What is your ER like.....need advice?

[Theocbean]

I have worked as an ER nurse just shy of a year and a half. I was a new grad when I started. My unit has 35 beds (6 beds are dedicated to psych patients and/or overflow medical patients) and we are staffed for 5 patients to one RN. As with any other ER we have a charge and main triage nurse. We rarely have a tech and if we do it is one tech for the whole 35 bed unit and there are times the tech utilized as a sitter for psych patients. About 50-75% of the time we will have one float/triage 2 nurse whose main job is to bring patients to rooms, transport admission patients to the floor or discharge patients home. We usually see about 160-180 patients a day.

With all this being said, I am curious about how other ER's run because I constantly feel like a terrible nurse and I have no other experience to compare to. I am always being made to feel like nothing is ever fast enough or good enough for management and the senior nurses. I truly love what I do and could not imagine doing anything else but I feel like a failure no matter how hard I work (even though I have been told my patients love me and I provide excellent nursing care). To make matters worse we might be moving half way across the country soon and I am scared of applying for an ER position only to end up feeling the same way I do now! Any advice, insight or personal experience regarding what other ER's are like would be greatly appreciated!!

[NickiLaughs, ADN, BSN, RN]

370/day in a 39-bed shop?! That's not just efficiency, that's magic.

You must have amazingly fast inpatient admissions, or be seeing a lot of fast-track traffic, to make that work. How do you keep up that kind of throughput?

3 docs and 3 RNs for fasttrack. We get our soft 3s, in and out under an hour. 4s and 5s get xrays before they even go to hallway chair and usually splinted or meds within 10 minutes and out the door. We frequently create hallway assignments if staffed for it as well.

It is magic, I've been impressed since I started a month ago.

[emtb2rn, BSN, RN, EMT-B]

Lately (past 2 months) half of our beds are holds, plus some holds (in hospital beds) in the hall, ratios hovering at 1-6 or 7. Not safe, morale down. Running a code? oh ok, your new one's just a belly pain.

[Lev, MSN, RN, NP]

Yesterday there were 42 boarders in a 43 bed ER.

[NickiLaughs, ADN, BSN, RN]

Yesterday there were 42 boarders in a 43 bed ER.

Sounds like a day to bank your head against the wall. :/

[wanderlustnurse88, RN]

Small ER here. 8 beds. We have two RNs on days 7-19, one RPN 09-15, and a transfer RN 11-23 (in case we need to transfer anyone to a bigger facility for scans or admissions ) one nights there is one RN 19-7 with someone on-call. One MD for the ER.

[bradons]

We can see over 60 pts in a day.

One doc, one aide (only 8 hrs of the day) and 2 RN's. Mon-Fri we get a 8 hr day RN as well.

No clerk, no floats, nothing. And at any given time our ratio is 10:1 depending on the day.

And this is acceptable apparently. Manager would rather save a dollar for another hospital in the region then properly staff and provide assistance.

[Lev, MSN, RN, NP]

We usually have 3-4 patients. I heard it can go up to 5-6 on a very very bad day. The 4s & 5s go to fast track. The others to the main ED. There is a psych area too staffed by psych RNs. Today I had four 2s at the end of the shift, two with BP issues >200, one of which was very lethargic and the other became acute on acutely short of breath who ended up on the venti mask. My other pt in pulmonary edema was put on bipap but that made her pressure drop. My other guy was an "easy" patient. He went off to dialysis. There were two codes today (that I'm aware of). The nurse next to me had two ICU level patients (one of which coded) plus 2 more I think. There is a triage nurse for all the walk-ins. We triage our ambos. There is a flow nurse who assigns them to rooms. Then there is a team lead who helps everyone out. There is usually a tech available when needed.

[LoveMyBugs, BSN, CNA, RN]

Have a 20 bed divided into 2 10 bed pods and 2 triage rooms.

We run with 4 nurses a tech and 1 doc 24hrs a day, then the mid- shift start coming in at a 11, 1, 2. We also have a mid shift md come in plus residents.

So by 5 pm we have 7 nurses 2 techs and 2 MD's and a resident.

Of the nurses is charge, one triage and one float nurse. We have a 3:1 ratio unless a critical 2 or 1. we have 2 dedicated psych beds. We can pull from our hospitals transport team in a pinch. We see 70-100 pts a day. Sometimes we are door to d/c in under 30min depending on the time of day

[ZooMommyRN, ADN, RN]

28 bed level 1 peds ED and we staff to 1:3 occasionally 1:4 with 1-2 triage RNs and 1-2 RNs for Resus that also float as resource until they are needed in a bay, on a good day we start with 2 techs and by 3p can have up to 4 techs.

[Guest03/15/15, BSN, RN]

Your staffing ratios are a dream to me. I work in NYC and there have been nights where I have had upwards to 17 patients to myself. Most nights it is between 10-12. Usually work on a team with two nurses (good nights there will be a third) and each team will have between 20-35 patients per team. If we are lucky we will have a tech. Pretty much do everything by the seat of your pants and pray.

I'd quit. They are pretty much throwing you under the bus. It's impossible to give adequate care for 17 ER patients to 1 nurse. Nope, not a chance.

[TRAUMARN05]

The ED I work in is a Level II Trauma Center. We are 1:4 for acute, 1:3 for critical, and 1:1 for Traumas. We see about 100-150 patients per day. We have 7 critical beds, 5 trauma bays, 16 acute beds, 3 beds for simple stuff like finger lac, stuffy nose. 4 psych beds and 8 cardiac obs beds. The only time we are assigned 5 patients is in the cardiac observation unit and you we get one CNA as well. We do have two Techs (EMT) that are able to start IV's, insert foley, transport patients, run POCT, and much more. I think it's the techs that allow me to feel like i have more time with my patients.

[WhoniverseNurse]

New to an 11 bed Trauma IV rural Emergency / Urgent Care Department (2 beds we share with OR). I'm still on my orientation (about 5 months long, have 2 months to go). I really love it - all the experiences, the faster pace, the odd cases, the codes. We see anywhere from 35-55 patients per day. We generally are staffed for 1:3 unless patient acuity is heavier (code, trauma, STEMI, etc). We also have minimum staffing requirements - which is super nice. We usually have at least 3 RNs, an EMT or Paramedic, an MD, and a mid-level provider. At night, we drop to 2 RNs, an EMT, and an MD. I don't really have anything to compare this setup with, but especially from reading some of your ratios, I'm really liking my job even more (if that's even possible).