room assignments/responsibilities

**canoehead, BSN, RN** · Mar 29, 2007

I worked in an ER that tried that system for one day. I complained because I didn't know when a new patient arrived or how sick they were. So if I was doing something in one room everyone else waited until I happened to walk past their door again. I had an abd pain waiting 30 minutes without an assessment or even a hello because I didn't happen to see them and no one told me they were there. If I don't do intake on the patient or take report I can't take responsibility for them, no matter whether the previous caregiver put them in "my" room or not. When a patient is just dropped off like that I think it is abandonment in the simplest sense of the word.

RunnerRN, BSN, RN · Mar 29, 2007

We moved into a new dept 2 years ago. Our old department working in a "pod" format....one nurse was assigned to 3 rooms/2 hallway spots at a time. The new dept has 15 rooms, 2-3 hall spots, and up to 5 nurses depending on acuity and time of day. So we went from having "these 3 rooms are yours, and these patients are yours" to "you guys sign up for these patients as they come in."

I love this system - I think it promotes teamwork more than the old way. BUT the problem with this system is that it allows certain nurses to slack. We had one nurse who did the same thing that you're talking about - she would sign up for a patient to look good, but wouldn't get to go see him. Or she would just not sign up for patients.

Everyone assumes someone else has talked to management about it, but that isn't always the case. I think you have 2 options....either talk to her directly if you feel you can, or go to management and just say "some of us don't feel X is pulling her weight" and include exactly what you said in here. It is easy to feel taken advantage of in a dept that relies on teamwork if not everyone is doing their share. This kind of nurse needs to stop.

Good luck!

neneRN, BSN, RN · Mar 29, 2007

We use this kind of system too, and we do have a couple nurses who slack off at times...get your charge/supervisor involved if you don't feel comfortable speaking directly to the nurse about it. It needs to be addressed, and if charge/sup isn't aware, then how will the problem be fixed?

Ariesbsn · Mar 29, 2007

What kind of rapport do you have with this nurse? Is she a new nurse or new to your dept? Before I went to management, I would try and feel out what the real problem is. For all you know, triage may not be telling her they brought patients back. I'm not saying it makes it right for her to ignore the patients. It doesn't. I just think that sometimes a positive nursing intervention can go a lot further than management descending on a person.

ERERER · Mar 29, 2007

we are trying to deal with this among ourselves. I do not like to "write someone up" or blah blah blah to management unless it is something we can't handle ourselves. This particular nurse has been taken "outside" and talked with, given direct orders, given report from triage, etc. Whatever intervention we have tried has only made the situation worse.

Is there a better way to divvie up the ER than assign rooms?

Trauma Columnist · Mar 29, 2007

I worked in a large level one truama center for 10 years:

When I first started, we did the pod thingie - you got 3 rooms and were responsible for all the stocking, cleaning, etc. (Yes, I know but we had no techs, no housekeepers, nobody - this was in 1996). My rooms always looked like hotel beds and everybody teased me.

Next, we went to the color concept - where you as an RN were assigned a color like blue and the blue nurse took first trauma/full arrest and had 2 "fast track" rooms. Didn't work well.

Next was the team concept where the ER was divided into two teams and then you had 4-5 nurses on each team and you made your own assignments. I liked this if you could get your friends on it because you knew how you all worked.

mamalle · Mar 30, 2007

we have our cardiac side and medical side divided. so normally in our 6 bed cardiac side we have two nurses. on the B side we have one cardiac bed and 10 beds for medical patients. this am I was the only B side nurse until 11am. I started off with 2 patients and a triage to do on a 89 year old female that was from the nursing home who fell out of bed. she had dementia and blind. Of course add a JACHO visit and my day is shot to hell. I had almost every room filled by the time 10:30 rolled around. Luckily I had a charge nurse to help with a few fast tracks but thats a normal day in our ER. we also have a trauma side we can use for monitored patients so you just never know where you will be. I make the medics wait to give me report but I do have triage nurses that put patients in rooms and say- by the way thats yours, etc... for the most part we all work together but there are a few that really are not team players... :idea:

NicoleRN07, RN · Apr 18, 2007

We do the Pod thingie...didn't like the idea at first, but it's better than the team approach where our dept was divided. I don't feel so overwhelmed in my POD, because I am only concerned with my patients, and when my Pod partner is overwhelmed, I help pick up slack, and vice versa.

EmerNurse, BSN, RN · Apr 22, 2007

Ours is similar with each nurse assigned a "zone" - with zone 1 being the "hot zone" with crash beds, and zone 2 taking overflow from that, and it goes through zones to the very least acute at the other end. A few of us seem to be permanently assigned to zone 1 & 2. Mind you, if we only have one bed available, it gets filled regardless of zone/acuity - all of our beds, except 1 hall bed, are hardwire monitored. We're not necessarily told when someone lands in one of our beds - it's our job to notice a new body on a stretcher, which isn't too tough since the stretcher is barely cool before the next person lands in it.

With staffing and overcrowding and acuity the way it all is, I can't see how things can improve. Btw - our fast track is an entirely separate area from the main ER and closes by 10pm on the dot, every night. Which of course, when everyone decides to call 911 for vague belly pain x3 days that turns out to be a perf'd bowel. Gotta love it.

chip193 · Apr 22, 2007

Btw - our fast track is an entirely separate area from the main ER and closes by 10pm on the dot, every night. Which of course, when everyone decides to call 911 for vague belly pain x3 days that turns out to be a perf'd bowel. Gotta love it.

Your missing the rest of the patterns for the day:

0600ish - I can't possibly go to work because of my x pain that's been bothering me for three days. I thought it would go away, but it didn't.

1500ish - My doctor's office told me that they can't see me today and my x pain that's been bothering me for three days really shouldn't wait any longer.

2200ish - I can't sleep because my three-day old x pain is really bothering me now.

Then, of course there's the trauma patterns:

0600-1800 - "I was [on my way to/at work] when..."

1800-2200 - transition period

2200-0600 - "I had a couple of beers when..." or "I was minding my own business when suddenly out of nowhere these two dudes..."

Now if the police could only pick up those two dudes, crime would be non-existant in most American cities!

BrnEyedGirl, BSN, MSN, RN, APRN · Apr 22, 2007

Those two dudes are in our town too!!! They seem to single out poor nice guys who are just out for a walk minding their own bussiness!!! Perhaps if we all got together, maybe contact the FBI we could catch these "dudes"!!!

:lol2: :lol2: :uhoh3: :uhoh3: :smackingf :smackingf :smackingf :lol_hitti

More to the point of the OP,..our ER is divided into the "trauma" side,.13 reg beds and 8 hall beds,.the "ED" side, ..11 beds and 6 hall beds,..then the "Fast Track"...8 beds,.each section is assigned its own staff,..on the Trauma side we are currently assigned "rooms" and when triage brings the pt back if they go into our room it's our pt,...we have been told we are changing to a "pod" or "team nursing" approach,.from what I understand we will have 3 RN's and a tech assigned to 5 rooms,..I'm new to the ED so I'm not sure I have an oppinion yet,...I'm not real thrilled with the way triage brings back a pt w/o talking to the RN,..like an earlier post said,.sometimes your tied up in a room and don't even realize you have a pt until Dr has been in and starts ordering IV, labs, meds etc,...maybe the new system will help this!!!