Hi everyone! I just interviewed at an ER in NYC on friday and they unofficially offered me the job! My goal has always been to become an ER nurse and I really want to do it as a new grad. The hospital orientation is 6 months long with a preceptor and 2 weeks of strictly classroom. It is a teaching establishment that is going for magnent status and is in the process of adding onto thier ER.
All of that makes me want to sign up and believe that I can become a great ER nurse. The terrifying thing is that the ratio is 8:1. I believe that they have it split up into critical and non-crital then they have a seperate asthma room, fast track, and ICU transfer....
Am I crazy to consider this? There is something exciting about being apart of the changes and the chaos.... But I don't want to risk my license when I'm just starting! I would think that the residents and attendings would really help out since it is primary nursing. What are some questions that I should ask before accepting the position? Thanks so much.
The acceptable ratio depends on the the severity of the condition involving the patients you are responsible for.
For example, If they are 8 "trauma" pt's then yes I can clearly understand how this may pose a problem. However, if these are 8 ambulatory pt's then no, they may not pose any significant problem for any specific concerns. I see no problem with caring for 10 or more ambulatory care patients for that matter.
It's a matter of keeping things in it's proper perspective. Patient management skills depends on how you distinguish your level of clinical abilities and how one applies that methodology to a specific number of patients.
Some can, some can't. It's that simple. The fact of the matter is that our profession needs to recognise the fact that each nurse has thier own set of limitations as we are not all created as equals.
Specializes in Emergency Nursing Advanced Practice.
The acceptable ratio depends on the the severity of the condition involving the patients you are responsible for.
For example, If they are 8 "trauma" pt's then yes I can clearly understand how this may pose a problem. However, if these are 8 ambulatory pt's then no, they may not pose any significant problem for any specific concerns. I see no problem with caring for 10 or more ambulatory care patients for that matter.
It's a matter of keeping things in it's proper perspective. Patient management skills depends on how you distinguish your level of clinical abilities and how one applies that methodology to a specific number of patients.
Some can, some can't. It's that simple. The fact of the matter is that our profession needs to recognise the fact that each nurse has thier own set of limitations as we are not all created as equals.
My Best.
Agreed. However, administration (in my experiences) rarely sees that nurses have limitations. Often there is a feeling that "a nurse is a nurse is a nurse" and there is no difference in capability, experience or competence. That is when it gets to be a problem. When you have a group of nurses who are understaff and are still expected to take on unsafe patient loads and there is no backup or safety net. Meds get missed. Wrong doses are given. Patients are forgotten about, often for over 2-3 hours. A bad trauma or traumas come in or an MI and then the load shifts to even more dangerous levels as the few nurses handling 20-30 patients now have 1 or 2 less nurses to help because they are 1:1 with the critical patient.
I worked long and hard for my medic license, my nursing license and now my NP. I am not about to throw it away because the administration cannot recognize dangerous practice patterns and refuses to listen to ways to improve them.
I completely agree but the focal point of the problem exists with administration. They are in it for the money and not for the actual quality of delivered pt care. They "speak" the lipservice like they are concerned about it, but their actions (or lack of any action) clearly demonstrate otherwise.
What needs to be done is to hold administration accountable using some method of measurement. Pt. wait times needs to be documented, complaints investigated or something which can demonstrate an influx of issues that affects the organizations bottom line.
"Money" or demonstrated loss of revenue is the only method of leverage that will gain thier attention and provide for any change in current staffing levels. Basically, if you can justify the losses in terms of lost revenue, you will magically increase staffing levels for the department.
Actual quality of care is a secondary issue. Sad, but that's the cold reality of the matter.
It's a matter of keeping things in it's proper perspective. Patient management skills depends on how you distinguish your level of clinical abilities and how one applies that methodology to a specific number of patients.
Some can, some can't. It's that simple. The fact of the matter is that our profession needs to recognise the fact that each nurse has thier own set of limitations as we are not all created as equals.
I think we've all acknowledged that taking care of 8 pts with a cough, sore throat, or other simple problems is not an issue- the issue is that nurses are being expected to care for 8 seriously ill patients- severe abd pain, traumas, chest pains, CVA's, hemodynamically unstable pts..... I don't care how much experience an RN has, it's not safe, and like others have said, this is how medications get missed, patients get forgotten about, and errors made...
I agree with Traveler. As ER nurses, we don't get to see the cough, sore throat pts. At least in my ER, they go to Quick Care or Express Care or whatever they want to call it. We get the GI bleeds, MI, pneumonia, A/P going to the OR, etc. 8 sore throats? I wouldn't be complaining.
Just this week actually, we were short 2 nurses. I took the medical beds and agreed to take the pts in a room (actually curtain). Rooms 5-14. That's 9 pts. all stable, medical/surg pts. Some admitted and some ER. Anyway, the doc asked me to "just give" the guy in the hall a med. I told him no and that I had anyone in the rooms but no more. I was at my limit. I had 9 pts who "just" needed something or another. I didn't matter what they needed, I wasn't taking any more. My charge nurse was aware and the supervisor actually came down and started IV and gave some pts meds because we couldn't keep up. The doc got mad, probably wrote me up. I tried to explain that I have a license too. I may not have gone to school as long or studied as hard but it's my license and wasn't going to risk it.
Now grant it, this doesn't happen all the time but still, admin doesn't care and God forbid if I missed something on those pts, I'm screwed, not admin. Anyway, 1. thanks for listening to me vent. 2. I agree, it's unsafe what they're asking of us. I wish ER nurses would band together like the CCU nurses and get a federal law passed capping us at a certain number of patients (acuity involved of course).
I am gleaning from your posts. Thank you all for responding and really offering advice that comes from experience... i think this community is a jewel.
Well, I started orientation at this level II trauma center. I am extremely happy with the administration there actually and the nurses that I have spoken with sincerely love the environment there, which is a big plus to me. The teamwork is amazing. It looks like 42nd street times square with everyone moving around, but it is organized chaos. Everyone knows thier part. The managers are already encouraging myself and two other new hirers about getting our CEN next year... I definitely want to go back to school and get my masters which they are supportive of as well. Full tuition reimbursment :) whoo hoo.
The ER is broken into 3 teams. On each team there are 2 RNs and a tech and they can have 8 to 10 pts. There is also an asthma room that is seperate with an RN and a tech holding up to 10 pts. The trauma bay consists of 2 code rooms and 4 beds for critical pts and that has two RNs and a tech. 9 RN's on a shift looks pretty good to me...We also have a fast track available.
While we will still recieve traumas, 90% will go to either one of the two level 1 trauma centers that are within 15 mins of us. I think this is a great place to get started. It's going to be crazy, but it wouldn't be fun if it wasn't a little frayed around the edges... I know my shifts will fly by.
I'm glad you guys are able to vent. I'm learning how to stick to my standards and protect my license as well.
It is sad to say that 8:1 is a reality for ED nurses in NYC. Diversion means nothing because everyone is on diversion, which really means that NOBODY is on diversion. Besides, if the patient requests to come to your hospital, they have to bring them there even if we are on diversion. I don't understand how the NY'ers that go down south complain about the wait times there, I know they are not waiting like they are here. They are either flat out lying, or have amnesia because there is no way they can be as miserable there as they are here.
NYer's complain down south because 1. They're used to getting everything NOW! A New York minute IS different from the rest of the world. 2. Sick people in general are miserable and 1 minute feels like an hour when you're sick and noone is helping you. And 3. because they see other people who came in after them be seen before them and that really pisses them off. Even if you try and explain that it's not a deli, it's not first come, first serve, it doesn't matter. They were first and that's all that matters! The other people are not their problem.
We currently have a 5:1 ratio in a 20 bed acute care ED. The ratio in urgent care is 5:1, and after fighting management for 2 years we finally got approval to increase our staffing, but not until we lost many good nurses due to the unsafe staffing of 5:1. I couldn't imagine what it would be like with 8 patients in an acute setting, unsafe and dangerous. I too would be afraid of risking my license working in a place with that high of ratio
Crash_Cart
446 Posts
The acceptable ratio depends on the the severity of the condition involving the patients you are responsible for.
For example, If they are 8 "trauma" pt's then yes I can clearly understand how this may pose a problem. However, if these are 8 ambulatory pt's then no, they may not pose any significant problem for any specific concerns. I see no problem with caring for 10 or more ambulatory care patients for that matter.
It's a matter of keeping things in it's proper perspective. Patient management skills depends on how you distinguish your level of clinical abilities and how one applies that methodology to a specific number of patients.
Some can, some can't. It's that simple. The fact of the matter is that our profession needs to recognise the fact that each nurse has thier own set of limitations as we are not all created as equals.
My Best.