Difficult night, heavy trauma/high acuity... vent/insight

You say leaving is not an option, but this is exactly why I got out. I miss a lot about ED nursing, but I am sooooo much happier now. There is not a nursing shortage, there is a staffing shortage, and until hospitals start pulling their heads out of their behinds and staffing appropriately, I'm outta there. I won't be one of the overburdened nurses who kills a patient because my workload is just plain unsafe.

Some might see it as "abandoning ship", but I don't. I do not believe it for one second when the administration cries "We're so poor! We need to cut costs!". Baloney. If that were true, they wouldn't still be getting their bonuses. The decision to prioritize profit above patient safety was made by them, not by me, and I refuse to be a part of it by continuing to work under those conditions.

And you know what? They still haven't filled my position, and I left months ago.

I am an ED nurse too and this was exactly what I was looking for, I was really worried about the unsafe working conditions of emergency departments in general, after our hellish night last night. I know it's the summer holidays and tidal waves of patients are piling in, but with lots of our staff off sick and the rest burnt out already, we need more staff on nights... simple!!! They are the same if not busier than days, and with a lot less clipboarding. Why don't the big cheeses spend a friday and saturday night seeing what an ED dept is REALLY like???

Don't get me wrong we're used to rudeness, aggression, glaring looks, complaints but the sheer guilt and sadness of not being able to look after everyone properly was ridiculous. Talk about sweating in the workhouse while the fatcats sleep!

After 3am we only had one locum (agency) doctor on the floor, who was the ED lead in a trauma team for about two hours, also during the night resus was full, over the course of the night we had a stabbing, fitters.... lots of poorlies, the saddest being a young cardiac arrest the same age as my husband, with a very dignified family, it was heartbreaking.

I was allocated to minors yet again, my fourth night running, left to just get on with it, and explain to the many walking wounded, drunk, and two abusive ladies, why they haven't been seen for 6/7 hours. What was truly amazing was that some patients had even seen CPR and emergencies rush and in the same breath were incessantly inquiring when they would be seen, and do they have time to go to McDonalds???

I honestly spent half the night apologising, explaining, placating. And I bet I will be pulled into the office and criticised for giving someone a rolled up blanket instead of a pillow. Even the ward staff left me speechless, one nurse knew full well what was going on in the ED (rumour mill runs fast) yet she still had the audacity to complain when there was no observation chart with the patients notes, the patient had only been with us about an hour and a half, with two sets of his obs recorded on the ED card. I do worry about humanity sometimes.. and I love emergency nursing but.....I'm going to pastures new I'm afraid, I've had enough of being flogged to death, without a sniff of any career development, dumped down minors day after day, watching awful people get promoted, and missing everybody's parties! You can find some other mug ;-)

Your story seems to reflect reasons for which I don't care for Primary care nursing. My hospital works on a team nursing principle, generally, and the RNs have their LPNs or Medics to rely on as well as their techs. Between all our medics, techs, and LPN/RNs things move smoothly enough (generally speaking).

What a great thread that speaks to me! I, too, have been an ED nurse for many, many years and know that my time in ED is coming to a close soon. I don't think this is just a summer problem and it will end in a few months. I think it is here for the long haul for a number of reasons. The economy in general is in shreds. Everyone is tightening their belt just for survival. Gas costs are up, food costs are up, taxes are up, so it is no surprise that health care costs are up, reimbursements are down, and cuts are being made at every level.

I work in a very busy ED 120,000+ per year. We are in better shape than others I have seen on this forum in terms of staffing. I really DO believe our ED management is doing the very best they can. They are not above coming in on holidays, nights or just horrible shifts to help out. They don't take patients, but will transport, start lines, make runs to the lab, and order pizza for us! But it is still very quickly taking it's toll on everyone.

At peak times, we have 2 triage nurses, 2 triage techs and a "greeter" nurse who does a quick screen to decide if the patient is appropriate for fast track, needs to go to the main ED quickly without triage, or can safely be triaged and wait for a room to open. We have 4-5 hour waits every evening with 40 or so in the waiting room at one time. These are the ones who are too sick for fast track but not sick enough for the main ED immediately, so they are our level 3 patients...urgent.

At any given time we have 8-10 trucks inbound with the sick and injured, or 1-2 helicopters on the way in or out. We are a regional trauma center so we get transfers from all local hospitals within a 100 mile radius. It never, ever ends.

The floors or ICU can say, "Stop, we have no more beds". We never have that luxury, and being a referral center, we can never go on ambulance divert. The psych issues are becoming more and more of a problem and a danger to staff and other patients. We can't get psych patients transferred many times for days or a week. We have to staff extra police and security just for them, plus additional staff as sitters because of the danger they present. We are seeing more and more homeless with huge medical, psych and of course social issues. We can't send them anywhere, so we are the end of the line for many of them, their last resource, and we are stuck.

Then, you have the "real" ED patients, i.e. MI's, traumas, strokes, general medical, orthopedic or surgical patients. Even with a 3:1 ratio on the acute care side with no available floats, it is a scary place to work. When you are tied up with a critical ICU patient who is not going to surgery or cath lab, you can't get out of the room to even admit your MI patient, or your new drug overdose. Oh, and your "stable" drunk hall patient who is there to sleep it off, but doesn't! He wanders in and out of patient rooms looking for something to eat.

Then the mother of the bratty febrile kid gets mad at you because you won't blow up gloves for the kid to play with! AGGGGGG! Lunch?? OK, in my 12 bed pod, I have my 4 patients, 4 patients of the nurse who went to lunch, and the 3 patients for the nurse who had to go to special procedures with her critical patient. Then they ask you to hold the charge phone while the charge nurse goes to a meeting!!

No, I don't think this is a passing problem that will be resolved anytime in the foreseeable future. What will healthcare "reform" bring? More nurses, less patients?? I don't think so. I pray for those going into the profession, I pray for those of us still in it and mostly, I pray for our patients, current and future who are getting less than they need.

After 38 years of acute care, primarily ED nursing, I'm ready to sit in a cubicle in an air conditioned environment, be around people who bathe everyday, and talk to people on the phone about their insurance coverage and if their particular ailment is covered. I will miss the patients, the other staff who share the "we're all in this together" battlefield attitude, the great ED stories, the adrenaline rush and the exhilaration of making an immediate difference in someone's life. I will miss the gratitude of the child who was afraid, but I was able to soothe their fears, the little old lady who recently lost her husband and came to the ED after a fall who gives me a kiss on my hand for taking care of her wounds, the raucous pizza dinners in the break room with those who understand, but I just can't do this much longer.

To all those new, fresh faced new grads who read these forums and ask, "Am I cut out for the ED?" I can only answer, "I certainly do hope so!"

It seems like staffing is a major issue. Are there just not nurses willing to work nights or do they not want to staff well? What would happen if EVERYONE working nights just started filling out incident reports EVERY time care was delayed due to volume/short staffing? Like, it takes you an hour to get in to a minor patient to give motrin or something? In the incident report you can indicate that you were in xyz rooms handling whatever priority. Your risk management department might take notice of staffing issues and lawsuit risk if you all do enough of them en masse. Draw attention to the potential sentinel events.And you say staff has tried to address understaffing with the bosses...but how high up the chain have you gone? Hospital CEO? Local media? I guess what you need to decide is how much of a fight you want to put up versus how much you'd rather wash your hands of it. Ultimately, I'm not sure how much you'd accomplish alone, but if everyone else is ready to revolt, who knows?

It seems like staffing is a major issue. Are there just not nurses willing to work nights or do they not want to staff well? What would happen if EVERYONE working nights just started filling out incident reports EVERY time care was delayed due to volume/short staffing? Like, it takes you an hour to get in to a minor patient to give motrin or something? In the incident report you can indicate that you were in xyz rooms handling whatever priority. Your risk management department might take notice of staffing issues and lawsuit risk if you all do enough of them en masse. Draw attention to the potential sentinel events.And you say staff has tried to address understaffing with the bosses...but how high up the chain have you gone? Hospital CEO? Local media? I guess what you need to decide is how much of a fight you want to put up versus how much you'd rather wash your hands of it. Ultimately, I'm not sure how much you'd accomplish alone, but if everyone else is ready to revolt, who knows?

It is all about incident reporting. trust me. I recently had a guy on the ward for 6 SIX!!! weeks waiting on a guardian to be appointed. he was homeless and deemed incompetent of making decisions. He was an alcoholic and a smoker. Would go down to the smoking area and come back drunk!! it was decided by me and my NUM to 1:1 him to stop him drinking.

I covered my NUM job for a week and had the Div DON in asking why he was being special-ed(coming out of the dept budget even though he was an overflow pt). I had the pt flow exec in asking why he was still here. Nothing was getting done and we were getting spat at and verbally abused every day by this guy who was a medical NOT a surgical pt (surgical ward) Our div DON was fantastic and suggested that we started doing incident reports every time he was verbally abusive or spat or swung for some one. After 25 reports - in 1 week. he was on the medical floor and in 5 days he had a guardian appointed and gone. All the reports were going to the medical div DON as he was her responsibly and our surgical HOU got CC'ed into all of them and kicked up enough of a fuss stating that approx 10 people could of missed out on surgery because of him. It is all about the data. Verbal complaints and ******** will do nothing. Objective data will

These posts sound like my night last week in the ED - I'm a per diem "float" (don't get me started...) who is now cross-training for the ED after doing mostly ICU and Med-Surg. I've been working as a nurse for a little over a year and I always thought I wanted to do ED nursing. Now...I'm not so sure.

One night last week was just too much for me - we went on ambulance diversion, we were simply packed. Most of the patients in my zone were not critical, just urgent - painful gout attack, broken nose, CP w/normal EKG and troponins....I felt like I was doing damage control the whole night and just got it from both ends. How do we advocate for patients who haven't seen in a doc in 4hrs because there is a cardiac arrest that just came in?

How do we explain the concept of triage to less-critical patients in the Almighty Customer Service mindset? I just don't think it's possible, and I'm not sure I want to be a part of it anymore

How do we explain the concept of triage to less-critical patients in the Almighty Customer Service mindset? I just don't think it's possible, and I'm not sure I want to be a part of it anymore

I actually feel a sense of relief and a bit of anxiety reading everyone's posts: seems the ED situation is on the same downward spiral everywhere. I've been in emergency nursing for about 5 years now and every time we have "the night of horror" - thinking it's the worst shift in our careers - another night comes along to claim the #1 spot. In all fairness to my current employer, this is by far the best ED I've been in thus far in terms of having an awesome team, adequate supplies, and a supportive/involved nurse manager. The biggest thing we hear about though is patient satisfaction scores because of its relevance to reimbursement now. Budgets are tighter, the sick patients are sicker, pts/families are more demanding, and there is a never ending tidal wave of inappropriate ED usage. Last night patients/families were all so upset and angry (guess who? the level 4's and 5's)...The nursing supervisor actually had to get involved because - as we have all the trauma bays full, 5 rigs en route (2 of which were priority 1's), a STEMI and a sepsis alert via triage, all the hall beds full - a guy was raising heck about his girlfriend not getting "treated" immediatedly for constipation!!! I have nothing to offer as far as solutions go...we dig in our heels, forget the meaning of the words 'lunch' and 'bathroom', and do the best we can. We file complaints and have meetings etc but I truly believe that when lack of reimbursement due to consistantly low patient satisfaction scores starts to hurt administration's bottom line, some changes will be forthcoming (ie K+MgSO4 above: objective data). Of all the specialties I've worked in over the past 17 years, I love the ED the most but it also frequently makes me seriously consider a complete change of careers. We are certainly in the trenches so to speak...my respect goes out - as well as my prayers- to all my fellow ED nurses. I'm proud to be a part of the team and know, no matter how bad it gets, we make a difference in someone's life every single day. Maybe together, as a specialty, we can all work toward a REAL healthcare reform solution.