We need sitters!

This is not OK and it puts you and your patient at extreme risk. Our ED does not allow this to occur because it puts everyone's butt on the line. And this is a major JC issue.

If a suicide/homicide risk patient enters, the nurse calls the charge nurse immediately. If the patient cannot be moved into the secured psych area by a) switching rooms with a less risky patient, or b) by cohorting, and there is no security guard or tech to watch the patient in a non-psych area, the Overhouse Supervisor of the hospital is called. The Overhouse Supervisor tries to pull staff from other parts of the hospital or from home to observe the patient, and it can take a while.

The receiving nurse of the at-risk patient does not rest until safety is achieved. It is difficult, but creativity and help from your charge are a must. If the patient can be seated/bedded across from the nurse's station in full view, especially across from the charge, the patient will not be forgotten while you are dealing with chest pains, strokes, etc. Multiple, incessant calls will get you a sitter, and make sure your ED Coordinator and Director are aware, too. They know if JC were to walk in and a 1:1 patient was left unsupervised, their butts would be on the line.

Suicidal patients can be very creative and determined. They will hang themselves with sheets from a 2-foot bedrail, cut themselves with the sharp edge of a cabinet drawer, or choke themselves with a tourniquet while you are working up an EMS in the next room. This lax attitude of your department needs to end now, especially in light of your close call. I would refuse such an unsafe patient assignment as you described unless creative solutions are achieved.

After twice being assigned a 1:1 suicidal patient while still being expected to care for my other critically ill patient, and told to "just do the best I can", I finally put my foot down. The hospital policy explicitly states that in cases of 1:1, the nurse/sitter must be within arms reach of the patient at ALL times. So, it is impossible to expect me to be able to carry out the assignment they gave me.

The last time they tried this, I refused to accept the patient, citing the policy to the supervisor and thus placing the problem back in managements hands. Their lack of staffing/planning is not a justifiable reason for me to place a patient in a dangerous situation or risk ruining my career. Not to mention, I don't want to live with the thought that a patient killed themselves under my care on my conscious.

I am fairly certain I am going to leave this ER and possibly ER completely due to the close calls. Yes, close calls. The ratio of 1:5 regardless of acuity is ridiculous. The same situation happened again. I am thinking about dropping my status part time and focusing on studying for a police officer test while getting into shape. I'll also work on getting back into the firefighting.

Sad to see another nurse go before she/he gets started. Things have got to change; this is sad, hemorrhaging caring, good nurses.

You do realize there are dozens of ways to be a nurse without working in the ER, right? Without even working in the hospital? Why waste a degree you worked so hard, and probably paid quite a bit, to get?

It's just frustrating I suppose. The last company I worked for as a medic and then an RN had issues with staffing in regards to trying to make it cheaper with less staff and then it's the same at the 2nd company. I am looking at other RN jobs, but I am really scared it will be the same in all units now where people are cutting corners to save a few bucks.

Like the other day I ended up two patients behind in the ER because I had to hang blood in one room and two were discharged in that time. Then two more discharged and two more tossed in while I was still getting labs, IV, meds, assessment, finishing up the paperwork in the first two. Then the fifth one and one of the other two ended up discharged. It was hectic because we were short nurses and there were no paramedics to start the IVs (which was the justification for us to have the ratio of 5 patients regardless of ESI).

And this is exactly why I am looking into another area of nursing. I have been doing this for 10 years and now due to cut backs patient care is compromised. I can't take care of 8 patients and then be expected to take care of the psych holds on the other end of the department that I can't even see because there aren't enough nurses. Yes they all have sitters but they still have to get their meds, assessments, gbs, showers. They would tell you that they can't control staffing and people still need to be cared for no matter how many come in. Well I would argue that you are not providing care. You are providing harm.