room assignments/responsibilities

[ERERER]

In our ER we are assigned a group of rooms for the shift. Patients placed in those rooms from triage or EMS are "our" patients. If we are getting "slammed", everyone else usually pitches in to help out.....

Lately we are having trouble with one nurse who focuses in on one or two patients (out of 4 or 5) and ignores the others, assuming someone else will pick up the slack (IV, labs, meds, etc). She does not even acknowledge that there are pts in those rooms (how can you walk past one of your rooms, see a pt lying there, and not know it?). It is getting worse.

My question is aren't you legally responsible for your assignment? is triage placing a pt in one of your rooms considered a "hand-off" by JCAHO? Can anyone give me some constructive suggestions on how to deal with this escalating situation???

[chip193]

The 3 ERs that I work in:

(1) The FT Place - Level 2 Trauma, 55-60K visits, 23 monitored beds in the main ED, separate 13 bed fast track, and separate 3 bed psych ER. In the Main ER, the Trauma Section is two beds and during days and evenings, is covered by one RN. The Cardiac Section is three beds and covered by one RN. At night, the Cardiac and Trauma Sections are covered by a single RN. Step Down is four beds with one RN. "Cubes" is five beds with one RN (at night may be an LPN). "Pod" is four beds with one RN (at night may be an LPN and this nurse is also responsible for Psych at night). "Back Hall" is five speciality beds (Ortho, GYN, and ENT) and is one RN (section closed at night). Psych is covered by the two nuses in fast track during the day and evening. You are responsible for the patients in your assignment. Help with them varries by the crush in the rest of the place (if everyone's busy, don't expect help...but there's usually someone to help!).

(2) Agency Place 1 - Community Hospital, 22-24K visits, 10 beds in Main ER (7 monitored) plus unlimited hallway beds, three bed Fast Track, unlimited bed Psych ER. Two RNs for the main block of monitored beds (1-6), with hard assignment. One RN for the back (7-10 and the Psych ER). Additional RN for the Fast Track. At night, staff is 2 RNs and work is divided equally regardless of where patients are assigned.

(3) Agency Place 2 - Community Hospital, 30K visits, 14 Beds in the Main ER (11 monitored) plus unlimited hallway beds, Fast Track (that I've never seen), separate Psych ER staffed by the Psych Department (best idea in the world!). Each nurse has a rigid three to four bed assignment plus the hallway beds.

As you can see, around here, we do rigid assignments...but most reasonable people work around it!

Chip