donate them to Goodwill.

Missy-you'll appreciate this. One ER I work in added 10 observation beds to the ER (for monitor overflows) It's mostly rule outs, nothing on vents or trauma (THEY get the beds) anyhow, they have been pulling ICU nurses down to staff it (on OT of course) and they're all complaining because of the nurse/patio ratio and the "high acuity". Hmmm, but that was okay for the ER to hold all those patients with less staff?????

They usually use versed with another agent maybe MSO4 or something short acting. The ER docs or whoever is doing the procedure usually orders the meds. We dont have anesthesia there.(If they need an ologist they shouldn't be done in the ER) Along with the consent forms, protocols for CS etc,etc.

Unfortunately, as the insurance dollar gets tighter, the admitted ER pt. is gonna be the rule rather than the exception. Hospitals would rather close floors to save money and hold a few in the ER for a day or two. One place I worked at (during the height of the flu) had 23 admits in a 15 bed ER..do the math. Until other states start following California with nurse ratio and acuity is DEFINED, you're going to see more and more of this stuff hit

Actually, there's alot of places in midatlantic that already have these "observation" areas. Basically, areas for soft rule outs, but other stuff is sent there as well. They get a mini admission, 3 sets of neg. cpk's. a stress, an echo and then see ya! It's more of a reimbursement issue than lack of beds. The hospital gets more money from the insurance companies if the pt. is a 23-hour obs. pt. rather than a full admit

Every ER I have worked in has held pts.,I've even discharged some of them after they've rule out. One ER (with 13 rooms) had camped 22 pt.s..how they fit them in, I don't know (in addition to being a Level II), but the place I work now IS dangerous. 8 rooms, 4 have monitors. A pt. I took care of had been there for 2days waiting for an ICU bed. He had a massive PE, got TPA, then heparin then went to angio for a greenfield filter and returned to his ER bed post-procedure..that along with 7 other rooms. It seem that the only thing that hospitals respond to is bad press. Obviously, litigation isn't the issue. So....you can take your chances and talk to Channel blah blah and never work again..or move on. Not a great choice either way.

Quit...

Unfortunately, haven't really seen one that has worked. Tried voluntary, then assigned on-call (which was even worse). Staff began questioning other staff as to what necessitated the on-call person being called in and it created alot of in-fighting. I believe it was inventually dropped and everyone just works short with back up from inhouse if needed. I know it doesn't help-but you're not alone