Tell us about your ED ?? =)

sumas8 · Oct 5, 2008

Hi from New York. I work at a level 1 trauma center/ univ. hosp/ teaching hospital. We are the only level 1 in our county, also have an interventional neurologist and the only cardiac cath lab/Cardiac surgery in the area. We get alot of transfers from other area hospitals for these and other specialty needs. We have no ratios-I can't imagine pts waiting for hours until I d/c a pt so I can take another one. We keep seeing as many pts as we can physically cram in. I'd say we avg 6-8 pts each, but can be more if we are packed.

I love the variety, adrenaline, comaraderie and learning something new every day. We have great docs and a great culture of learning and never feeling stupid to ask questions like "what do you think that is" or 'can you explain that to me'. The jokes, humor, love and admiration for my coworkers is what gets me through the dark moments. I love the stupid patients, the sad stories, the success stories, the grateful patients- all of it good and bad. As I like to say, besides a paycheck the sheer entertainment value of coming to work every day is an added perk....

mmutk, BSN, RN, EMT-I · Oct 5, 2008

Crappy ER in Middle Tennessee. Staffing is 1:4 ideally, but can go up to 1:6 especially at night.

Salaries are the best in the region, 21-23 dollars an hour for new grads is what u can hire in at.

We see mostly cardiac as there is a level I trauma center down the road, and we are inner city with 4 hospitals within walking distance of 2-3 miles.

mmutk, BSN, RN, EMT-I · Oct 5, 2008

I'd say we avg 6-8 pts each, but can be more if we are packed.

Wow how sick are these 6-8 ?

Seems a bit dangerous to me, 1:4 is ideal per ENA. I wonder how many facilities (outside of CA) follow this reccomendation...

jenfromjersey · Oct 6, 2008

Our ED starts with a ratio of 4:1 but can flex up as needed. Usually would not get more than 5 but have had 6 on occasion.

However, I recently resigned from a per diem job at another ER where starting with 5 or 6 was the norm. I once had 7 patients there...a septic, hypotensive trach patient, an active GI bleed, a SOB dialysis patient who missed their treatment, a chest pain and 3 psych patients. Since there were only 2 seclusion rooms, the 3rd was in the hallway (until she started undressing herself in front of everyone). Needless to say I don't work there anymore.

care4you · Oct 6, 2008

I work in a Level 1 trauma center that has 98 beds... we have 3 trauma rooms, 3 revival rooms, and the ER is broken down into wings according to the severity of the pt. if we are working in the north station (which is the highes accuity, we have 3 pts. each) the other wings vary.

ecat81 · Oct 6, 2008

I work in a not-for-profit 32 bed Level II ED. 8 of those are express beds but we have up to 8 other patients in the hall. We start at 4:1 but sometimes it goes 5:1 very rarely is it 6:1. In express 8:1-2 varies during the day. We see about 58,000 a year and recieve trauma's from a 35 mile radius from 3 states. Pay is low due to 4 nursing schools in that 35 mile radius. I believe starting pay is $19.50:chuckle plus $1.00:cry: ED diff.; 8-16% second and third diff. Our staffing has really come up in the last few months we will see if they hang on through the winter season. We have 42 FTE's (6 short of being "fully staffed" financial difficulties-yeah another subject:devil:), 3 clinical managers, quality nurse, educator, case manager, study site nurse, 8 per diem's, and director. And many techs/sec's.

sumas8 · Oct 6, 2008

I had posted about my NY hospital with 6-8 pts or whatever the traffic will bear. That more refers to our 'main' area, not critical care patients- our 'acute' higher level area is more like 3, maybe 4 pts on a really busy day.

We have a separate fast track area where you may have more, but the RN had little to do for each pt. We had a nurse who moved to Calif and while the 4:1 ratio is nice, she can't believe the length of time patients have to wait to be seen. (6+ hours as a norm....) Ratios have 2 sides- the nurses' side and the waiting patients' side.... :specs:

Editorial Team / Moderator · Oct 6, 2008

Freestanding ED! 15 beds. Much fun. Awesome teamwork. We're on the edge of suburbia and the DC sprawl, but we also serve a rural population; we see a bit of everything, from legs-vs.-tractor to drug overdoses.

shannonFNP, BSN, MSN, RN · Oct 6, 2008

I work in a Level 1 trauma center that has 98 beds... we have 3 trauma rooms, 3 revival rooms, and the ER is broken down into wings according to the severity of the pt. if we are working in the north station (which is the highes accuity, we have 3 pts. each) the other wings vary.

Wow, your ER sounds like one that I'd like to work in when I receive my RN. Could you PM me what hospital you work at?

Thank everyone for all the information so far! I love hearing how each ED is set up differently. I forgot to mention that my 38 bed ER is divided into the red, blue, and green zones. Each zone has a nursing station, a secretary, and certain doctors will man each zone. So far the zones don't have much to do with type of patient, but the idea is that when patient volume consistently stays large enough to keep the green zone open all the time (currently it is only open when staffing and volume allow) the acuity or type of patients may be divided. They dc'ed the chest pain center so now chestpainers are spread out all through the ED in whatever rooms are closest to the nursing stations.

When a patient is brought to a room, we have a touchscreen per zone that you write the patient's last name on. Next to it, you can write on the screen what labs, xrays, etc are needed.Then you make a line or X through the labs when they are completed. Each nurse has her group (ratio is 1:4) in her own color. It reminds me of PAINT that you have on your typical computer, only its divided a little better. It's hard to explain. These screens have seperate LARGE screens that you can view throughout the ED. Sorry if it doesnt sound like I'm making sense! We're switching from this system however to something called Radianse. The triage nurse has to admit the patient to a room, labs are entered on each room, you have to discharge and transfer on it. There's so many options to mess with such as cleaning the bed and making it available, etc etc. The nurse gets busy sometimes so they forget or don't have time to DC the patient from teh computer, so then the triage nurse can't admit another patient. So far it's not well liked, but it's supposed to have accurate times for procedures completed. It's only working now because we can compare it to our old system to see what patients are actually there. But you know... anytime you like a system, they change it!!

Keep the info coming! I enjoy reading it! :nurse:

gonzo1, ASN, RN · Oct 7, 2008

On staff at a level 2 with 1:4 ratio and often a float nurse and a tech. 99% of the doctors are fun to work with. Everyone gets along really well for the most part. It is a supportive environment.

Do agency at other ERs with up to 8:1 ratio. Hair-raising and scary. ED docs are almost always really nice to work with though.

My ER is 35 beds, a fast track and about 55,000 visits per year. It is known as the knife and gun club due to its location in/near bad area. But our security is top notch and I feel very safe

ecat81 · Oct 7, 2008

One thing I do want to ask everyone. Do you have locum tenems doctors or full time? Are they board certified in ED med? Luckily we have 8 board cert. ed docs and recently added 1 board cert. locum due to a doc leaving until they get someone else hired. I think it makes a big difference to have full time board cert ed docs. You get to know them, what they order, and have consistency among them.