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We open beds according to staffing. we have zones. (red, green, yellow) green opens first and the nurses open beds there as the pt's roll in. When another nurse arrives at say 0900 they open red and start putting pt's in beds there. When the 1100 nurse comes in she opens the fast track rooms. When the 1200 nurse comes in they open more beds depending on the need or they start relieving the 0700 nurses for lunch. When the 1400 nurse comes on they go to the side that has the most open beds or they take triage or they float...

Our ED has been really pressured lately...hospital wide lay-off's, new director, new schedule, and decrease in pt census has really put a damper on all staff. I work with some really wonderful people and some who would like to roll you under the bus!

I have some seniority in my dept...I've been there 5 years. Others in the dept have been there longer but I am number 4 on the seniority list. (of day shifters) Due to budget cuts and pt numbers we recently changed shift times. I am now required to work either 6-6, 7-5, 9-9 or 10-10. I'm ok with the 9-9. But seriously? 10-10? That (to me) is a midshift... What has your dept done to help with staffing during the busy times? Are you required to work mid shift or alternating night shifts? 10-10 is exceptionally hard on my family. We have to be up by 5am for school and child care becomes problematic sometimes too. I signed on as a 12 hour DAYshift...I'm happy to have a job and I'm mighty sure I will just have to suck it up...But, I feel like our director is semi reasonable and may listen if I can come up with a plan that might work. My thinking is that the last 2 people hired on day shift move to a more mid-shift position...Is that fair or reasonable?

I was hired as a 12 hour DAY RN...I guess that really doesnt matter anymore to our new management. I can see why they need to move people around to staff to pt needs, but DANG it sucks!

What kind of pt to nurse ratio does this give you?

We have 21 beds. We also have 4 fast track beds. Our ER was poorly designed and it is like having 2 completely seperate ER's. Our fast track used to be seperate but we decided to have the PA's take pt's in the main ER (they "cherry pick" the fast track pt's) We found that when fast track was slow the nurse over there was knitting...or reading...or playing online when the rest of us were busting our butts. We rarely have to hold pt's. Our ICU and med surg floors try to be very cooperative with the ER to prevent bottle neck's. As both a floor nurse and a charge nurse I try really hard to staff with 3:1 ratio's. We have one tech per 7-8 rooms. When you say 2 nurses from 7-7 how many rooms do they each have? and do you have a designated triage nurse? How about a charge rn? I'm really more interested in HOW you decide who works what shifts/days...Do you have a set schedule? Do you choose? Does someone else choose and you just work whatever you are told to work?

Our poor little ER is going through HUGE changes in staffing. We are needing to staff to expected pt census. Meaning less RN coverage in the morning hours and more in the evening hours. The new manager tried a "self schedule" where we were all placed in groups (a,b,c,d) weekender's always choose first then it rotates through a,b,c,and d. If you are last to choose you are completely hosed. They have made 4 different day shifts. 6-6, 7-5, 9-9 and 10-10. All dayshifters protest the 10-10. (in my opinion this is swing and we shouldn't have to work it) The self schedule option is not working. The staff wants to go to a template or a matrix where you know what you work till the end of time and if you leave your position the nurse that takes it agrees to work your matrix/template. My question to you all that have a template/matrix system is HOW did it start? How did you fill in all the little holes and come up with a system tha works for BOTH the ER and YOU??? I would love to see anyone's staffing grid if you would be willing to email it to me. I would LOVE to hear about any scheduling options that work. ANY ideas would be welcome. Our staff is nearly ready to rip each other apart in order to A) work the days we need/want to work and B) do as few 9-9 and 10-10's as possible. we are trying to staff for 90pt's per day. heeeelp...

is your 30minutes all cardio? If so, I would try to squeeze in maybe 10minutes of some kind of resistance or weight training. I know it is easier said then done, but adding weight workouts seems to help me with the weight I seem to so easily put on...Also, could it be water weight? I am like a giant waterballoon sometimes and cutting back on sodium really helps. My doc also rx a very low dose of hctz. (I only use 1/2 25mg tab for 2days of the month) This seems to help. When I was in school I bought a set of 10pd dumbells. I would eek out about 10 minutes at night (in front of the tv) to do some curls and pushups and situps. Real quick, real easy. ((()))

I met my husband when he was a newbie RN and I was a newbie CNA. (we were "set up" by the RT:p ) We got married the year I started my LPN program and had been married (with a sweet little girl) for 4 years when I FINALLY got my degree! He has been a nurse for 8 years. I have been a nurse for 6 (LPN/RN) I love being married to another nurse. He totally gets the stress. He is VERY smart and a really good nurse so asking him questions during school was really helpful. (I even call him from the breakroom when I have something that I'm not sure about:LOL)

Hi there! My daughter is a senior this year and taking the CNA class at her high school. This is a wonderful way to see if nursing is what you want to do. If you are interested in nursing I would be taking science/biology classes now to help you prepare for your degree. My pre rec classes included anatomy/physiology, english, math, chemistry,sociology,psych and an art class.

I work in a level 1 trauma center. (very very new here) I had my first burn pt yesterday. This pt had 2nd and 3rd degree burns to 45% of pt's body. Full circumferential trunk, arms, hands. No face involvement. Airway fine. Anyhow, it was a very sad case d/t the age of pt. We shipped to the closest burn unit asap. I am wanting to know what you do when this type of pt gets to you. I know the rule of fluid replacement. Does this pt get debridement right away? What about pain control? infection? nutrition? tx? How long does it take (best case scenario) to heal from burns like this? Thanks in advance

You need a good sun-hat too. They also make very lightweight breathable long sleeved t-shirts that won't make you roast in the sun.

The only specific that they told me was that I needed to be able to move my pt's faster:chuckle Which is a total crack up. The incident they gave me was no way my fault. I had a family practice doc send a pt to the ER with "orders" They read "no need for ER doc to see. order cxr, cbc, chem 12 and wait for my admission orders after these tests are done" I ordered just as he asked. I did a brief assessment. pt v/s all in normal limits-just c/o sob and has some dim bases. I check with my preceptor about starting a line and ordering anything else and she says nope. So the family practice doc shows up at the hospital wonder why his pt isn't admitted yet:confused: charge nurse makes him look at the orders he wrote. He apologizes and asks for a bed. I call bed control and am told no beds available-they need to be cleaned. I'm finally given a bed and I try to call report. No one will take report-they are still telling me the bed is not clean and they will call me back when it is. Meanwhile I am thinking that I should start a line. (so I do) I am still waiting. So I call them back. Sorry no go. I tell charge RN. She gets the med surg charge on the phone and MAKES them take report. Of course family practice doc is on the floor WAITING for this pt. (unhapilly at this point)--My fault? I guess so. I appreciate your replies. I have a mtg today with my manager. I hope I will have further info. I know I am not ER super nurse. But, I can throw lines in with the best of them. I can assess pt's quickly and intervene when I need to. I work well with the other nurses on the floor and they really have seemed to accept me. My family is ready to sell me. I guess I have just answered my own questions. I think if they can't let me off orientation this week I will have to just stay with my day job. But this is the only trauma hospital in the valley:scrying: and I like trauma...

technically I'm not a "new grad" I have been an ER nurse for 2 years. I think that is why my ego is so bruised. (and yes, I know 2years is not a very long time) I'm afraid to quit the new place--Don't want to shut any doors.

My ego is terribly bruised. I have been an RN since 2004. I was an LPN for 6 years prior to that. I work in a small-ish hospital in the ED. (I love it) I wanted more experience and more action:stone so I applied and was hired at a bigger hospital. I was told that with my level of experience it would probably take a while to get me oriented. (I only wanted to work PRN at this hospital) I thought "ok, fine" and started my orientation. That was (I am humiliated to say) back in november. Granted, when I started I was only orienting for 1 day per week. My preceptor coordinator told me I needed to commit to 2 days per week of orientation to get me through. I have been working 4-5 days per week since the begining of January. I am so exhausted that I just want to quit. I thought that I would be done this week, but my preceptor coordinator called to schedule my next few WEEKS of ORIENTATION. I can't keep working like this. I really like both places. I am more loyal to the smaller one-and it pays a helluvalot better too. I asked for specific's on what I need to work on and was just told "with your level of experience we feel it is better for you to have a good orientation" I KNOW that I am fairly inexperienced. BELIEVE me. But in my home hospital I am doing fine. I take really critical pt's there with just a little twinge of fear (I don't think that will ever change) But my self esteem in this new hospital is knocking me down. I'm trying not to act afraid, but the longer they keep my orienting the stupider I feel. How long is a good orientation? What is it that you preceptors look for? What makes you think someone is "ready" to go out on their own? lemme have it...

of course. monitor, b/p, sat monitor. I was adressing the c/p protocol. I guess I just assumed everyone would know that any pt presenting with c/p would be put on a monitor.

ekg in 5min. start a line draw the blood-order the cardiac panel nitro sl x3-depends on b/p asa @ 325mg ox at 2lt md to see ekg within 5minutes morphine is a sticky point-we have a "pain protocol" that includes being able to pull morphine for chest pain without a doc's order. I hesitate to use it-only if the doc is impossibly busy.

Let's see...Here is my workout schedule. If I work 3 12's in a row I will get up super early the first 12 and do 30 minutes on our treadmill with hand weights. I will come home the night of the second 12 and TRY to get at least 45 minutes on the treadmill or take the dog on a 45 minute walk. Day 3? forget it:rolleyes: On my days off I alternate between the gym (hour cardio/class then 20min wieghts) and running (at least 3miles-sometimes 5) Yes, I am completely addicted. The problem is that I LOVE to eat. And I have worked out like this for so long that it no longer drops the pounds the way I would like:(

I like most of my pt's in the ER. I really really like to be able to give comfort to people when they are scared or hurting. But, as everyone else has said...I am not a "waitress" Nor am I someones personal assistant. I worked so so hard yesterday. I had a triple A in one room and a pt with sats in the 60's next door. But in my third room I had a toddler that had been on abx for 3 days and now had diarrhea. This toddler was running laps around the hospital (and eating cookies and drinking juice). I asked his mom (very politely) to contain said child. after the third time of almost running him over with a gurney I was not so polite. Mom scooped him up-parked him in the bed in the room and forced him to stay in the bed while he SCREAMED the entire time. I brought coloring books and suggestions for entertainment (hey, I see you have brought toys and books maybe he would like it if you read to him) But no. If she was going to wait she was going to make everyone suffer with her. When the doc got in and gave her the abx do this and baby needs a bland diet with lots of good fluids speech she complained that the nurse "hurt the kids feelings" and told the doc that she expected an apology from all of us for the wait and the treatment she recieved. I hear her say this while I am next door breaking down the crash cart. I did NOT apologize. I did not like her and I was not overly polite to her as I took her out to sign out. I do not expect my pt's to be my biggest fans. I expect human decency from them. I have seen people with amputated limbs be POLITE. I do think some ER nurses are mean and bitter. They have seen too much and been treated poorly for too long. I hope if I ever hit that point I find another line of work.

:chair: Were you at my ER last week? We only have one doc from 0800-1200. Usually the nurses have everything done by the time the doc can get in to see the pt. Last week our poor doc was completely slammed. We really didn't have a tremendous number of pt's--we had one really complicated one(our doc was on the phone trying to get this pt transfered out) and a few minor things going on. We were all taking advantage of the "downtime" But, I know it probably looked bad:uhoh21:

Telling them to sit tight is totally appropriate. It is not a matter of "better things to do" it is a priority list. Child with breathing difficulty takes priority over water and warm blanket for grandma.

Do you mean something is physically stopping the foley from advancing? Or you don't have an order to insert foley??

I had a pt come in with a letter from her pmd that basically states "this pt is taking so many narcotics that she will require excessive doses of med's to help with her pain-if pt presents in ER please contact me to discuss her care" We called the primary doc and he attempted to help our ER doc decide what to do with her. End result was to refer to pain specialist (AFTER 4mg dilaudid and 25 of phenergine) pt left crying and waving her "letter" saying that she was still in 8/10 pain and needed another shot of dilaudid. This is a frustrating situation for everyone involved.

How do you answer this question? It seems to be the triage nurses job to keep everyone posted about the "wait time" I got so irritated at that question yesterday! I had a lady with a "toe infection" who waited 3 hours. She asked me about the wait EVERY 15MINUTES. She had a toe infection for 3WEEKS! Why was today such an EMERGENCY? Because she had a date and wanted to wear open toed shoes:madface: Seriously...what do you tell people waiting to get to a bed? Can you ever even guess? I try not to EVER tell someone "15minutes" or "2hours" because if you get ambulances in the back door and the pt ends up waiting--whew...bad scene. and, how long to most people end up waiting in your ED?

I don't have the exact numbers in yet... Yesterday was absolutely insane. We were short one tech. Our ER is smallish-We have 14 beds and 4 fast track beds. EVERY bed was full ALL day yesterday. At one time we had 12 people in the tracker (waiting for triage) and 7 triaged and waiting for beds. No one got lunch. No one got breaks. I ate standing up when I started shaking from low blood sugar:lol crazy profession we have chosen:rolleyes: