RN burn out in ED

[BSNtraumaqueenRN]

I have always loved ER nursing! I currently work at a high stress level one trauma center that averages 400 patients per day. I am a new grad but as a student I have been in this ED a lot over the past 2 years and there are only a handful of nurses that are still working there. A lot of new people are hired but nurses usually don't stay long.

ER nursing is physically and mentally exhausting but this ER is amazing the atmosphere is great. This is a teaching hospital and for the most part the attendings and residents have great relationships with the nurses. Team work is huge here! We have Pharmacy for the Er only they come during codes, RSI, traumas, etc. we never have to crack open the code carts bc the pharmD always hands the nurses everything they need!

Although we do have NAs, they are hard to find during the shift so I always try to handle my assignment without NAs. I understand that some RNs ask to much of NAs! When you are looking for an NA for15 minutes to do an EKG, I just think that is ridiculous because the RN could have done it her self in that time. We have issues with keeping NAs and RNs and I don't understand why? What do other ERs do to keep there staff that we don't do? I would just like to know how it is in other ERs?

[emtb2rn, BSN, RN, EMT-B]

Glad to hear your enthusiasm. But, high/rapid turnover is usually a red flag indicating employee disatisfaction. You're in the honeymoon phase so you may be overlooking things that have experienced rns voting with their feet.

You mention great teamwork and then say pct's can never be found. That's a contradiction. Something is going on.

Do you know why people are leaving?

[BSNtraumaqueenRN]

I can't figure out why people are leaving?

The great team work is between the RNs and the physicians but there is a disconnect between the RNs and NAs

[Sassy5d]

I've only been in ER a year now.. Been in nursing much longer.. But if I had to guess, I'd say volume and patients.

Many left right before I started, some that were hired after me are already looking for jobs.

What I hear, is the volume, and the patients. Some people just don't like the fast pace and the chaos. The last 1 said to me they'd like to work less and make the same. This is true in nursing. Home care, a few pts a day, make the same amount as the icu nurse and the ER nurse.

I think it has a shelf life. The prn's are always happy.. They've been there forever.. But many only work 1-2 shifts every 2 weeks. No wknds or holidays.

[BSNtraumaqueenRN]

That is a good point!

I guess what I am wondering is what kind of staffing models are used in your ER? What is the nurse patient ratio?

I've heard of team nursing where the nurses work in pairs?

We have a code nurse that is like a float and the nurse helps out in code strokes, sepsis, stemis, and traumas, etc. nurse patient ratio is 1:4 in our ER.

[Sassy5d]

We're 1 to 4 but it's not based on acuity. Sometimes I have 5 pts. We try to have free charge.

[Z71RN]

we have 4 rns and 1 er tech from 7a-11a, then 11a-11p nurse and tech clocks in. so from 11a-11p ther will be 5 rn's and 2 er techs. thank god we dont see 400 pts q 24hrs! our 24hr avg is right at 94 pts, which about 65 of them will be seen during 7a-7p. our er functions well too, though we have poor leadership over our er. both the manager and 2nd in command are basically absentee bosses. i came to this er about 8mos ago and the ones who trained me have long gone and basically there are few faces still here that were here when i came. im considered a old timer here now!

[emtb2rn, BSN, RN, EMT-B]

We have a code nurse that is like a float and the nurse helps out in code strokes, sepsis, stemis, and traumas, etc. nurse patient ratio is 1:4 in our ER.

Your ratios sound good, so the reason for turnover lies someplace else. Keep doing what you're doing, learn as much as you can and have fun. With more experience (and when the glow wears off) you'll probably be able to discern the reason for folks leaving.

[Lunah, MSN, RN]

People leave for lots of reasons: different shifts, better commutes, opportunities for growth, etc. Some go on to places with different populations or different paces (faster or slower). Some go elsewhere for different/better benefits. Whatever the case, turnover is common in the ED. I have worked in a few different EDs, and you can pretty much guarantee that the mix will change from year to year. The EDs that I worked in as a civilian RN were fantastic, for example, and I would have happily remained, but I left to be an Army ER nurse.