Surge capacity, triage holding?

[running42km]

Our emerg is frequently incapacitated with admitted patients. We have a curtained divided four stretcher area behind the triage desk that is staffed with a RN to act as triage support ... responsibilities include possibly making a list of patients needing to be triaged, triaging ambulance influxes, caring for the patients in triage holding. At times the four stretcher area assignment expands into a hallway that connects triage with the ambulance bay and the trauma room, filled with stretcher bound debilitated patients, triaged but no where to progress; at least four times last week that assignment became 7-13 patients for 8 or more hours. One nurse for 7-13 debilitated patients, while the remaining nursing staff (eight ER RN's, four med/surg RN's, one orthotech lpn) thank heaven for their 3-5 patient assignment. I struggle with the mentality that we can all drop our assignments to deal with an intubated post-arrest in the trauma room, nurses stumbling over each other, but we can't deal with sudden capacity surging in a cooperative manner. I've spoken to the manager but only received a doe eyes caught in the headlights response. Any similar scenarios? Solutions?

[Emergency RN]

one of the most often overlooked necessities of the emergency professions is to stand ready for any emergency. however, the sad reality today is, that most if not all of the emergency facilities in the us are not able to fulfill their primary mandate; that of standing ready to receive emergencies. that is, if you're overwhelmed on a near daily basis, you're already a failure in your primary mission.

in the above case, your patient volume to facility capacity is quite obviously inadequate if you're holding onto 7-13 patients for up to 8 hours, more than half the time. the question then becomes what to do with cases that have been received, admitted and then have no place to go. nurse managers really don't have any real answers because they certainly don't have extra beds or nurses in their pockets that can be pull out at a moment's notice. nor do hospitals wish to spend already tight resource dollars into extra staff. in fact, hospitals often don't do anything unless they have to by law.

hence, the solutions then have to come from the state through legislation. when hot button issues like patient safety, rise to the fore of political consciousness, then pressure will be applied in ways that ensure that these problems be finally addressed.

this is why organizations like nurses unions are so important in the fight for better, safer and more expeditious patient care. unions ensure that politicians are informed of the importance of such issues, and that their voting member's support depends on the politician's actions towards resolving them. one look at the efforts by the california nurses association and what they did with nurse to patient ratios should inspire the rest of the nation's nurses.

together, we can make a difference for our patients and for our professional selves. i know that all of this is not going to help your institution in the short term. however, legal mandates are probably the only real long term tool to keep hospitals honest, and that can only come through legislation.

good luck!

support your nursing unions!

[Huachuca]

All of our hospitals are having similar issues with exceeding maximum capacity on a regular...and this can be daily basis. My hospital has instituted a hospital wide approach, called Code Purple. When we are holding more than 5 admitted patients (our capacity is around 60 patients, counting hall beds), AND the rack waiting to be seen is loaded, it is announced overhead. Every unit then must accept one additional patient, even if this means the patient is in the hallway upstairs. We stay at this level until the back log is cleared up, which may not happen. The times we are are Code Purple are tracked, and eventually upper management gets called.

All this being said, it makes for a dangerous situation for patients and staff. It happens way too often. We have a nursing shortage, but yet, positions are slow to being filled or not filled. Support staff has been cut back. Moral has tanked. I agree that only legislation will change this, because management won't.