ER: - No ancillary staff, rooms are rarely mopped, theres never any toilet paper or paper towels, trash is overflowing daily. Routine maintenance is not a priority. Often supplies will go missing and questions will be met with a shrug. - CNAs are not empowered to do their jobs, often being used as transport or in specific roles they cannot leave, not for nursing support. - Extremely fast turnover of critical patients. Ratios are generally always at least 4:1, with no consideration of acuity. New patients will be waiting outside of the room before the previous patient even leaves, so rooms will only get the bare minimum of cleaning, and there is no break from the constant pressure. - Serious brain drain, very few nurses with >3 years experience, virtually no nurses with >5 years. New grads training new grads. - Management is strapped, unable to enforce accountability, very much a wild-wild west, no rules situation. - Pediatrics is not a separate department, ER Peds nurses are often floated to adult areas. - Often more than 60-80 holds in the department. - Heavy psych burden with scant resources to protect nurses from physical and emotional dangers. - Lack of rooms due to holds means critical patients, who require monitoring, are placed in hall beds with portable monitors that are not connected to central monitoring unit. - Very high turnover means that most staff are new as of a couple years or less, no ownership of the unit, supplies placed wherever, no systems for taking accountability in place. - Flexing people off up to a week in advance has led to short staffing during surge times, no one on call to make up the gap.
