Unsafe assignments in the ED

[LeahJet]

Just curious..... do you ever (on a regular basis) have to have more than 4 rooms in your ED? If so, how many?

I have worked in many ED's all over the country and they would close rooms before a nurse would have to take more than 4.

The place I work now...it's not unusual to have 6.

Would appreciate your input. Thanks.

[Jen2]

Our ratio in a Level 1 trauma center is 1:6 (non-monitored), 1:5 ( 3 monitored), 1:5 (3 monitored), 1:4 (all monitored), and 1:4 (all monitored). We put patients anywhere in the hallway that we can which I hate. I also hate the fact that the 1:6 non-monitored patients end up being the sickest ones. Can be very unsafe at times. We also have a 4 bed fast track area that is staffed with one nurse. Funny how a 4 bed fast track area can have a less acuity and better ratio. Management keeps teling us that our ratios are some of the best you will see in a level one trauma center. After seeing these posts, I think I'll start looking for my boots.

[TinyNurse, RN]

4 rooms max as it is a brand new ED., but i'm sure it will be more in the coming times.

[ERheart, BSN, RN]

In our ER (52 beds not counting fast track or peds) we used to take 6 in the "back" and 3 in "front" (more critical) until the Calif. ruling. Then shortly after, we were changed to "4 max no matter what" which lasted all of a month. Now, they TRY to keep us at 4 but when it's busy, you get 5 anyway. It wouldn't be so bad except that no one LOOKS at acuity and pts are placed in any open bed. There have been nights when I have had just too many high acuity pts like one when I had 1 pt on a vent, 2 acute GI bleeds awaiting ICU beds, an evolving MI, and a PID shuffler. (Thank God for her) It's not safe and when you complain, you get "well whatever you do for them is better than NO care." While that may be true, I doubt the attorney handling their case will present it to the jury that way. He won't know (or care) about the other high acuity pts that I had that night, just that his client didn't get the very best care including a bath, etc. (They sue over the small stuff most often).

OK, enough said, thanks for letting me vent... :banghead:

How right you are? We live in a society that luv's to sue. Since CA is a union state, can't you go to your union representive and discuss this matter? I'm mean your paying your dues; literally.

[teeituptom, BSN, RN]

In high acuity area we have up to 4 rooms, in low acuity we go up to 9 rooms. No biggie, Remember no matter what you can do " Only one step at a time"

[roxburin]

Our ER (Level I Trauma) seems like a mad house. I'm sure there is some logic to it, but we have over 20 beds/rooms, trauma area(s), people outside those rooms in beds, people in the hallways in the ER.... etc ...

...nurses.... doctors... patient advocates... everywhere! Never seems to be enough.

Same old story that I hear is happening in alot of other ERs around the country.. eh?

[PyxisPrincess]

Coming from the busiest ER in New Jersey, which just so happens to have a no divert/no bypass policy and is not (yet) unionized, my average pt load runs between six and eight and the majority of these patients are truly ill. Our Minor Treatment and Kid Care areas relieve us of sore throats, blisters, sprains, breaks, UTIs, and febrile seizures, so our ER concentrates on Cardiac, Respiratory, GI, and anything with a nausea, vomitting, or syncopal component. We're in the middle of a huge senior citizen population, so we see a lot of change in mental status and septic patients, as well. For me, a light assignment is having at least one patient who can actually tell me that she needs a bedpan. A truly heavy assignment consists of four ICU admits, three CCU admits, and one trauma to be transferred out. How unsafe my daily assignment is depends on the acuity of the patients and how long they will have to wait for beds upstairs. Six patients with diarrhea can keep you plenty busy but eight psych holding patients will suck the life out of you after 12 hours. :chair:

[neneRN, BSN, RN]

Our ER is separated into Fastrac, Pediatric, Intermediate Care, and Critical Care.

I've always been in the Critical Care section, where pt load is determined by acuity. Three of our 2-pt rooms are designated for the most critical pts and each is staffed with one RN; these are the sickest pts in the ER, but more often than not, you also get 2 hall pts as well.

The rest of the Critical Care side gets 7-11 pts to an assignment, but are staffed as teams with an RN, LPN, and tech. If one of the pts in these areas goes bad or ends up being sicker than initally thought, they get transferred up to one of the higher acuity rooms either at MD or RN request. So the nurses with the higher numbers of pts really don't ever have to care for the really sick ones.

[hogan4736, BSN, RN]

pardon my ignorance, but why do ER nurses put up w/ 6-9 pt assignments (other than urgent care)

LEAVE THEM BEHIND, and go someplace that values pt safety...ENA standards are 4:1

p.s. in the last UC I worked, we had 20 rooms, 4 RNs, an LPN, and an MA