Triage

I work in a small hospital that staffs one nurse 24 hours a day, and an extra one from 1300 to 0100. There are 6 beds. If the OB nurse does not have a patient, she is expected to help out both the ED and M/S, but this of course is hit and miss. There is no triage, simply a waiting area. When the patients present, they ring the doorbell and we look at them. They are not checked in, vitals are not taken, and if we are busy they are asked to wait without anyone watching them. The only other staff is a unit clerk, whose only responsibility is to check the patient in after we room them. Our "great" new computer system has the nurses and docs doing all else. Although respiratory is there in the day and for paged out emergencies, at night we are expected to act as the "triage" nurse, charge nurse, respiratory therapy, pharmacy, ed tech, and housekeeping. We also do outpatient therapy. In the day, they do outpatient therapy, work meds and DOT physicals none of which are accounted for when staffing is considered. Recently, we had a pulseless patient present POV on the weekend, kitchen staff and housekeeping assisted with recording and compressions.....We were recently reprimanded for paging out for assistance and were told that ED standards require a 4 to 1 ratio. I explained that those standards are designed for ER's that have all the other resources and don't do ambulatory care treatments and asked for a protocol be in place. Needless to say, I was reprimanded and notified of lengthy wait times in urban hospitals. What are your experiences and comments? I am concerned with patient safety.