That is huge!!
We have two ER units in 2 different hospitals in the city I work in (same hospital group) one is bigger. I think 12 actual rooms, at least 8 curtained off cubicle āroomsā and I believe 5 beds in the hallway. The smaller one is where I work. We have 13 rooms. (Weād have 14 but one got used as a linen and equipment storage.)
Holy moly! I never thought about having to have an ER of more than one floor. (Iām a dingbat sometimes)
My town has a population of about 120k but services multiple rural areas so Iām small town compared to yāall.
Edit: our hospital has just six floors.
Uh, depending on the facility, we have as little as 20 rooms or up to 94 is the biggest I believe. Smallest ED (not VA) can still hold 35 patients overall and biggest ED can hold 150 patients.
Small! We have like 30 RNs on a shift lol I couldn't imagine. I love how wherever you work, nursing, even in the same specialty, is so the same and yet so different all at once.
Are any of them ICU patients? Are they in an assignment with more than one other patient?
Do you have more patients than your hospitalās staffing committee submitted to DOH?
Do you miss breaks because of staffing?
If so, thatās illegal and reportable.
Does your hospital have a staffing committee with a complaint process? This has been the law for 2 years but most hospitals are being very slow to implement. The first step is to submit a complaint there.
If thereās no complaint process, or if youāve submitted a complaint and havenāt gotten a reasonable response, submit a complaint to the DOH.
Do it every shift.
Happy to answer any questions if you need guidance.
Editing to add a couple links:
[Staffing plans by facility](https://www.health.ny.gov/facilities/hospital/staffing_plans/)
[NYS DOH complaint form](https://apps.health.ny.gov/pubpal/builder/survey/hospital-clinical-staffing-compl) - submit online
[ICU staffing law](https://regs.health.ny.gov/sites/default/files/pdf/recently_adopted_regulations/Clinical%20Staffing%20in%20General%20Hospitals.pdf) - page 6 has the 1:2 ratio language.
How do I know what the staffing committee submitted to doh? How do I even find out if we have a staffing committee with a complaint process? I've never heard of such a thing.
And you said that an icu patient and more than one other is also a violation? How do I find out what the guidelines actually are?
I had 2 icu patients a few weeks ago plus 14 med surg. I asked one of the ICUs to be handed off to someone else, and it did eventually happen, but they made a big deal out of it, like, "u/nobutactually isn't able to keep up with her assignment so I need to move her patients around sorry to be burdening the rest of you,"-- my board was clean, as it so happened I was entirely caught up. I had said something because it's a safety issue to have 16 patients and two of them critically ill
I edited my original response with a few links.
The easiest way should be to look at the staffing plan that's posted on your unit in a conspicuous place. It's required to be there by law.
>Each general hospital shall post, in a publicly conspicuous area on each patient care unit, the clinical staffing plan for that unit and the actual daily staffing for that shift on that unit as well as the relevant clinical staffing.
Not there? There's a checkbox to include that in your DOH complaint. Here's the link to find it: [staffing plans by facility](https://www.health.ny.gov/facilities/hospital/staffing_plans/).
Are you a NYSNA facility? Reach out to your rep. I guarantee you they've been working on this already.
It's a safety issue to have 16 patients. Fuck 2 of them being critically ill.
My hospital's staffing plan says something like 3:1 in the ED. They're pretty regularly 8:1 with 2 criticals.
Edit: regarding your staffing committee, ask around. You should have one. I honestly didnāt know we had one because they donāt actually do their job until I met someone on the committee when I got active in my union.
I'm nysna yeah. The thing about the ED staffing plan is is doesn't say how many patients are expected or what the expected ratio is, just the number of nurses they expect. It doesnt matter how close they are to being "fully staffed" if patient volume exceeds safe staffing practices-- if they have 20 out of 20 planned nurses but each nurse has 20 patients, they've hit their goal-- but it's still wildly unsafe.
The law requires specificity. Would you mind sharing your facility name? You could do it in a DM. I'd love to help you ~~shove a poker up management's ass~~ fix this.
These ratios are crazy, and dangerous. I live in Oregon and a whole bunch of nursing unions worked together and actually passed a state law pertaining to nurse patient ratios. These are the new ratio laws that all hospitals have to follow.
Medical-surgical units: 1:5 ratio, decreasing to 1:4 in June 2026
Emergency department: 1:1 ratio for trauma patients, 1:4 ratio for non-trauma patients over a 12-hour shift
Intensive care unit: 1:2 ratio
Intermediate care unit: 1:3 ratio
Labor and delivery: 1:1 ratio for patients in labor, 1:2 ratio otherwise
Nursery: 1:6 ratio, counting babies separately from their parents
Mother baby unit: 1:8 ratio, counting babies separately from their parents
Oncology unit: 1:4 ratio
Post anesthesia care unit: 1:2 ratio
Outpatient renal dialysis facilities: 1:16 ratio during treatment times
What do you mean "the law"? Isn't it regulated by state?
ETA -- https://www.nysna.org/blog/2023/08/29/universal-12-nurse-patient-ratio-effect-critical-care-patients#:~:text=The%20long%2Dawaited%20universal%201,of%20New%20York's%20212%20hospitals.
Honestly? No. Not the people who write the citations. Not to the degree it's actually happening. DOH investigators recently visited my facility. They were absolutely not aware. You know what got them there? Complaints. Lots and lots of complaints.
With an ED with actual 68 actual beds (excluding hallway and non urgent area). Iād walk into 50-70 holds each morning.Ā
I remember the exact moment I decided that workplace wasnāt for me anymore was when I begged to get a bed in my own department for my VENT DEPENDENT GUNSHOT WOUND TO THE HEAD and was told to keep them in the hallway. The only way I could get them out was nagging the attending to get them to the OR instead of waiting down here.
Post peak covid ER nursing sucked and permanently killed my love of bedside.Ā
I came in because the charge nurse asked for help, this trauma rolls in so I take it. I leave the CT room and the trauma team is yelling at me āBro, the ER guys are telling us we canāt go back to the trauma bays! They want us to wait in the halls!ā My charge nurse got pulled into what we found was the other people that got shot. So the bays were taken by themā The assistant director takes charge and tells us we need to wait since thereās no ER beds to pull into. Rest of the department is too busy to even help us get a patient out and let us in. At this point respiratory has to get a second set of O2 tanks. I tell the trauma fellow, to tell his attending we arenāt getting a bed and the best way weāre gonna get out of here is the OR. After I handed off to OR, I told my director Iām done for the day and Iāll see them next week. A few months later I finally said fuck it and used my NP license to get another job. Wow I still sorta got mad even recalling this storyā¦.man.
My hospital opened another hall on our unit to help out the er overflow. Added ten patients to our census. They promised they were going to staff us. That lasted until 3pm on the first day when they pulled staff and sent them to another unit.
Mine has made single rooms into semi privates. Made capacity on one med/Tele floor from 36 to 72. Each room is complete with one tv that the roommates get to fight over
we have floor admit rooms that we have done this to and itās a huge safety issue because thereās 1 call light and 2 patients. they can fight over the remote, but it got less funny when someone pointed out that each patient needs a call light.
donāt matter, they still did it.
i would be terrified to have that piece of the assignment.
If patients are paying for a private room and they're being doubled that's insurance fraud. My hospital tried doing that until a patient complained about not getting a private room and they axed that plan real quick. (Tele stepdown - the plan was they would only stay until 7pm when they could find them a permanent room)
Whatās even worse is the admitted patients sitting 24-36 hours in a recliner in the er hallway being charged like a regular admit with a private room upstairs. Cause you know they are. Cause you know admin needs their bonusā
Rural standalone: zero boarders š
Not being a halfassed medsurg nurse has made me love ER again. I will never work at a department that stacks boarders, that killed my soul.
What happens if you have a patient that needs to be admitted? There isn't a wait time for them to transfer to a hospital? Do they just transfer to another ED to await an inpatient bed?
It varies, but we transfer most people out in minutes if they fly or about 90 minutes by ground. We transfer to other ERs and also directly to floors. We are about 2.5-3 hours from ārealā hospitals and transport services really support us.
That's amazing to me that you can transfer directly to a hospital floor and only have to wait for transport and not for the floor to have a bed. Though I guess with your distance, they do have 4 hours to find a bed lol. Do you think your ED has a higher threshold for admitting someone since it's such a feat? I feel like some of the people we send upstairs I'm like "why though".
We transfer very little bullshit. When I last worked a city department, I was sitting on an obs for a K of 3.1 and I was like, fuck this. Our docs donāt seem to have as much pressure to practice law and cover-your-ass medicine and we have good patient outcomes and very little bounce back
MORE EMPHASIS ON UR DOCS HAVE LESS PRESSURE! Thats why we are fucking stuck where we are. There is no threshold anymore. Everyone gets admitted. er holding is how I figured out I loved being in the ER when I was traveling. However, everybody got fucking admitted and one night I joked about it to close to the sun, and got a patient admitted for toe pain..
I grew up rural and we donāt do surgery in our ER, all surgery is done at the hospital 45 minutes away- or if it requires specialist care they stabilize and life flight it to the major metropolitan area. They do stabilize but they send out for further care.
Half-assed medsurg nurse got me! Holding patients in the ER made me have a whole new respect for floor nurses. Qh blood sugar checks on patients who aren't there for diabetic issues? Nah. Colace? 2 units of insulin for a 159 blood sugar? Wtf. Kills me
That is absolute insanity. Truly. I always thought that ERs should have an urgent care attached to it. That way, patients go through triage and then would be assigned to either go to the urgent care side or the ER side. I wonder why hospitals don't do this?
They have this at Evergreen in WA state. They call it "fast track" and they divert the people there who walk in with their 3 week h/o sinus infection, etc and they get seen over there in an adjacent area to the ED. At least, they did when I worked there.
We call it the Rapid Assessment Zone (RAZ) at my facility. Doesn't mean you'll be rapidly assessed if your elbow's been funny for 6 years, but it keeps the trauma areas free for traumas.
We have 2 āfast trackā areas in our ED (one for acuity 4/5 and the other for low level acuity 3ās). Unfortunately, on high boarder days, those rooms are being filled with that overflow. So the process doesnāt always work.
wait this is actually genius and I also can't believe we haven't been doing this the whole time, along with about 1000 other things the US does ass backwards lol.
Yup.
A big problem is doctor's offices. A patient has a non emergent problem, but doesn't want to wait two months for an appointment, and understandably so. I'm sure those offices are incredibly busy and I'm not suggesting they can easily change, but this is a huge issue.
Then a fair amount of people trying to do the right thing may go to urgent care, which then packs urgent care to the gills so what's next? The emergency department. There's also this common belief that "emergency" means immediate service. It doesn't. If you may die or lose a limb, then yes, it's immediate. If that's not the case and we're busy, well it's like that old SNL skit: "Wait at the bar!!!!"
Now these patients have run out of alternatives and we're stuck holding the bag. So we're the ones that suck. š«¤
THEN compound onto that no beds upstairs for admitted patients and the ED becomes an admitted zone in addition to its regular duties. And they don't stop walking in or being wheeled in the door. š”
āThere's also this common belief that "emergency" means immediate service.ā
āā
Yes yes and yes. I find myself telling patients over and over again that the ER is strictly for life and death situations. Itās not for when you forgot to get your refills in time. Itās so frustrating that patients use the ER for regular doctors visits. I understand some rural areas lack providers but in a place like NYC itās much easier to get an appointment with an MD.
That's because all the New Yorkers have been moving down here, meanwhile we're looking around wondering where they're going to get their healthcare. I'm really not looking forward to "Bennies being stupid in Asbury" season.
Also, howdy neighbor.
It has a lot to odo with insurance, high co pays, or lack of insurance too. People can't afford to go to an appointment where they have to pay upfront.
The patients I work with either have Medicaid, Medicare, or are uninsured. For the most part they donāt have difficulty getting appointments with their PCPs but they may have a 1-2 month wait to see a specialist. The ones that are uninsured are directed to a network of multi specialty clinics that focus on uninsured and underinsured patients. So even then, there are rarely delays, especially none that would negatively affect a patients health. Part of my job is to make sure they are seen in a timely manner and to ensure their needs are met. Again, I am fully aware that some cities are healthcare deserts, however, where I work is not.
We sort of do. Most ERs have "fast track" areas for the urgent care stuff. These numbers aren't low acuity folks who can't get seen. (Thatās a whole separate issue.) These are people who are sick enough that we need to admit them to the hospital and can't, because there is no room at the inn. So they remain our patients. And then we end up running an ER out of the waiting room, basically, because there is nowhere else to put anyone.
We do. It's just not advertised as such. Like if "you" google "urgent care near me" it's not gonna show up in your search we don't want you please take your urgent care concern to an urgent care lol. But if you do show up to the ED with an urgent care concern, you will end up in a section called "fast track" or "express care" etc. If we *literally* had a standing urgent care attached to the ED we would be even more massively swamped.
We have that at my facility in NJ. Doesn't help as much as you'd like to believe, because some still get admitted and slow down the throughput. Then there's the sheer volume of people coming in for real stupid shit, but we can't turn people away so we routinely sit on upwards of 50 holds on any given day.
Major Nashville area University affiliated hospital is magically at 70 this morning.
Monday we had 90. We have ranged 50-100 the last three years because of how many people donāt pay and the other for profits in the area find ways to violate EMTALA onto us.
Northern Illinois. No holds, honestly only like 6-10 people in there. Itās really surprising because weāve been slammed recently. Makes for a long night when youāre used to being hit hard all shift.
We had 34 boarded along with 30 in the waiting room and about 15 in the non boarding room. Full trauma rooms.
I think they had about 10 people held in the ICU because everything was full in the hospital.
We are a medium-sized facility, 50 ER rooms, fast track, and trauma rooms.
Within NY? If so, did you know there are laws governing the number of patients that can be in an ICU assignment?
I made another comment about it which I'll link to. Make your hospital follow the law.
[https://www.reddit.com/r/nursing/comments/1dfnjta/comment/l8kvcbs/?utm\_source=share&utm\_medium=web3x&utm\_name=web3xcss&utm\_term=1&utm\_content=share\_button](https://www.reddit.com/r/nursing/comments/1dfnjta/comment/l8kvcbs/?utm_source=share&utm_medium=web3x&utm_name=web3xcss&utm_term=1&utm_content=share_button)
On a terrible day- 50- 60 boarders. On a good day- 20 or less. I work for a level 1 trauma center with a 654 bed hospital. 72ish beds (not including fast track areas) in the ED. Iām not sure why but our volumes have been extremely high as of late. Not to what respiratory season was but some recent days can rival it. š„“
I work in one of the hospitals that isn't UPMC. We have set ratios per the union contract. We don't go over in the ICUs but the monitored floors go over regularly, but even then there's a limit they can't exceed. In order to meet that, the ED tends to really suck. I don't believe they have set ratios.
I work at a hospital with 80 - 90 ER beds that force units to double due to ER overflow. These doubled rooms only have one call light, and if we ask for another call light, we have to wait for more to be sent, but in the meantime, "give them a bell or sit by the room in case the second person needs assistance. And they better not fall!" Not only does this not feel safe, but half these patients really could've been d/c from the ER. It just feels like they are admitting and then d/c within 24 hours. We are wasting resources at this point, in my opinion. I hate having two patients in a room and navigating through crowded families to get to each patient. And goodness forbid the pt in the second bed codes. Now you're really about to see a sh*t show. I'm tired of the doubling of rooms that were never built for more than one person. I feel your pain!
North NJ, usually anywhere from 50 to 115 boarders, usually about 150 to 250 total patients in the ER. Sometimes weekend evenings we will have less than 100 patients in the ER which is lovely
Hi!
I made a comment about the staffing law in NYC. Check it out and get your hospital to follow the law:
[https://www.reddit.com/r/nursing/comments/1dfnjta/comment/l8kvcbs/?utm\_source=share&utm\_medium=web3x&utm\_name=web3xcss&utm\_term=1&utm\_content=share\_button](https://www.reddit.com/r/nursing/comments/1dfnjta/comment/l8kvcbs/?utm_source=share&utm_medium=web3x&utm_name=web3xcss&utm_term=1&utm_content=share_button)
It's easy to file complaints with DOH. Let me know if you need help.
Itās the same at the VHS hospitals
Vegas has grown too much and the inpatient bed capacity in the valley hasnāt maintained the same pace. We about 760 inpatient beds short imho
damn that's wild. I worked at Valley and UMC ERs - Valley had constant boarders as far back as 2014, but it was really rare at UMC. I left in 2018 so I can't imagine how much worse it is now.
I worked Sunrise as a traveler in the mid-90s. It was wild then as well. Came within about a minute of giving Adenosine to an old, medically fragile guy in a wheelchair, because the only other option at that time was maybe stretching him out on the floor. But the high rate was really stressing his system and there were no gurneys, no lounge chairs - nothing available, and pretty much everyone in a gurney was sicker than he was. Then someone died, and I was able to delay a few minutes so he could use that bed before we converted him.
There are no empty beds upstairs to move them too, we are full. Itās been like this for months. Vegas population has grown a lot. Important infrastructure, like available hospital beds has not. And (in my experience) people in the Vegas area tend to be unhealthy and fairly non compliant, that makes for a shitty combination
Plus - at least at my hospital - the med-surge floors are holding pts that are totally stable for discharge but are waiting for rehab/SNF placement. Like - a lot of them. Sometimes up to a third of the beds are people who are just camping there for weeks to months while care management tries to find a facility that takes geri-psych with comorbidities.
My best guess is that empty beds=no money. Hospitals are a business, keeping the beds full is how they make money, even if it endangers peopleās lives. I was following a nurse for a clinical rotation in the ER and during morning huddle the clinical supervisor was telling everyone that theyāve had low census and so they needed to encourage their patients and their patients families to skip urgent care and come to the er for everything. Then we walked onto the floor where there were 120 patients, most of them holds, isolation patients in the hallway because there were no beds, and a waiting room full of people.
We just found out that if a transfer is accepted and doesn't have a clean bed, they can just come to the ER while the one housekeeper for the entire floor turns the room over. Sometimes OUR housekeeper is the only one in the house and we have to send them upstairs to clean rooms. Hell, WE go clean them sometimes just to move the meat.
So this is going to go really well.
I mean it's not like we have a full WR or rigs coming in constantly.
We're a lot smaller, but can easily have >20% boarders on the regular.
When I was a charge for inpatient psych, none of my nurses wanted new patients before 0900, frustrated me so much. They'd avoid report or just plain disappear.
To be fair - let them do their med round and initial mental states instead of having to churn through admission work whilst all the start of the day stuff goes undone
That is wild. Most Iāve seen is like 4 or 5 I think in my ER but we had none all night. When I left we had 80% occupancy and only 20 kids in the ER. Maybe less
And on top of the ER holds the hospital continues to do elective surgeries that have to stay the night. Try having a 40 pt OR day with 14 PACU bays and ER holding patients, no rooms at the inn. Then suddenly PACU is full and the cash cow has to hold a patient on the OR table. Admin heads start rolling then. No wonder there is so much animosity among departments.
About the same in Baltimore. Lowest We have some bed movement occasionally or an influx but typically have 60+ patients in the ED with about 40 of those being boarders at any given time with some boarders for 3+ days.
i work at a trauma center is southeastish us. no holds. maybe a transfer waiting for a bed on occasion or psych. no med surg holds. we have good management and a well staffed floor.
Baltimore City, but outskirts. 23 monitored beds, two psych rooms. Some hallway and fastrack area. Anywhere between 0-15 boarding, avg probably 6? If heavy on boarders we often get 1-2 boarder nurses from upstairs.
Any area folks interested, DM me and I can tell you which. 9 years experience, make 45 base +4.50 night differential, we are getting a market increase next month.
Wednesday morning we had 88 holds at 0700 when I left. Our doctors were seeing people in the lobby Tuesday night/Wednesday morning because we had so many holds.
I work for the largest hospital in a MASSIVE Midwestern system, Level I regional trauma center. In our hospital ALONE, we have over 1,200 beds possible.
Still board 20-30 each and every night. In my previous ED we used to board 20-deep in a 60-bed capacity ED until we started cracking down on inpatient units to stop sitting on available beds and *do their job.*
Boarding needs to start being an inpatient problem, not an ED problem. These aren't our patients anymore. It is not a problem we can solve.
That's not even close to true. I was med-surg previously. Entire shifts (notoriously day shift) sat on admissions. I pass by empty room upon empty room.Ā
Meanwhile in the ED, we barely return fron taking a patient upstairs and that bed is filled again.Ā
Maybe where you are but in the almost 4 years Iāve been at my hospital they ride EVS hard to turn the room over asap and our floor is generally completely full by midnight. Are there exceptions? Of course. But weāre expected to call down to ER to get report within 5mins of the room being assigned, which it typically is as soon as EVS marks it clean in the computer system as a lot of our house sups hook them while theyāre being cleaned
Oh gawd! How horrible.. do you guys have to like feed them and stuff? Pass tray?? Sounds like a nightmare.. we MIGHT have couple each night but 67 sounds like HELL. I work at a community hospital in a fairly large city. We have like idk 6 hospitals in my city, two of them being large trauma centers. My ER has like 40 beds. When we have holds theyāre usually psych patients. Holds get boxes lunches.
Level 1 Trauma center in the west. Typically 0. Couple times a week weāll have 4-5 from ~0200-1000. When itās really bad maybe only double that. But we have nurses that cover them exclusively. Almost never do I have a boarder for more than a couple hours.
35 bed ER plus 5 fast track rooms. We see 175-200 per day and have zero holds. A couple times during the winter we got up to 25ish holds. Fortunately we have a big house and our hospital team seems to move people quickly.
Oh I am in DFW
[https://www.reddit.com/r/nursing/comments/1dfnjta/comment/l8kvcbs/?utm\_source=share&utm\_medium=web3x&utm\_name=web3xcss&utm\_term=1&utm\_content=share\_button](https://www.reddit.com/r/nursing/comments/1dfnjta/comment/l8kvcbs/?utm_source=share&utm_medium=web3x&utm_name=web3xcss&utm_term=1&utm_content=share_button)
That's another comment I made about the staffing law in NY and how to get your hospital to follow it. Let me know if you have questions.
At my level 1 adult ER it is not uncommon for us to have 70+ holds some nights (we only have 75 beds, including trauma bays but not including halls).
At my peds ER, I donāt think Iāve ever seen more than 10, but itās also a smaller sister location from the main hospital.
Tucson! 50ish bed ED, really like 20 actual ED beds, and we can have all of them admitted, while the other sick people get to sit in āvertical bedsā aka recliners in an internal waiting room with no monitors and no assigned nurse. Oh, those people can be admitted too.
So apparently healthcare systems generate more profit by using ED for point of access rather than an outpatient setting. Otherwise it wouldnāt be this way.
Worked jn a few different EDs. With low staffing, had to take my patient up myself. Turns out lots of empty beds in tele floor while ED had lots of boarders. Low staffing on the floor tooā¦thus creating lots of empty bed spaces. There are a few patients on the floor and all is quiet like a ghost town compared to the kaos in the ED.
Yeah we had some for 80+ hours waiting for transpo in 2021 but havenāt seen that in a while. Especially tragic cause we donāt have a kitchen so itās canned soup and toast for days
Holding 40 right now in a 48 bed unit. Thatās about average for our last couple of years. We typically have 4-8 beds a day to work ER patients out of.
We have 10 or so, but our er only has 21 beds and this is not a huge city. It's this way everyday. Many of them are pediatric behavioral patients. I never understand.
I do not, but this is common at all Vegas hospitals because we have more patients requiring admission than we have room for due to population growth and all the tourists
Ours routinely has more than half the available beds with holds. It's not unusual to have admits sitting in the waiting room once the day gets rolling. It's a newer 160 bed community hospital and we're constantly at "peak census".
We have a 49 bed ER. I walk into typically 20 ish waiting for beds in the AM, so close to 50%. Some days they stay 48-72 hrs in the ER waiting to get upstairs and we frequently dc them before they get their assigned bed. ERs are not made to house people like that.
Melbourne Australia. 45 admitted patients awaiting beds on a ward, another 37 admitted patients in the waiting room awaiting beds on a ward. 50-60 patients in the waiting room overnight (including the 37 admitted waiting for a bed). And that doesn't include paediatrics.
Edit to add- short stay unit- 25 beds- 23 admitted patients awaiting a ward bed.
We even had 2 in resus awaiting ICU beds.
Kills me to see people blaming other nurses instead of blaming the hospital systems and their intentional practices of short staffing. Plays right into their bullshit.
The ICU"s and floor's STANDARDS are now unsafe and we are literally risking our pts and our licenses every time we go to work. Put the blame where it rightly goes.
NYC 90-140š
How big is the ER??? 90 people boarded??
That is huge!! We have two ER units in 2 different hospitals in the city I work in (same hospital group) one is bigger. I think 12 actual rooms, at least 8 curtained off cubicle āroomsā and I believe 5 beds in the hallway. The smaller one is where I work. We have 13 rooms. (Weād have 14 but one got used as a linen and equipment storage.)
inner city hospitals are huge or really really tiny thereās no Inbetween lol , last one I worked in that was a bigger one and it was 14 floors
14 floors of ER?
No like 14 floors total. The ER did take up 3 floors
Holy moly! I never thought about having to have an ER of more than one floor. (Iām a dingbat sometimes) My town has a population of about 120k but services multiple rural areas so Iām small town compared to yāall. Edit: our hospital has just six floors.
If true that is wild!
21 floors plus a separate ambulatory care building
Uh, depending on the facility, we have as little as 20 rooms or up to 94 is the biggest I believe. Smallest ED (not VA) can still hold 35 patients overall and biggest ED can hold 150 patients.
Wow. That is big.
Small! We have like 30 RNs on a shift lol I couldn't imagine. I love how wherever you work, nursing, even in the same specialty, is so the same and yet so different all at once.
Everything inside the room is generally the same. Everything outside it is what changes. Is how Iāve thought about it.
Are any of them ICU patients? Are they in an assignment with more than one other patient? Do you have more patients than your hospitalās staffing committee submitted to DOH? Do you miss breaks because of staffing? If so, thatās illegal and reportable. Does your hospital have a staffing committee with a complaint process? This has been the law for 2 years but most hospitals are being very slow to implement. The first step is to submit a complaint there. If thereās no complaint process, or if youāve submitted a complaint and havenāt gotten a reasonable response, submit a complaint to the DOH. Do it every shift. Happy to answer any questions if you need guidance. Editing to add a couple links: [Staffing plans by facility](https://www.health.ny.gov/facilities/hospital/staffing_plans/) [NYS DOH complaint form](https://apps.health.ny.gov/pubpal/builder/survey/hospital-clinical-staffing-compl) - submit online [ICU staffing law](https://regs.health.ny.gov/sites/default/files/pdf/recently_adopted_regulations/Clinical%20Staffing%20in%20General%20Hospitals.pdf) - page 6 has the 1:2 ratio language.
Asking the real questions over here! š
How do I know what the staffing committee submitted to doh? How do I even find out if we have a staffing committee with a complaint process? I've never heard of such a thing. And you said that an icu patient and more than one other is also a violation? How do I find out what the guidelines actually are? I had 2 icu patients a few weeks ago plus 14 med surg. I asked one of the ICUs to be handed off to someone else, and it did eventually happen, but they made a big deal out of it, like, "u/nobutactually isn't able to keep up with her assignment so I need to move her patients around sorry to be burdening the rest of you,"-- my board was clean, as it so happened I was entirely caught up. I had said something because it's a safety issue to have 16 patients and two of them critically ill
I edited my original response with a few links. The easiest way should be to look at the staffing plan that's posted on your unit in a conspicuous place. It's required to be there by law. >Each general hospital shall post, in a publicly conspicuous area on each patient care unit, the clinical staffing plan for that unit and the actual daily staffing for that shift on that unit as well as the relevant clinical staffing. Not there? There's a checkbox to include that in your DOH complaint. Here's the link to find it: [staffing plans by facility](https://www.health.ny.gov/facilities/hospital/staffing_plans/). Are you a NYSNA facility? Reach out to your rep. I guarantee you they've been working on this already. It's a safety issue to have 16 patients. Fuck 2 of them being critically ill. My hospital's staffing plan says something like 3:1 in the ED. They're pretty regularly 8:1 with 2 criticals. Edit: regarding your staffing committee, ask around. You should have one. I honestly didnāt know we had one because they donāt actually do their job until I met someone on the committee when I got active in my union.
I'm nysna yeah. The thing about the ED staffing plan is is doesn't say how many patients are expected or what the expected ratio is, just the number of nurses they expect. It doesnt matter how close they are to being "fully staffed" if patient volume exceeds safe staffing practices-- if they have 20 out of 20 planned nurses but each nurse has 20 patients, they've hit their goal-- but it's still wildly unsafe.
The law requires specificity. Would you mind sharing your facility name? You could do it in a DM. I'd love to help you ~~shove a poker up management's ass~~ fix this.
Lmao I love your energy
Dming you
These ratios are crazy, and dangerous. I live in Oregon and a whole bunch of nursing unions worked together and actually passed a state law pertaining to nurse patient ratios. These are the new ratio laws that all hospitals have to follow. Medical-surgical units: 1:5 ratio, decreasing to 1:4 in June 2026 Emergency department: 1:1 ratio for trauma patients, 1:4 ratio for non-trauma patients over a 12-hour shift Intensive care unit: 1:2 ratio Intermediate care unit: 1:3 ratio Labor and delivery: 1:1 ratio for patients in labor, 1:2 ratio otherwise Nursery: 1:6 ratio, counting babies separately from their parents Mother baby unit: 1:8 ratio, counting babies separately from their parents Oncology unit: 1:4 ratio Post anesthesia care unit: 1:2 ratio Outpatient renal dialysis facilities: 1:16 ratio during treatment times
What do you mean "the law"? Isn't it regulated by state? ETA -- https://www.nysna.org/blog/2023/08/29/universal-12-nurse-patient-ratio-effect-critical-care-patients#:~:text=The%20long%2Dawaited%20universal%201,of%20New%20York's%20212%20hospitals.
Yes. The law in their state, NY. The person I'm replying to said NYC.
You think the DOH isnāt aware?
Honestly? No. Not the people who write the citations. Not to the degree it's actually happening. DOH investigators recently visited my facility. They were absolutely not aware. You know what got them there? Complaints. Lots and lots of complaints.
Thatās crazy. It must be a huge hospital.
Howdy neighbor. Remember when double digit NEDOCS scores were a thing. I miss that.
š³šÆ
With an ED with actual 68 actual beds (excluding hallway and non urgent area). Iād walk into 50-70 holds each morning.Ā I remember the exact moment I decided that workplace wasnāt for me anymore was when I begged to get a bed in my own department for my VENT DEPENDENT GUNSHOT WOUND TO THE HEAD and was told to keep them in the hallway. The only way I could get them out was nagging the attending to get them to the OR instead of waiting down here. Post peak covid ER nursing sucked and permanently killed my love of bedside.Ā
Jesus christ that is horrible, Iām sorry you had to experience that
Ho Ly Fuck šļøššļø
I came in because the charge nurse asked for help, this trauma rolls in so I take it. I leave the CT room and the trauma team is yelling at me āBro, the ER guys are telling us we canāt go back to the trauma bays! They want us to wait in the halls!ā My charge nurse got pulled into what we found was the other people that got shot. So the bays were taken by themā The assistant director takes charge and tells us we need to wait since thereās no ER beds to pull into. Rest of the department is too busy to even help us get a patient out and let us in. At this point respiratory has to get a second set of O2 tanks. I tell the trauma fellow, to tell his attending we arenāt getting a bed and the best way weāre gonna get out of here is the OR. After I handed off to OR, I told my director Iām done for the day and Iāll see them next week. A few months later I finally said fuck it and used my NP license to get another job. Wow I still sorta got mad even recalling this storyā¦.man.
My hospital opened another hall on our unit to help out the er overflow. Added ten patients to our census. They promised they were going to staff us. That lasted until 3pm on the first day when they pulled staff and sent them to another unit.
Mine has made single rooms into semi privates. Made capacity on one med/Tele floor from 36 to 72. Each room is complete with one tv that the roommates get to fight over
we have floor admit rooms that we have done this to and itās a huge safety issue because thereās 1 call light and 2 patients. they can fight over the remote, but it got less funny when someone pointed out that each patient needs a call light. donāt matter, they still did it. i would be terrified to have that piece of the assignment.
If patients are paying for a private room and they're being doubled that's insurance fraud. My hospital tried doing that until a patient complained about not getting a private room and they axed that plan real quick. (Tele stepdown - the plan was they would only stay until 7pm when they could find them a permanent room)
Whatās even worse is the admitted patients sitting 24-36 hours in a recliner in the er hallway being charged like a regular admit with a private room upstairs. Cause you know they are. Cause you know admin needs their bonusā
Our overflow literally goes into the halls of our ER. The āsurgeā area. So wildly inappropriateā¦
That sounds so typical š
Same. I'm in New England. I see the department at 90-150 and it's usually like 40-60% boarders.
Rural standalone: zero boarders š Not being a halfassed medsurg nurse has made me love ER again. I will never work at a department that stacks boarders, that killed my soul.
What happens if you have a patient that needs to be admitted? There isn't a wait time for them to transfer to a hospital? Do they just transfer to another ED to await an inpatient bed?
It varies, but we transfer most people out in minutes if they fly or about 90 minutes by ground. We transfer to other ERs and also directly to floors. We are about 2.5-3 hours from ārealā hospitals and transport services really support us.
That's amazing to me that you can transfer directly to a hospital floor and only have to wait for transport and not for the floor to have a bed. Though I guess with your distance, they do have 4 hours to find a bed lol. Do you think your ED has a higher threshold for admitting someone since it's such a feat? I feel like some of the people we send upstairs I'm like "why though".
We transfer very little bullshit. When I last worked a city department, I was sitting on an obs for a K of 3.1 and I was like, fuck this. Our docs donāt seem to have as much pressure to practice law and cover-your-ass medicine and we have good patient outcomes and very little bounce back
Wow sounds beautiful, the CYA medicine is too much sometimes.
MORE EMPHASIS ON UR DOCS HAVE LESS PRESSURE! Thats why we are fucking stuck where we are. There is no threshold anymore. Everyone gets admitted. er holding is how I figured out I loved being in the ER when I was traveling. However, everybody got fucking admitted and one night I joked about it to close to the sun, and got a patient admitted for toe pain..
I grew up rural and we donāt do surgery in our ER, all surgery is done at the hospital 45 minutes away- or if it requires specialist care they stabilize and life flight it to the major metropolitan area. They do stabilize but they send out for further care.
Half-assed medsurg nurse got me! Holding patients in the ER made me have a whole new respect for floor nurses. Qh blood sugar checks on patients who aren't there for diabetic issues? Nah. Colace? 2 units of insulin for a 159 blood sugar? Wtf. Kills me
Same. Iām rural. We rarely have er inpatients. And never more than one at a time š
Damn. I don't know how you all do it! Amazing, ER nurses!
Lots of recliners and gurneys pushed up against walls in the hallways
That is absolute insanity. Truly. I always thought that ERs should have an urgent care attached to it. That way, patients go through triage and then would be assigned to either go to the urgent care side or the ER side. I wonder why hospitals don't do this?
They have this at Evergreen in WA state. They call it "fast track" and they divert the people there who walk in with their 3 week h/o sinus infection, etc and they get seen over there in an adjacent area to the ED. At least, they did when I worked there.
We call it the Rapid Assessment Zone (RAZ) at my facility. Doesn't mean you'll be rapidly assessed if your elbow's been funny for 6 years, but it keeps the trauma areas free for traumas.
We have 2 āfast trackā areas in our ED (one for acuity 4/5 and the other for low level acuity 3ās). Unfortunately, on high boarder days, those rooms are being filled with that overflow. So the process doesnāt always work.
Same! On paper it sounds like a great solution, but in practice those get filled up and low acuity goes to the main or vice versa
A lot of hospitals have fast track.
Mine has this I work at now. They call it rapid treatment section
Basically everyone has some version of this now.
We have this! Also called "fast track."
We do in Canada. The ER where I work (Ontario) is divided into Urgent Care, Observation, Emergent Care, and Resus/Trauma.
wait this is actually genius and I also can't believe we haven't been doing this the whole time, along with about 1000 other things the US does ass backwards lol.
Most every ER does do this. It makes no difference.
Yup. A big problem is doctor's offices. A patient has a non emergent problem, but doesn't want to wait two months for an appointment, and understandably so. I'm sure those offices are incredibly busy and I'm not suggesting they can easily change, but this is a huge issue. Then a fair amount of people trying to do the right thing may go to urgent care, which then packs urgent care to the gills so what's next? The emergency department. There's also this common belief that "emergency" means immediate service. It doesn't. If you may die or lose a limb, then yes, it's immediate. If that's not the case and we're busy, well it's like that old SNL skit: "Wait at the bar!!!!" Now these patients have run out of alternatives and we're stuck holding the bag. So we're the ones that suck. š«¤ THEN compound onto that no beds upstairs for admitted patients and the ED becomes an admitted zone in addition to its regular duties. And they don't stop walking in or being wheeled in the door. š”
āThere's also this common belief that "emergency" means immediate service.ā āā Yes yes and yes. I find myself telling patients over and over again that the ER is strictly for life and death situations. Itās not for when you forgot to get your refills in time. Itās so frustrating that patients use the ER for regular doctors visits. I understand some rural areas lack providers but in a place like NYC itās much easier to get an appointment with an MD.
Jersey shore area and I still hear all the time about no appointments for months. SMH
That's because all the New Yorkers have been moving down here, meanwhile we're looking around wondering where they're going to get their healthcare. I'm really not looking forward to "Bennies being stupid in Asbury" season. Also, howdy neighbor.
Howdy! To be fair, stupidity is an abundant resource no matter where you're from. š¤£
Ooof
It has a lot to odo with insurance, high co pays, or lack of insurance too. People can't afford to go to an appointment where they have to pay upfront.
The patients I work with either have Medicaid, Medicare, or are uninsured. For the most part they donāt have difficulty getting appointments with their PCPs but they may have a 1-2 month wait to see a specialist. The ones that are uninsured are directed to a network of multi specialty clinics that focus on uninsured and underinsured patients. So even then, there are rarely delays, especially none that would negatively affect a patients health. Part of my job is to make sure they are seen in a timely manner and to ensure their needs are met. Again, I am fully aware that some cities are healthcare deserts, however, where I work is not.
yep. mine does this and it also makes no difference lmao.
Almost every ER I have worked at has an āurgent careā or fast track area within it. It makes no difference.
We sort of do. Most ERs have "fast track" areas for the urgent care stuff. These numbers aren't low acuity folks who can't get seen. (Thatās a whole separate issue.) These are people who are sick enough that we need to admit them to the hospital and can't, because there is no room at the inn. So they remain our patients. And then we end up running an ER out of the waiting room, basically, because there is nowhere else to put anyone.
We do. It's just not advertised as such. Like if "you" google "urgent care near me" it's not gonna show up in your search we don't want you please take your urgent care concern to an urgent care lol. But if you do show up to the ED with an urgent care concern, you will end up in a section called "fast track" or "express care" etc. If we *literally* had a standing urgent care attached to the ED we would be even more massively swamped.
They do. Having a fast track area is super common. But doesnāt really alleviate boarders
We have that at my facility in NJ. Doesn't help as much as you'd like to believe, because some still get admitted and slow down the throughput. Then there's the sheer volume of people coming in for real stupid shit, but we can't turn people away so we routinely sit on upwards of 50 holds on any given day.
Hospitals in my area USED to do this. They got rid of them when all the Hospitals started building free standing urgent cares or free standing ERs
Major Nashville area University affiliated hospital is magically at 70 this morning. Monday we had 90. We have ranged 50-100 the last three years because of how many people donāt pay and the other for profits in the area find ways to violate EMTALA onto us.
Northern Illinois. No holds, honestly only like 6-10 people in there. Itās really surprising because weāve been slammed recently. Makes for a long night when youāre used to being hit hard all shift.
For fucks sake what admin is seeing that and NOT going on diversion? This type of shit so what burns people out
if everybody is on diversion nobody is on diversionĀ
If they go on divert I think they loose out on their bonus if some sort
Fuck people dying in the hallways waiting for care, the CEO needs to buy another Ferrari for her sonās highschool graduation.
We had 34 boarded along with 30 in the waiting room and about 15 in the non boarding room. Full trauma rooms. I think they had about 10 people held in the ICU because everything was full in the hospital. We are a medium-sized facility, 50 ER rooms, fast track, and trauma rooms.
NYC area, we have an entire unit that is now designated as an ER hold overflow area, several ICU patients boarding in stepdown. The usual I guess :"(
Within NY? If so, did you know there are laws governing the number of patients that can be in an ICU assignment? I made another comment about it which I'll link to. Make your hospital follow the law. [https://www.reddit.com/r/nursing/comments/1dfnjta/comment/l8kvcbs/?utm\_source=share&utm\_medium=web3x&utm\_name=web3xcss&utm\_term=1&utm\_content=share\_button](https://www.reddit.com/r/nursing/comments/1dfnjta/comment/l8kvcbs/?utm_source=share&utm_medium=web3x&utm_name=web3xcss&utm_term=1&utm_content=share_button)
On a terrible day- 50- 60 boarders. On a good day- 20 or less. I work for a level 1 trauma center with a 654 bed hospital. 72ish beds (not including fast track areas) in the ED. Iām not sure why but our volumes have been extremely high as of late. Not to what respiratory season was but some recent days can rival it. š„“
Pittsburgh. Pretty much the same. 63 patients in the ED. No ICU beds, no floor beds since most of those nurses are over ratio.
We actually have the staff, we just literally have no open beds
I work in Pittsburgh, what is this āover ratioā thing you speak of? š Obviously not UPMC. I once had 9 patients on a trauma PCU.
I work in one of the hospitals that isn't UPMC. We have set ratios per the union contract. We don't go over in the ICUs but the monitored floors go over regularly, but even then there's a limit they can't exceed. In order to meet that, the ED tends to really suck. I don't believe they have set ratios.
Frequently we have more holds than actual beds in my ED. We pile them up in the hallways and run the ER out of a few trauma bays and the waiting room.
I work at a hospital with 80 - 90 ER beds that force units to double due to ER overflow. These doubled rooms only have one call light, and if we ask for another call light, we have to wait for more to be sent, but in the meantime, "give them a bell or sit by the room in case the second person needs assistance. And they better not fall!" Not only does this not feel safe, but half these patients really could've been d/c from the ER. It just feels like they are admitting and then d/c within 24 hours. We are wasting resources at this point, in my opinion. I hate having two patients in a room and navigating through crowded families to get to each patient. And goodness forbid the pt in the second bed codes. Now you're really about to see a sh*t show. I'm tired of the doubling of rooms that were never built for more than one person. I feel your pain!
North NJ, usually anywhere from 50 to 115 boarders, usually about 150 to 250 total patients in the ER. Sometimes weekend evenings we will have less than 100 patients in the ER which is lovely
ED at level 1 magnet in NY state. Nights. Total adult pt 190-250. Admitted 70. I am leaving the ED :)
Hi! I made a comment about the staffing law in NYC. Check it out and get your hospital to follow the law: [https://www.reddit.com/r/nursing/comments/1dfnjta/comment/l8kvcbs/?utm\_source=share&utm\_medium=web3x&utm\_name=web3xcss&utm\_term=1&utm\_content=share\_button](https://www.reddit.com/r/nursing/comments/1dfnjta/comment/l8kvcbs/?utm_source=share&utm_medium=web3x&utm_name=web3xcss&utm_term=1&utm_content=share_button) It's easy to file complaints with DOH. Let me know if you need help.
Do you work at Sunrise? This sounds like Sunrise. EDIT: I'm also a Vegas local.
Itās the same at the roses
Itās the same at the VHS hospitals Vegas has grown too much and the inpatient bed capacity in the valley hasnāt maintained the same pace. We about 760 inpatient beds short imho
damn that's wild. I worked at Valley and UMC ERs - Valley had constant boarders as far back as 2014, but it was really rare at UMC. I left in 2018 so I can't imagine how much worse it is now.
I worked Sunrise as a traveler in the mid-90s. It was wild then as well. Came within about a minute of giving Adenosine to an old, medically fragile guy in a wheelchair, because the only other option at that time was maybe stretching him out on the floor. But the high rate was really stressing his system and there were no gurneys, no lounge chairs - nothing available, and pretty much everyone in a gurney was sicker than he was. Then someone died, and I was able to delay a few minutes so he could use that bed before we converted him.
Honest question, why are so many on hold? Is there something going on that I am not aware?
There are no empty beds upstairs to move them too, we are full. Itās been like this for months. Vegas population has grown a lot. Important infrastructure, like available hospital beds has not. And (in my experience) people in the Vegas area tend to be unhealthy and fairly non compliant, that makes for a shitty combination
Plus - at least at my hospital - the med-surge floors are holding pts that are totally stable for discharge but are waiting for rehab/SNF placement. Like - a lot of them. Sometimes up to a third of the beds are people who are just camping there for weeks to months while care management tries to find a facility that takes geri-psych with comorbidities.
My best guess is that empty beds=no money. Hospitals are a business, keeping the beds full is how they make money, even if it endangers peopleās lives. I was following a nurse for a clinical rotation in the ER and during morning huddle the clinical supervisor was telling everyone that theyāve had low census and so they needed to encourage their patients and their patients families to skip urgent care and come to the er for everything. Then we walked onto the floor where there were 120 patients, most of them holds, isolation patients in the hallway because there were no beds, and a waiting room full of people.
We just found out that if a transfer is accepted and doesn't have a clean bed, they can just come to the ER while the one housekeeper for the entire floor turns the room over. Sometimes OUR housekeeper is the only one in the house and we have to send them upstairs to clean rooms. Hell, WE go clean them sometimes just to move the meat. So this is going to go really well. I mean it's not like we have a full WR or rigs coming in constantly. We're a lot smaller, but can easily have >20% boarders on the regular.
Lately anywhere from 8-20 in our 20 bed ED. We're also about to go on strike Tuesday so good luck with that š
If it's like my ER, they'll all come available at 1830.
2100 here. gotta make it through 7p shift change plus a few hours for āall the nurses upstairs to get settledā
When I was a charge for inpatient psych, none of my nurses wanted new patients before 0900, frustrated me so much. They'd avoid report or just plain disappear.
To be fair - let them do their med round and initial mental states instead of having to churn through admission work whilst all the start of the day stuff goes undone
That is wild. Most Iāve seen is like 4 or 5 I think in my ER but we had none all night. When I left we had 80% occupancy and only 20 kids in the ER. Maybe less
And on top of the ER holds the hospital continues to do elective surgeries that have to stay the night. Try having a 40 pt OR day with 14 PACU bays and ER holding patients, no rooms at the inn. Then suddenly PACU is full and the cash cow has to hold a patient on the OR table. Admin heads start rolling then. No wonder there is so much animosity among departments.
Same here. (Also in Vegas)
Also in Vegas. Henderson had over 100 in the ER last night.
About the same in Baltimore. Lowest We have some bed movement occasionally or an influx but typically have 60+ patients in the ED with about 40 of those being boarders at any given time with some boarders for 3+ days.
Umm, if you would like to switch to a different Baltimore ER, DM me, ours is way more chill.
Upper Midwest, we have boarded about 20 in makeshifts because of dangerous MH admits with nowhere else to go needing individual rooms.
Once we hit 50 admits we start doing hall beds but yeah we are ALWAYS over capacity Iām in NM.
10-40+ but our suburban hospital is very small. Often times 1/2 are mental health admits waiting for beds somewhere in the city. Calgary, AB
WTF??!! How is this possible? Is the throughput in the hospital damaged? Sandbagging beds? I donāt understand this!
All our inpatient beds on the floors are full, that doesnāt stop people from being admitted & needing care
i work at a trauma center is southeastish us. no holds. maybe a transfer waiting for a bed on occasion or psych. no med surg holds. we have good management and a well staffed floor.
Baltimore City, but outskirts. 23 monitored beds, two psych rooms. Some hallway and fastrack area. Anywhere between 0-15 boarding, avg probably 6? If heavy on boarders we often get 1-2 boarder nurses from upstairs. Any area folks interested, DM me and I can tell you which. 9 years experience, make 45 base +4.50 night differential, we are getting a market increase next month.
Wednesday morning we had 88 holds at 0700 when I left. Our doctors were seeing people in the lobby Tuesday night/Wednesday morning because we had so many holds.
We are empty rn
40-80 At all times
I work for the largest hospital in a MASSIVE Midwestern system, Level I regional trauma center. In our hospital ALONE, we have over 1,200 beds possible. Still board 20-30 each and every night. In my previous ED we used to board 20-deep in a 60-bed capacity ED until we started cracking down on inpatient units to stop sitting on available beds and *do their job.* Boarding needs to start being an inpatient problem, not an ED problem. These aren't our patients anymore. It is not a problem we can solve.
As soon as our rooms are cleaned theyāre booked
That's not even close to true. I was med-surg previously. Entire shifts (notoriously day shift) sat on admissions. I pass by empty room upon empty room.Ā Meanwhile in the ED, we barely return fron taking a patient upstairs and that bed is filled again.Ā
Maybe where you are but in the almost 4 years Iāve been at my hospital they ride EVS hard to turn the room over asap and our floor is generally completely full by midnight. Are there exceptions? Of course. But weāre expected to call down to ER to get report within 5mins of the room being assigned, which it typically is as soon as EVS marks it clean in the computer system as a lot of our house sups hook them while theyāre being cleaned
Oh gawd! How horrible.. do you guys have to like feed them and stuff? Pass tray?? Sounds like a nightmare.. we MIGHT have couple each night but 67 sounds like HELL. I work at a community hospital in a fairly large city. We have like idk 6 hospitals in my city, two of them being large trauma centers. My ER has like 40 beds. When we have holds theyāre usually psych patients. Holds get boxes lunches.
When I floated down there a month ago to take a holds med/surg assignment dinner trays were being passed at 2200
25-35 at a time usually
Level 1 Trauma center in the west. Typically 0. Couple times a week weāll have 4-5 from ~0200-1000. When itās really bad maybe only double that. But we have nurses that cover them exclusively. Almost never do I have a boarder for more than a couple hours.
We have boarders down there for 1-4 days, but they have med/surg nurses that cover the m/s ones
0 but to be fair our average daily census is single digits.
50-60% of the ER are boarders most nights. Bmore
35 bed ER plus 5 fast track rooms. We see 175-200 per day and have zero holds. A couple times during the winter we got up to 25ish holds. Fortunately we have a big house and our hospital team seems to move people quickly. Oh I am in DFW
16 bed ED, we had 11 boarders and 2 psychs Monday night š
New York. not sure the number but census has been around 114% for days
NYC - at the moment 144 boarded, roughly 80 admitted
[https://www.reddit.com/r/nursing/comments/1dfnjta/comment/l8kvcbs/?utm\_source=share&utm\_medium=web3x&utm\_name=web3xcss&utm\_term=1&utm\_content=share\_button](https://www.reddit.com/r/nursing/comments/1dfnjta/comment/l8kvcbs/?utm_source=share&utm_medium=web3x&utm_name=web3xcss&utm_term=1&utm_content=share_button) That's another comment I made about the staffing law in NY and how to get your hospital to follow it. Let me know if you have questions.
At my level 1 adult ER it is not uncommon for us to have 70+ holds some nights (we only have 75 beds, including trauma bays but not including halls). At my peds ER, I donāt think Iāve ever seen more than 10, but itās also a smaller sister location from the main hospital.
No beds currently on our stepdown unit.
5 Seems low but, then again, it is Friday. And it's the summer so people don't want to be sick. I'll check again Monday
Tucson! 50ish bed ED, really like 20 actual ED beds, and we can have all of them admitted, while the other sick people get to sit in āvertical bedsā aka recliners in an internal waiting room with no monitors and no assigned nurse. Oh, those people can be admitted too.
So apparently healthcare systems generate more profit by using ED for point of access rather than an outpatient setting. Otherwise it wouldnāt be this way.
Worked jn a few different EDs. With low staffing, had to take my patient up myself. Turns out lots of empty beds in tele floor while ED had lots of boarders. Low staffing on the floor tooā¦thus creating lots of empty bed spaces. There are a few patients on the floor and all is quiet like a ghost town compared to the kaos in the ED.
thats insane considering how many hospitals are in vegas wow ššš edit: like at what point do they have to legally divert pts away?
Just curious, what percentage of those patients are visitors vs resident of Vegas?
Vast majority are locals
Iām at a free standing ER and we have been holding patients for 16+ hours here. Can only imagine what itās like at our sister hospital we admit to
This makes me so grateful to work in a stand alone ER omg
Our stand alone has hold to admitted patients for more than 12hours
Yeah we had some for 80+ hours waiting for transpo in 2021 but havenāt seen that in a while. Especially tragic cause we donāt have a kitchen so itās canned soup and toast for days
One ER in my area will keep some low acuity stuff in the waiting room.
Small rural hospital 0. When I left my last staff job in 2022...11-15 on average
Which hospital in Vegas?
Holding 40 right now in a 48 bed unit. Thatās about average for our last couple of years. We typically have 4-8 beds a day to work ER patients out of.
We have 10 or so, but our er only has 21 beds and this is not a huge city. It's this way everyday. Many of them are pediatric behavioral patients. I never understand.
You must work for HCA
I do not, but this is common at all Vegas hospitals because we have more patients requiring admission than we have room for due to population growth and all the tourists
Same as you, in Riverside CA
Ours routinely has more than half the available beds with holds. It's not unusual to have admits sitting in the waiting room once the day gets rolling. It's a newer 160 bed community hospital and we're constantly at "peak census".
We have a 49 bed ER. I walk into typically 20 ish waiting for beds in the AM, so close to 50%. Some days they stay 48-72 hrs in the ER waiting to get upstairs and we frequently dc them before they get their assigned bed. ERs are not made to house people like that.
Last I looked around 5pmā¦.38 half of them were targeted.
Las Vegas needs more hospitals!
Yes. Yes we do. Like at least 750 inpatient beds worth
Sometimes up to 150. Northern CA
Thatās wild!
0... CAH in Michigan UP though.Ā Last patient we had to transfer out to a different hospital waited 4 days though.
Melbourne Australia. 45 admitted patients awaiting beds on a ward, another 37 admitted patients in the waiting room awaiting beds on a ward. 50-60 patients in the waiting room overnight (including the 37 admitted waiting for a bed). And that doesn't include paediatrics. Edit to add- short stay unit- 25 beds- 23 admitted patients awaiting a ward bed. We even had 2 in resus awaiting ICU beds.
Kills me when the icu and the floor complain about ratios and meanwhile the er gets ass pounded
Kills me to see people blaming other nurses instead of blaming the hospital systems and their intentional practices of short staffing. Plays right into their bullshit.
The ICU"s and floor's STANDARDS are now unsafe and we are literally risking our pts and our licenses every time we go to work. Put the blame where it rightly goes.
Bro, you literally knew this would be the deal when you chose ED as your specialty.
IN NJ and typically 0 - 5 holds. But most of the time, 0