ERJunkieBSNRN

Traci, Your ED sounds almost identical to the one I work in and we have the same issues. We have 17 beds and a trauma bay w/ 2 beds. One thing that I think will really help is to have add'l support staff. We have one medic who floats the entire ER and thus each nurse is pretty much left to do everything alone. For what it would cost to hire one nurse you could hire 2-3 techs. Assign a tech to one to two nurses and that person can run labs, place foleys, perform ekg's, etc. Thus the nurse can focus more on medication administration and higher acuity care. As an example, when I get a patient that comes in w/ chest pain I am doing everything. I get them on the monitor, oxygen. I grab the things I need and start one to two lines. I run and grab the EKG machine. I run the bloodwork to the lab downstairs. I give the medications. If the patient needs a foley or to go to the bathroom I'm the ONE to assist the person. Oops, I forgot I have two to 4 other patients, depending on my bed assignment...i sure hope they're ok! The hospital I work at is one of the busiest in it's "system". It's not uncommon for us to triage 200-300+ patients a day. Many of us are burnt out because we feel like we start getting pummeled as we walk in the door. The jobs I had that were less stressful always had enough support staff.

The hourly nursing rate in NC is awful! Contacted three hospitals in my area and was told I would get paid 18-19 per hour as an ER nurse with experience....RN pay. Graduated in 2002 with 5 years of ER experience.

We have had a huge number of patients for the past month and staff has been overwhelmed, especially because we are short right now. We have been getting an increase in both the seriously ill folks and the people who are coming in for superficial things because they can't or won't see their private physicians. Patients have become more irritable and around 3 pm and will start yelling at whoever is doing triage. Continual questioning about how long are they going to have to wait and why did that person go before me, I was here first or that person doesn't look sick at all! Our ED is designed that both fast track and higher acuity patients use the same entryway into the ED thus people become more irritable when they see the 16 year old who was laughing and smiling in the lobby being taken in before them. Worst of all is people have no compassion for those who are truly ill. By God I don't care if that 55 year old man is walking into the department diaphoretic and clutching his chest...he better not get pulled before me.....

We have this posted on our bulletin board at work. :smilecoffeecup:

Hey There, This is my first time posting and I would like to start off by first saying it would be beneficial for us all to spend time in different units to see the adversities within our jobs. I am an ER nurse, have only been an ER nurse but have worked at different facilities and thus have seen the complexities that ED's and nurses face. I work in a facility that has little to no support staff...that means the nurses are taking patients to every service (CT, XRAY, US) and they also run lab work to the laboratory, perform EKG's, etc. Due to the number of patients we see a large majority of our physicians will try to do a basic workup on folks in order to expedite care and turn patients over in a timely matter. So often a BMP and CBC are ordered, something unusual shows up and then additional orders are added. This tends to happen a lot. A few orders here and then add more an hour later when you get your first set of results back. You had indicated that a person was waiting downstairs for 5 hours...there could be a variety of reasons....the adding on of orders as I had stated....CT with oral contrast workups. Waiting for your admitting service. Admitting service taking the chart and showing up an hour later with orders. However, they feel a large number of orders could/should be done by us before they get the patient upstairs. This is a point of contention right now w/in our hospital. Recently I had a patient w/ a GI bleed and it was taking time to get the 4 units of PRBC's and 4 of FFP. The MOD was wanting the patient to stay in the ED so we could transfuse the patient. He was stabile enough to be able to have this done upstairs. I can tell you that w/ 90% of the patients I admit, the majority of what the admitting physicians want done are done in our dept initially. Repeat labs, meds, vitals seem to be the only thing that remains. We start the antibiotics they need, etc. Someone had mentioned that it appears as though an influx of patients come at shift change. The providers gather their charts at their convenience and do their charts/admissions, etc often at once, especially if they know they will be going home soon. While it is a challenge for your floor, it is a challenge for us as well to get orders done on the other patients, to copy charts, gather personal belongings, arranging for security to pick up belongings, getting acutely ill patients to surgery, etc. and then transporting the patient(s). When I get the patient upstairs someone takes the chart from me and I am left alone to get the patient situated in a bed. I can tell you that our department is so busy nurses are sent from other floors/departments to assist. 95% percent of them (and I don't believe this is an exaggeration) are overwhelmed and appear as though they've been thrown into a battlefield. On top of all of those toss in a trauma or an acute MI workup into the mix and see how much more that delays admissions. My two cents worth.:smilecoffeecup: