Wednesday, November 20, 2013

dangerous nurse staffing is gonna kill your dad

In the past year legislation has been introduced nationally regarding nurse patio ratios.  This will be a long time coming if it ever happens at all.

Our ER staffs by volumes.  We have, for the most part, good staffing.  During the day shift it sucks.  We desperately need another nurse.  Something bad is going to happen.

When we get a critical patient it requires two nurses as a norm.  In the early morning hours we have 14 beds open, we have 3 nurses on.  Most of the time the 14 beds are full.  When that critical patient comes, that leaves 1 nurse to take care of 13 patients.  Often times the charge nurse is out in triage helping the one nurse out there because it is so busy.

Later on another nurse comes on the side with 14 beds. So now when we have a critical patient, there are 2 nurses to manage 14 patients.  It is not until 3 pm that the staffing becomes adequate.

I work in a hospital that specializes in cardiac care, stroke care.  The patients we see in our ER are complex.  They are not your in/out laceration, ankle sprain type patient.  Add to this an order happy medical staff and you get the picture.

It is commonplace in the ER to have 2 critical patients in the ER at the same time.  This ties up 4 nurses in a 35 bed emergency department.  Good luck to the rest of the nurses caring for those other patients.

This is a dangerous situation.  To think that our management expects 1 nurse to monitor 13 patients when there is a critical patient during a period of the day is crazy.  Or to expect 2 nurses to manage 7 patients each during another part of the day, is ridiculous and dangerous.  It is an accident waiting to happen.  That accident is coming any day now.

Now add this scenario onto the drive for patient satisfaction.  How satisfied do you think those other 13 patients are when they have 1 nurse to care for them?


jimbo26 said...

Although I live in the UK , I'll bet there is more administration than there is nurses . If 90% of the admin was cut and their places was taken by nurses , it would be a happier situation .

NCLEX Preceptor said...

Really dangerous, especially when patients and relatives demands so much from nurses. Indeed nurses are overworked and understaffed at many hospitals and with nurse-patient ratios such as these the kind of health care patients would receive will really be sub par.

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Crusty ER TECH said...

Besides having a sentinel event happen (I hope not) there is little that can be done. I worked in a hospital that had a similar situation. It took Joint Commission AND the state to correct this type of shitty staffing and get rid of dreaded hall beds.

The clip board types like studies. Start looking up studies that support the nurse to patient ratio. Like better pain management, better communication, and better pt flow. Shove a few of those in an inter-office mail envelope and send it to the CEO and watch the shit roll down hill.

A stop gap is having Paramedics as extenders (not techs) in the ER. A Paramedic with the right protocols can help a nurse work up a critical pt or help work on the pts that are more minor freeing up another nurse another words taking on their own patient load. I know some nurses bristle at this but it works, problem is that you have to have an administration that is flexible that will accept these "radical" ideas.

Either way standing up and saying something is wrong is only part of the battle the other parts is having a working plan to push this kind of thing through. Good Luck!

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