Room assignments and pt load.

MajorDomo · Jan 16, 2006

Good Morning hollykate,

The 'magically appearing pt' is a pet peeve of mine. In the ERs that I have worked we were assigned rooms/teams/zones (or whatever else management decided to call it). Where I currently work, each nurse is responsible for 5 beds.

For the most part the charge nurse decided where the pts went with input from the bedside nurse. It kind of dampens moral when a nurse has two vented pts and the charge nurse gives that nurse a maniac pt to babysit.

When I am working bedside, I always request to the charge that they give me the chart and that I will bring the pt back, that way I can get a 'walking assessment' of the pt, figure out what interventions I will most likely be doing, start the inital documentation ect... before the doc sees the pt.

Some charges are good about that or atleast giving a heads up, like 'I just put an abd pain bed 4.' Others are not, then it is just a grin and bear it time.

When I charge, I ask the individual nurses what they prefer and try to abide by that for stable pts. I also tend to rotate an empty bed incase an unstable pt presents to the ER. This covers me so that I don't have to shuffle pts if a chest pain appears, it also gives the nurse with the empty bed time to catch up and/or take a breather. I also frequently ask how each nurse is doing and get dispo updates, so I can plan on who to bring back next. Communication is key as is knowing each of the nurses strengths and weaknesses. Newer nurses are given more time, complicated pts are given to the 'stronger' nurses, ect...

MajorDomo

ER2Ed · Jan 16, 2006

The ED I'm at has "sides" - if your one side one beds 1-8 belong to you and your side-mate(s) (depending on staffing that day). When busy you get hallway patients. Triage brings them back, ambulance calls come in and whoever takes the call puts that ambulance wherever they see fit and on the assigns it to someone. We have a tracking board they put your initials up there with the patient assignment. When slow or if you are standing there when triage comes back you get report - otherwise you have to keep watching the board to see if anyone gave you a "new one".

When slow it's not a bad way to go. When it's busy - it's terrible. Often you discharge your 3-7 patients (we have no ratio or acuity limitations) and get slammed with who knows what seconds later. Sometimes you have two people in restraints and two MIs at the same time. This is the kind of thing that makes me want to see nurses become a heck of a lot more organized!

erjulie · Jan 16, 2006

in our 21 bed ED (40,000/year) level 2, there are no room assignments. The charge nurse assigns pt to you depending on what you have going on. We have a tracking board. This works well with most of the charge nurses, but there's always one! She is clueless as to acuity/timing, etc. Finally I asked her why I kept getting slammed, and she told me because I never complain. Well, that changed pretty darn quick. I think she's clueless because she a) doesn't like confrontation and b) hasn't too much experience in ED. She is expected to start patients who appear in our beds, if we're not available. Sometimes that happens, most often not. I think the benefit of room assignments would be that you'd be sure that your rooms are stocked...that's a nightmare without room assignments.

ClaireMacl · Jan 17, 2006

Our Ed is a bit chaotic to say the least being one of the busiest in London, but room allocations are pretty good, the only exception being resus.

Resus is four bedded and only includes (obviously) the MI's, traumas or possible intubations... sometimes you can have four pt's all critically ill and get no help at all! In Majors, we have 15 beds, 1-4 are potentially critical monitored pts, usually a more senior nurse running that. 5-9 is general and gynae, 10-15 is general and psych. Most of the time of late there is no float nurse (we don't have CNA's or anything), it can be very very demanding and often you have a pt in the bed and a person sitting on the chairs with a possible critical problem waiting for the bed. But at least we don't have toooo many pts, minors is usually the most manic place!

neneRN, BSN, RN · Jan 17, 2006

In my ER, each nurse is has a room assignment, and these assignments are switched daily. This is in a Level II, >110,000 visits/year.

We have 3 critical rooms; in these areas, it is one RN for two pts, as well as up to two hall pts. These nurses get all the vents, codes, MIs, anyone unstable. Typically only our stronger nurses work these assignments.

We then have blocks of 5-8 rooms, with up to three hall beds, that are assigned to an RN, an LPN, and a tech. They don't get unstable pts, and if a pt starts to go downhill, then that pt gets bumped up to one of the critical rooms.

Charge places ALL pts and does not take an assignment. The charge nurse sits at the desk to be able to watch all monitors and answer all EMS calls. All charts of pts waiting out in triage are kept in a stack at the charge desk so that they can be reviewed and placed. All pts walked directly to the back from triage are wheeled to the desk so the charge can review chart, give the pt a lookover, and place the pt.

Our big dry erase board is right next to the charge desk, so that available rooms/filled areas can be kept updated.

This is just for the critical care area; we of course have a fastrac, but also have a separate intermediate care area that gets stable pts, i.e., simple MVCs, Fxs, ob/gyn, abd pains, dehydration, N/V, etc. We also have one of the RNs from the critical care side that runs a chest pain screening area- her assignment is one room where anybody coming through triage with chest pain goes; she starts a line, does EKG, bedside chem7 and troponin, and fills out a chest pain screening form before sending the pt to the charge for placement.

TazziRN, RN · Jan 17, 2006

I currently work in a rural ER where there are two RN's on at a time, and we take turns and help each other out. Not uncommon for both of us to work on the same patient during a visit. In the last ER I was in (14 beds) we were assigned rooms but if our room wasn't busy we pitched in elsewhere.

Trauma Columnist · Jan 17, 2006

I work in a level one trauma center (65,000 visits/year) and we have "zones" five total, and each zone has three nurses (all RN staff), one-two techs and one attending MD and two residents (we have an ER residency program). We work as a team and though there are definitely some very bad days, for the most part, its not too bad. The doctors help out when they can and that makes it a real team effort.

errn7 · Jan 22, 2006

In the local ER I have worked for the past 10yrs. We have 13 beds we have 5 nurses from 11/11 plus 1 triage. We have 3 rooms each with the charge nurse taking the Code room. We see 36K and usually stay full most of the time. The traige nurse most of the time will rotate until we are full and then its whoever has an open bed. When we get full and an ambulance comes in then we use hall beds. Usually whoever is free will take care of the hall pts....Most of the time we all work together if something needs to be done regardless of whose room it is...

Uptoherern, RN · Jan 23, 2006

this is interesting. Our new manager tells us that the national average load for an ER nurse is 5 patients each. ???

We typically have (and this changes day to day, it seems) 4 rooms each, plus sometimes we are assigned to a hall bed, or to our L & D room for gyn. exam. We normally have no tech until 6 pm-6am. Fast track opens 11-11. We have a dedicated triage nurse. Our charge is supposed to have no patients and "facilitate" (getting pts. out, up to floor, trouble shooting, etc.) But depending on who is in charge, I find it easier on all of us if the Charge is the triage nurse, or the charge has her own patients. (this brings us down from 4-5 each to 3 each), Even with 3-4 patients by yourself, sometimes you can barely keep your head above water. If you discharge all, then you get all new patients. Of course, then you have all new assessments, interventions, etc. What takes the Dr. 3 minutes to write may take the RN 30 minutes to do! and with no tech, if you need help you just have to search for another RN to help.

ED RN 911 · Jan 25, 2006

40 bed ER Level I. We are staffed with only RN's and Medics, we each take a room assignment of normally 3-4 beds each. Usually goes like 1 crit bed and 3 monitored beds per RN or Medic. We have no LPNs or Techs. MD staff consists of 4 Attendings and 4 Physician-Extender Paramedics

kitcat3968 · Jan 27, 2006

I come from a 24 bed, 40,000 per year, suburban, soon-to-be ghetto, level 3 ER. As far as patient assingments go, we used to have primary nursing, 1 nurse to 4 beds. It worked very well. However, the senior staff found it quite amusing to let the new kids sink or swim and not help out when they were caught up. Because of this, we switched to "team nursing," 13 patients to two RNs and one ancillary staff (aide or EMTP). The problem with team nursing comes from having more than one critical patient at a time because then both RNs are busy and the ancillary staff sure as hell can't handle it. OUr charge is pretty much responsible for bed assignments from triage and squads. When I charge, I try very hard to bounce back and forth from team to team, provided there are beds available in that area. I have also worked at a 75 bed, 100,000 per year, inner city, level 1 ER and it pretty much functioned on the concept of primary nursing with the ancillary staff floating between a number of nurses. The ratio was generall 4:1. I much prefer primary nursing and specific assigments because it allows for accountabilty, responsiblity, a better knowledge of your patients, increased ability to detect subtle deteriorating changes, and the more interaction. But, management doesn't want to hear it because team nursing allows for more patients with less RN staff - which, I guess makes sense because of the lack of staff any facility is able to keep for long.

Just my opinion.

Cathy, RN, BSN, Cleveland