Thanks to the wise advice of the people at allnurses.com, I took a stand at work and started refusing to take assignments that were more than double the ENA recommendations for staffing because it wasn't safe for my patients for me to have 5 shock room patients or 9 exam patients. I have been very vocal at work about how unsafe it is to have all 28 beds full with only 5 nurses in the department. I have also been quoting the quarterly publication that the board puts out regarding how a nurse should handle an unsafe assignment. The icing on the cake was having to put a trans-venous pacer in a woman with a heart rate of 20 and not enough nurses to cover the little things such as recording (we paper chart) and someone to be the "go-fer" for the sterile nurse setting up for the pacer.Yes, I was smart enough to start looking for another job BEFORE I did this and have accepted a position in a different hospital. It is a good thing too because this went over like a lead balloon. I was told last week by the assistant manager that I was not allowed to say at work that I was going to call the board and find out if the article from 2005 was still in effect, or if I needed to do something different to protect my license. I was also told that my negativity was undermining "all of the positive changes" that they had implemented. Now, at the time of this conversation, the changes that had taken place were that all of the agency nurses (30-40% of our "staff") were cut from the schedule, additionally, the number of nurses allowed for every 4 hour time block was decreased by 1, in-house registry (IHR) staff were allowed to bump a regular staff off the schedule because IHR never gets put on call, the exam beds were going to be staffed at a 1 nurse to 7 room ratio, and there was the addition of 12+ tasks to the list of things that we already don't have enough time to do. My immediate supervisor has been very supportive of me and my stand. She confirms that I haven't missed any positive changes. She also confirms that no, I am not negative, I am realistic and the reality is that it is dangerous here. She was told by the assistant manager to stop mentioning the ENA recommendations because we weren't going to staff by them and the assistant manager was tired of hearing about them. There are 10 people that are trying to find a way out of this department. I am one of the lucky 2 that so far have. It is bad enough in our department that one of that people with 15-35 years of ED experience are saying it is unsafe an looking for jobs.One day, after reading something here about staffing ratios what popped into my head was "Shame on them for putting me in a position where my patients and my license aren't safe, but shame on me for allowing them to do it day in, and day out."So, thank you to everyone who has ever contributed to threads about staffing ratios since I found allnurses.com in March. If it hadn't been for this site, I would have never gotten up the courage to take a stand. I would have bought into the philosophy that 1) Staffing was like this all over so I just needed to suck it up. 2) If I didn't take the extra rooms, I would be making more work for everyone else. 3) A good nurse would be able to handle this and not even complain.