We are also critical access, with a moderate ED patient volume... big fluxes some days pretty slow, others crazy. My opinion is that it is unrealistic for us to care for OBS patients adequately. There is the whole thing with a Medex, kardex, different computer system, computer charting (we chart paper) that we know nothing about. I realize we can be trained, but still. What our facility has just implemented is that we will keep ANY inpatient if census on the MED/SURG floor is zero (which does occassionally happen). Once a second patieint is to be admitted, then we can call the MS nurses and the floor will be opened up. Pity the patients if we are swamped. Their care can be severely compromised. We only have 2 nurses on staff in the ED. On midnights one is an LPN. This is not a good situation at all. Damn bean counters!