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!!

[slunsfordrn]

I created a survey to see what other ED's were like also.

https://www.surveymonkey.com/s/SFX8D3D

[theantichick]

My last ED: Trauma I center, county facility. Trauma hall did it's own thing with team nursing and an average ratio of about 1:4 with a tech. Fast track type area with 10 beds and holding chairs while tests result (total of about 20-25 patients in fast track at a time) with usually 2 nurses (sometimes 3) and 1 or 2 techs. Rest of the ED - 1:6-9 regardless of acuity (mixed acuity 2-4) or stability of pts, usually if you had to go 1:1 with a really unstable pt, the rest of your pt care backed up in the meantime. Techs ratio 1:8-12. Crazy place, I got out fast.

Current ED: Acuity 1-2 area is team nursed with average ratio 1:2, sometimes 3 and almost always a tech. Fast track area 8 beds with 1 RN and usually 1 tech. Rest of the ED ratio 1:4 (pretty hard limit, though sometimes we flex to 5, but if we get an ICU hold for example they'll block out rooms to keep us 1:3 with that hold included) with variable tech support. MUCH better workplace. I flow pts a LOT faster here than I did at the last place, and I feel I can do a better job not only with keeping up tasks, but overall patient care.

[acolby07]

Wow, this is scary. I have been looking for a new jib and this makes me think I should just hold on to my current one.

I have a 34 bed emergency department. If we are full staffed during our peak times we will have 17 nurses and 7 techs, if we are lucky a few NAs. We use hospital patient escort to transport patients to units and ct, X-ray etc. the average nurse to pt ratio is 1:3 but several are only 1:2 and then multiple float nurses. If we are really busy (either a surge in pts, or census over 180-200) we just page out for any rn that wants to come in to come in.