gardengal1

We never get lunch or breaks - you grab a bite whenever you can. BUT, no lunch break is taken out of our 12 hour shift - we get paid for the entire 12 hours - even if we would happen to be able to take a break. I think I would be filling out the "no lunch" paperwork every single shift because they must pay you if you continue working during meal times.

Most ER's don't hire new grads - they expect about 2 years of medical/surgical/ICU background before allowing a transfer into the ER. Get your foot in the hospital where you want to work on any floor that you have interest in. Pay your dues, watch for ER openings as it gets closer to your 2 year stint in the unit where you were working and then, start applying for a transfer. The transition will be much, much smoother for you with some experience under your belt. If, for some reason, you ARE hired into an ER, this is going to be extremely stressful for you as you learn to cope with the pace and knowledge base that you must have to function in that environment.

We NEVER hold a patient during shift change - that is what the Resource Nurse is for. Admits go up as soon as they are ready, no matter what time it might be.

We use the same computer system as the admitting floors. When we call to give report to an admitting nurse, if they are not available, they MUST call back within 10 minutes, otherwise, the Resource Nurse takes report. During report, they have the chart open in front of them and can ask appropriate questions while the ER nurse is giving that report. It seems to work well when the nurse calls back within the 10 minute time frame. The patient then goes up immediately after report via transporter (except ICU patients which require a nurse transport and confirmation of drip rates at the bedside). There are rare call backs with questions when both of the nurses - the sending and the receiving - are looking at the same information at the same time.

Money. It is the driving force behind most all higher-level certifications. Of course, the recognition should come with it but, if others on their unit know that a raise came with this certification, others will follow suit. The personal satisfaction only goes so far (I have taken specialty certifications and passed) and then, it fades. Money should be contingent upon staying certified (if you want everyone on your unit to be certified and stay that way); reimbursement for books/testing costs should also be reimbursed. The raise should be significant enough - a dollar or two per hour above other staff - which then is the motivating force for the rest of the staff to follow suit. If they let it lapse, this "bonus wage rate for certification" is then removed and that understanding has to be very, very clear - no certification renewal, no more "bonus wage". We got $1.50 an hour more and within 2 years, everyone of our staff members had their specialty certifications which was the goal of our manager.

We use Etomidate exclusively for bedside procedures (reduction of dislocated joints). For intubation, we combine Succ with Etomidate pre-intubation as a 2 drug combo. For procedures, Etomidate is short acting with the patient waking back up in minutes rather than hours and discharges are more expedient after the required monitoring time and without many residual side effects.

Regarding the post that kids now will snort anything: I recently had a teen ask me if he could get high from snorting Warfarin. I calmly told him "no - but you will bleed to death". Then came the lecture. Kids believe that anything that comes in a tablet form can now be crushed and snorted. Are we going to have a future generation of young adults that are permanently brain damaged?

People do this crap in our hospital all the time but fortunately, we never see them. At staff meetings, our boss will tell us we have had some write ups about ie: sending a pt for a MRI with a running IV rather than a saline lock; elderly demented female was wet when she arrived at X destination (she was dry when she left ER); there was a spot of blood on the siderail of the ER cart, ICU complains we did not do X, Y and Z before they got the patient, etc. Our boss mentions this stuff as a general learning situation and does not look at nor point out who might have been the offending nurse. Sometimes, she gives the other complaining department head an ear full (in a nice way - she never gets mad). We all let this stuff roll off our backs - we have to, otherwise, you begin to question your abilities.

We do NOT float, EVER. And, it is the rare occasion that you are allowed to go home ON CALL and must be within at 15 minute response time to get back there when **** hits the fan. I do not have sources for you to check. We follow safe staffing for ER's from the ENA recommendations. When we do occasionally have downtime, it is time to spruce up the unit - things that never get done - hosing down beds and letting them air dry, getting under the crevices of the mattresses which no one ever does; straightening out the supply room, etc. On occasion, we have other staff float to us when we are in crisis and need more bodies than we are staffed (which happens frequently) but they only task and do not chart. You might also check California rules for staffing since they now have mandatory staffing ratios - maybe you can find one for their ER's.

Am searching for a computer charting program/system for the Emergency Department which you think is easy to use, is complete in it's content and doesn't require you to flip through dozens of screens in order to use. Is there a program out there that can do this?

Not having the TIME to spend TIME with my patients due to all the other "stuff" we have to do in addition to the unsafe staffing loads.

We are now talking about bedside registration to see if it will work for us. I have read the posts from the past year and understand that communication is key. What about actual numbers of staff to man the ED and staff it for the very busy days. I would like to compare our staffing to other hospitals to see if we are staffed to make this work. What numbers of nurses are you using out there? During what hours? how many staff at triage? RN, tech aide, registration? Do you habve a dedicated doc for triage or one who can at least come to triage to start orders? Do you have standing protocols? How many for fast track ? What hours? RN's, aides, NP, PA or MD? How many yearly visits or daily visits average? How many beds in ED? Fast track? i will be very interested to know. TO SENIORWVNURSE; 28,000 patients per year, 14 ER beds, 2 RN's in back (bed area) 7a - 12 then 3rd nurse comes in 12-12 - 3 RN's total until midnight, 2 nurses come in at 7p - 7a. HUC (secretary) all 3 shifts, paramedic on-staff all 3 shifts - does most of IV's, IV meds. Triage nurse 8 am until 8 pm. Urgent care 5 pm to 11 pm weekdays, 12-11 weekends, own PA and medical assistant - we do not help them unless they are drowning - then we lend a hand when able, they are off a wing of our ER (5 rooms) (we use these rooms during the day when we are busy but must have them vacated by 5 pm). One ER physician, has nothing to do with triage. One PA comes in at 10 AM and another at 12 pm - so 3 providers in the ER - they work 12 hour shifts - doc and PA's. We have one tech in back 12 noon to 12 midnoc. Out front in waiting room - 2 ER techs - they do registration (name, birthdate, primary complaint and consent for treatment form signed) - take pt into triage room, get vitals, triage nurse takes over in triage room. Then, when ER techs at front desk are free, go back to patient rooms and do complete bedside info-address, phone numbers, copies of insurance cards. Standing orders for pain/nausea control. IV starts ordered by triage nurse, anti-nausea medication and pain medication can be given before physician/PA even sees the patient. Triage nurse orders appropriate labs and these are often drawn before doc gets in there - also from standing orders for "adult abdominal pain" or "adult chest pain", etc. Docs have approved all the standing orders so that nurses can get whole process started sooner rather than later.

We are smaller hospital, 19 beds, 28,000 ER visits/year. We have 2 ER techs (most are nursing students or paramedics) who get name/birthdate/presenting complaint and sit at a desk in the waiting room. They have written criteria beside them - shortness of breath, chest pain, vomiting - all go back immediately and one of them takes them to an unassigned room. They have also been trained which rooms are appropriate for the presenting complaint. While they are moving the patient, they vocera the triage nurse to meet them in Room X. She triages them in the room, tech assists with undressing, monitoring applications/EKG and then goes back out front - often taking 5 minutes or less. When triage nurse is almost done, she voceras the nurse being assigned and asks her to come into the room. Verbal report is given, primary RN now assumes care. It is not very often a patient is left alone when they initially present, other than the triage nurse to leave the room, ask another paramedic to go start an IV on this patient and she goes immediately back out to her triage room. More minor complaints are triaged in the triage room and then placed into an unassigned room. If she is not available when a chest pain comes in, ER tech has already vocered her, she has assigned a room via vocera and she then calls receiving nurse on vocera, instructing to meet this patient in Room X with "chest pain". ER tech does not leave the room until the assigned nurse physically comes into the room which is usually a very short period of time. By that time, pt is on the monitor, vitals have been taken and EKG is done. Our triage nurses can do a basic health history in the computer in about 3 minues. Complete assessment or any additional health history is up to the primary nurse. Staffing ratios: ESI Level 1 1:1, ESI level 2-3 often 2-3:1, ESI level 4-5 can be 5-7:1 sometimes more.

Kelly clamp and ink pens - everything everyone else has mentioned is at my fingertips in every room. Computers in rooms have micromedix so don't need to leave room. BUT - have my own personal stash of SILK tape which is excellent for buddy taping toes and has good tolerance for water plus good adherence for a longer period of time. Silk tape is NOT a stock item in our ER. And paper towels are wonderful scratch pads - takes ink well, folds into your pocket easily!

We follow the same guidelines as mwboswell has quoted