Room assignments and pt load.

[hollykate]

How does your ED manage patient assignment???

I've recently started traveling and am on my second ED assignment. The ED I came from (A largeish Level One trauma center 50 beds plus we unfortunately usde hallways) has us responsible for our own assignment with the team leader coming down on you if you weren't picking up enough patients. There was a high peer pressure factor, and if a nurse couldn't/woudn't pick up patients in a timely manner they were essentially "shunned" (New nurses of course are helped in this matter, and not shunned, but the person who has worked there for 8 years and is trying to get away with taking care of 2 pts at a time all day is not appreciated) Occasionally we did have problems with repeaters coming in and no one wanting them, but generally the team leader then just put the patient somewhere and we all sucked it up.

I'm now on my second assignment where I've been assigned rooms. At the first ED it wasn't too busy (Don't let them hear me say that!) and the ED I am in now it is still not that busy, so it isn't that bad.

But, I do find it unsettling to have been in a room for about say 8-10 minutes to:

Put a patient on the monitor, start a line and draw labs, get the history and do an assessment, and maybe say, put in a foley. and when I come out I'm needing to get an xray and an EKG, and send off the labs and there is some guy from triage sort of groaning away... usually it's fine, but when I discharge 4 out of my 5 patient and get 4 new ones right away, I find it a bit unsettling.

I see the benefits of a fairer workload with assigned rooms, but I also see the side of not knowing what is really coming (Knee pain guy turns out to be also having Chest pain for a few days, and looks odd on the monitor...LOL who fell seemed OK in triage but back inthe back appears to actually be having a TIA or CVA...)

So, I'm wondering how do you do it? Do you assign rooms? Who decides which patients go where, and when. And how does it work? I heard recently that my old ED is trialing room assignments, so I guess it is the wave of the future (Or maybe we were very behind the times and its the wave catching us up??)

And for all of you room assigned people, any tips for keeping up with the patients that magically appear in the beds? They say I'm doing ok, but I can tell I'm a bit slower than the rest!!

[PennyLane, RN]

We're a busy community ED. 63,000 visits/year. Each RN has 3 assigned rooms, sometimes 4 if we're short-staffed. Ideally each tech has 6 rooms (works with 2 RNs). We will also put ppl in the hallway, but usually we have float or hallway RNs for these patients. The charge RN never has an assignment. We have 2 triage RNs, and an 8-bed Fast Track area with 2 RNs and one tech.

It works OK except when you spend an hour in the room with a nrsg home patient covered with poop, pee, multiple decubs, trach, vent, etc etc etc, only to come out and find you have 2 other new patients and orders waiting in the rack. The other nightmare is finding all 3 patients up for discharge at the same time.

[TinyNurse, RN]

always in an ER I've had assignments ( 2 yr traveller). whether team or self assignments. Then again i started off in a 9 bed ER where it was give and take as far as assignments go.

you need a strong charge nurse to fairly balance the workload, that is what they are there for.

magically appearing patients.???? well, yeah that happens anywhere, because in the ER , they just keep coming,.

please PM me to let me know more about your current assignment. thanks, jen

[Cary_Rn]

Where I work, we use room assignments at my one job and dont at the other. I seem to find I like the room assignment option. We have a specific set of room assignments we use each day.

My ER has 1-4 cardiac beds 5-7 general medical, peds, ent, gyn, and othro, we also have 3 basic urgent care rooms a,b,c and the trauma room that is not assigned generally.

Our max staffing for the er is 5 nurses during the week and 6 nurses on the weekend. And usually 1 secretary and 1 er tech, our room assignments go as follows.

5 nurses

1, A - Charge nurse

2, 5, ortho, ent

3,7, peds, c

4, 6, gyn, b

triage

with 6 nurses,

1, ent - Charge nurse

2,5, ortho,

3,7, peds

4,6,gyn

a,b,c

triage.

I like this you are typically not suck with the same room every day of the week. the triage nurse decides which pt goes in what room and if needed consults with the charge nurse.

If we happen to have a good triage nurse she will divide up the rooms appropriatly, and not give one nurse 2 pts back to back unless she has to and the triage nurse with come out and talk with you about how busy you are and give you a heads up. Last year I believe our census for the year was around 35,000.

AT my other job the 2 nurses on for a small rural hospital take turns with pt. it is a 10 room er with a trauma room.

I personally perfer the room assignment aspect and works well with the enviroment and pt complaints we usually have.