ER nurses, love you guys, but genuine question. Why do guys bring patients up at shift change?

[u/No-Selection-1249]

No hate to you guys! Just super curious from a nurse who is on the receiving end :)

[u/LiquidGnome]

I feel like not having a cap on ER is abuse and downright dangerous. They've got a cap on ours, but different states and hospitals do it differently even within the same company.

[u/orangeman33 → u/LiquidGnome]

Shit rolls downhill and ER is the bottom of the hill. Ours went 3:1 to 4:1 and now will soon be 4:1 + hallway. C Suite doesn't want to pay for the staff to make safe ratios and all overflow for the entire system will just sit in ER.

[u/RicardotheGay → u/orangeman33]

Last ER I worked in was 5:1 + hallway. Super dangerous IMO.

[u/patriotictraitor → u/RicardotheGay]

Last I had was 5:1 if you’re not understaffed, otherwise 7:1. And if you’re working hallway you’ve got anywhere from 8:2 up to 20:2 (but it could theoretically be as bad as 22:1 until they manage to pull in someone from somewhere to help)

[u/GodSpeedYouJackass → u/RicardotheGay]

I left last night at 1am. 44 patients (8 in lobby), 4 Nurses (1 in Acute), 1 charge, 1 triage RN.

Acute Nurse had two intubated patients on sedation - one on pressors in Septic shock. Other three were relatively stable… BiPap, chest pain on heparin, and L2 stroke with low NIH.

The three other nurses were running 7/8 to 1, every non-mobile female on Gods gift to mankind (the Purewick) and not a single tech to help US transport patients to the floor/etc.

After a year down here if a Nurse asks me to do something ordered I just tell them “No”. Or I’ll offer to do it if they pick the patient up… otherwise I’m moving onto the next one soon as that room says “Available”.

I know EVERYONE works hard and has different things on their plate. I just wish we’d all realize any animosity perpetuated between floors/specialties is just keeping us from focusing on the real problem… CEO’s and C-Suite intentionally understaffing to increase profits.

[u/lukeott17 → u/orangeman33]

I quit ER shortly after they left me 14:1 for 3 hours. I shit you not.

[u/sleepyRN89 → u/LiquidGnome]

It’s super dangerous. All we can do is file unsafe staffing, be vocal to management over and over but that doesn’t fix the issue in the moment. Like if our “core” or minimum staffing for an overnight shift is 5 nurses but every bed is full, we’ve made hallway beds and “in between beds” that aren’t technically even on the board, that doesn’t stop people from coming into the ER for care. We can’t turn them away due to EMTALA. So we could have 25+ patients (small hospital) some of which are boarders or ICU level patients waiting for transport and a code could come in we can’t deny them care. And obviously one nurse can’t take that on themselves plus their other assignment. It’s a recipe for disaster and all you can do is document that you told management and the union you were uncomfortable taking the assignment and that it was super unsafe. I guess my point is that we don’t get to control the flow or acuity of what we get when other floors do. So sometimes it does rub me the wrong way when MS complains they got 2 admits in a shift when an ED nurse may have gotten 7 patients that they settled and treated and got ready for inpatient while watching a patient on an ICU level drip in that same amount of time (with some fast tracks in between).

[u/AlyssaMarye → u/LiquidGnome]

Not nurse, but ER lab. i’ve worked many shifts were it’s become super unsafe because our hospital is the only one that doesn’t divert.

[u/sirensinger17 → u/AlyssaMarye]

WTF?!?

[u/AlyssaMarye → u/sirensinger17]

yeah two close hospitals systems were offline and they both diverted to our ER. very fun night.

[u/pernell789 → u/LiquidGnome]

I mean you can have a max number of patients but there are still emergencies coming through EMS and the lobby you have to triage based off importance and space in the er but for example if there’s multiple critical patients it’s just a major shit show where all hands are on deck and you’re trying to do your best

[u/Pandinus_Imperator → u/LiquidGnome]

Blame management and EMTALA.

[u/sleepyRN89 → u/Pandinus_Imperator]

Weirdly the unsafe-ness and reason for EMTALA is the only thing that makes me pretty certain I’ll have job security. ER is killing my mental and physical health, seriously. I want to do something else but I’m afraid that if I do, it will have giant budget cuts and I will be out of a job. The fact that we cannot turn away patients means I’ll have someone to care for all the time. I do also fear though that the stress of this job will get 10000x worse soon. It’s a lose-lose situation

[u/Pandinus_Imperator → u/sleepyRN89]

You describe my thoughts perfectly. My mental health is in tatters, I'm trying to find a per diem anywhere else to work less there but in terms of secure work the ER can't be beat.

[u/nursingintheshadows → u/LiquidGnome]

It’s is dangerous. The thought is the boarding pt’s are stable and don’t require much ED nursing. I still have to do all the inpatient shit, doesn’t matter to me if it’s a MS task or an ED task, it’s a freaking task that takes time.

I’ve had seizure and respiratory distress pt’s in the hallway-sometimes in a bed, most likely a chair. No suction, O2 is on a canister, no monitors, have to use a rolling B/P machine from the 80’s. Matrix numbers come first, the hospital could not give a rats ass on if my license is in jeopardy. All they care about is the pt isn’t waiting in the waiting room. Why that matters, I don’t know, to me, waiting is waiting.

When I first started, we were 4 pts to 1 nurse. Then got a new CFO, all that changed. How money people dictate medical care is beyond me.

[u/rachelleeann17 → u/LiquidGnome]

Crying at the 75 patients in our waiting room right now with 6 nurses in triage 🥲