We are switching to a 'pull til full' model in a few weeks. We have done this before with bad results, mainly because our ED hires new grads and most of the charge nurses remain stagnant in their chair. Pull til full only works if you have great flow control, that is, supervisors willing to give beds ASAP, doctors willing to sit down for 15 minutes and dispo as many as possible, etc. Our ED was remodeled and now holds 32 beds plus hallways, and the managers got us a mid-level and are proposing 2 charge nurses, taking away the triage nurse, having a full time float nurse, yada yada.
Our mid-levels are not allowed to see peds under 1 year old, and they have to be a level 4 or 5. They are underutilized to say the least.
The ED works as it is, and it is my mantra that 'if its not broken, dont try to fix it.'
Someone in corporate that has their Master's degree that has never held a nursing job is trying to implement change and test a hypothesis. No other way to put 6+ years of school to work!
Sounds like if you do not have a charge, why not designate a team leader? 3 nurses for 7 beds is awesome, you guys have enough manpower but how is patient flow? Do you have a medic or tech? And I think a room assignment would be awesome, split the room 3/3/1 and whoever has the 1 trauma room will be the float/charge. Walkie talkies for staff for easier communication?