hmwaggs

This one has 12 med/surg beds, 2 L&D, 2 post partum, 2 OR's, and 6 ER beds. We have respiratory on call after 6pm and before 7am. There is a paging system used for Traumas and code medicals, but only respiratory, the surgeon for Tx1, a doctor, and anesthesia are legitimately on call. RN's aren't and so them showing up is sporadic, and so far only on dayshift or early evening. I had a septic patient one night and 3 other patients. Luckily the others were low acuity and were discharged. I had her for 4 hours titrating levo until the dayshift nurse showed up and provided transport, then I stayed over my shift 3 hours to wait until he returned. There aren't paramedics here, so we must transport any patients that need blood or drips. I found staffing recommendation information through ENA that states that even the smallest facilities should have 2 ED RN's 24/7, but it was from 2005.

We call the floor nurse or OB nurse. Also, the pharmacist has the HUC take some class and they are set up to waste if the nurses are unavailable. The same for verifying high risk meds, like insulin or drips....not sure about blood (knock on wood)

Altra, That was exactly my point. I previously worked in a hospital with sometimes long wait times. That being said, vitals and a brief history were taken, protocols were initiated, and a triage nurse was there to watch and round on them. My DON "explained" to me that we can leave patients wait in the waiting room, that our small community is too used to being brought straight back, and then she told me our sister hospital (a Level II trauma center) and a hospital in Chicago have 2 and 8 hour wait times respectively. I think comparing this tiny facility to those is, like you said, comparing apples to oranges. I know those hospitals have an RN assessing and monitoring them while they wait. My administrator is too used to the way things were back in the day....The ways that have changed because there were too many incidents. She retires next month, and I think that is her main focus now.

Mike, Thanks for your response. I am interested in the staffing that was done in the rural access hospital. If this hospital weren't closely associated with hospitals within 30 minutes that are much larger, than this would be considered a critical access hospital. I would like to find resources for staffing from other hospitals and recommendations from organizations such as the ENA and give a presentation of options. There will be a new DON hired shortly. To address Annie and PacoUSA, in the meantime we are going to move closer to the larger facilities and I will be updating my resume. I've been a nurse for 10 years, just about done with my BSN, am a CEN, and have experience in surgery, ICU, ER.....I chose to work here when we moved here just over a year ago because it is closest to home and my husband already travels....I didn't want to be too far from my kids, one of the many sacrifices of parenthood :) However, I'd still like to initiate something as I have great coworkers and I am worried about the possibility of unintentional patient harm.

I work in a small hospital that staffs one nurse 24 hours a day, and an extra one from 1300 to 0100. There are 6 beds. If the OB nurse does not have a patient, she is expected to help out both the ED and M/S, but this of course is hit and miss. There is no triage, simply a waiting area. When the patients present, they ring the doorbell and we look at them. They are not checked in, vitals are not taken, and if we are busy they are asked to wait without anyone watching them. The only other staff is a unit clerk, whose only responsibility is to check the patient in after we room them. Our "great" new computer system has the nurses and docs doing all else. Although respiratory is there in the day and for paged out emergencies, at night we are expected to act as the "triage" nurse, charge nurse, respiratory therapy, pharmacy, ed tech, and housekeeping. We also do outpatient therapy. In the day, they do outpatient therapy, work meds and DOT physicals none of which are accounted for when staffing is considered. Recently, we had a pulseless patient present POV on the weekend, kitchen staff and housekeeping assisted with recording and compressions.....We were recently reprimanded for paging out for assistance and were told that ED standards require a 4 to 1 ratio. I explained that those standards are designed for ER's that have all the other resources and don't do ambulatory care treatments and asked for a protocol be in place. Needless to say, I was reprimanded and notified of lengthy wait times in urban hospitals. What are your experiences and comments? I am concerned with patient safety.