September 18, 2006, 9:02 am

What A Girl Wants….What A Nurse Needs…Is A New ER!


What’s wrong with this picture?

There’s a nurse in it.

Half the hospitals in the San Francisco Bay Area are building new facilities.


It is cheaper to rebuild than it is to retrofit to new earthquake standards.

In all the hospitals I’ve worked at and all the plans I have seen, guess which department gets either rebuilt or worse, remodeled last?

Yep, the ER.

And how much input do you think nursing has in the development of the new department?

Oh, about 0.1%

Yes, they stick up a big set of blueprints and then ask us for our “feedback”.

Show of hands please: how many nurses out there can read a set of blueprints?

Oh, it isn’t only me?

They aren’t even talking to the nurse in the photo. She’s just trying to make heads or tails out of the, you guessed it, blueprints!


So what would the “perfect” ER look like?

Well, for one it would have a triage room with:

  • SPACE!
  • An ice machine
  • A sink
  • A gurney for examining pedi patients.
  • A phone
  • A small med refrigerator for holding diptheria/tetanus vaccinations
  • Scales – infant and adult
  • Tylenol and Motrin
  • A cupboard with: slings, ace wraps, ice bags, preformed splints, Kerlix, 4×4 gauze emesis basins and urine specimen containers.
  • A view of the entire waiting room through a bullet-proof glass window (that’s not a joke!)
  • Dedicated security for ERs in high crime areas.

Then I’d like every room to have the capacity to be a pelvic room. Keep pelvic supplies on a “pelvic cart” that moves from room to room. There is no reason why every gurney can’t break down into a pelvic gurney.

I’d like monitors at every bedside. Cardiac monitors with O2 Sat and BP capabilities.

I’d love to see LARGE ROOMS. There is a world-famous university medical center not so far from me with the tiniest excuse for a trauma room you would ever hope to see. If you can spare space for those damn VIP suites upstairs then you can spare space for your trauma department, of all things. Same thing with Inferior Medical Center – tiny trauma rooms.

Wrong!!! Just wrong!!!

I want all rooms private and I want a bathroom in each room. With urine dip-sticks so I don’t have to run to the dirty utility room to dip a urine.

I think the rooms should be in a “pod” formation around a desk where the nurse assigned to that pod can sit and chart. Pods of 3-4 beds.

An exception can be made for the “crash/Code 3/Critical Care room, which should be huge and have curtains in between beds. No bathroom. If you are well enough to go to the bathroom, you don’t need that room.

Which brings me to another desire.

Desk space. Lots of it. The ER docs need it. The interns and residents/registrars need it. The attendings need it. The nurses need it. The hospitalists need it. The primary doctors need it.

Why does it have to be so hard to find a place to chart?

And since I’m describing the ER of my dreams, is it too much to ask to have a med room that can actually hold more than one person at a time and allow more than one person access to the Pyxis?

I’m going to go waaaay out on a limb and ask for a computer system that allows you to order x-rays and labs before the patient is registered by using their complete name and birthdate, with the medical record number automatically attaching upon registration.

I don’t mind working hard, but I mind working stupid.


Yes, I’m grumpy.

Just did a 12-hour night shift.

Wore just one shoe because the blister on my right heel was so bad, I just put a shoe cover over my sock.

I just limped all night and got lots of sympathy.

And that post-Notre Dame loss headache?

Still have it.

48 hours later.

I’m just one attractive nurse, eh?

And I have 30 seconds to get this to Grand Rounds.

Will I make it?????


  • TheTundraPA

    September 18, 2006 at 11:31 am

    OF COURSE you made it, Kim! Sorry you had such a nasty night, but I love your dream ER…

  • Deacon Barry

    September 18, 2006 at 2:49 pm

    There’s never enough desk space. And what there is, is subject to Parkinson’s Law – Paperwork expands to fill the desk space available.

  • DisappearingJohn

    September 18, 2006 at 2:56 pm

    I must admit, we are in the middle of building a $59 million ED, and, not only did they bring us the blueprints, they set up a mock nurses station, treatment room, and trauma bay, brought us all over there, and said, “what should we change?”

    And they listened… We moved some things (O2 and suction setups closer to the head of the bed) we asked for, and got, more writing space in the trauma bay and nurses station..

    They didn’t mock out the triage area, though, and I don’t think anyone even mentioned that…

  • scalpel

    September 18, 2006 at 3:06 pm

    I wish you had designed my ER. It was obviously designed by someone who goes to meetings all day. Probably someone with a bunch of initials after their name. 😉

  • Mother Jones RN

    September 18, 2006 at 3:49 pm

    You forgot to mention the state-of-the-art nurses lounge. It would have a free soda machine, stock with an never ending supply of Pepsi, a hot tub, a mini bar, and a wide screen TV.

  • Tatiana, RN

    September 18, 2006 at 3:54 pm

    I hear you on the bullet proof glass in Triage! I worked downtown Memphis as a student and it could get rough.

    Monitors in ever room w/ BP & SaO2, but that you can also flip a lever to unlock them from the wall and take to CT with you. (Did have this in Memphis, but they were the ICU’s old cast off monitors.) The also had the ability to do pressure modules if some ambitious intensivist fellow decides he needed a PA catheter or an art line inserted in the ER.

    Pelvic cart…This would be nice. In Memphis we had a light that could be found…Somewhere. You had to search for it. And every room had disposible specula. And we also had to search down the stirrups that fit on the end of the streatchers. Why can’t people put stuff back where it belongs??????

    Amen to the desk space. You know it’s rough when the nurse’s stations has it’s own bedside table allotment just for charting space.

    Sorry you had such a bad night.

  • Candy

    September 19, 2006 at 7:55 am

    There is one gorgeous ER in the Bay Area that was designed with loads of input from the RNs who would be working in it. It’s roomy (including lots of counter space for charting) and even has a dedicated peds room. The exam rooms are big, too. Of course, this is not a trauma center and I’m guessing doesn’t see the huge numbers of ER patients that others in the area do, but it is a showplace ER.

  • jen

    September 20, 2006 at 8:03 pm

    yay!!! pelvic carts DO exist, my new ER has one, you don’t even need to break down the bed, the cart has it’s own stirrups!!
    Anyway, I was amazed when I was at UCSD. I “thought” the big “x’s” on the windows were for earthquakes, but then I was told that they really are! Turns out that UCSD isn’t even up to current earthquake standards, and there is nothing left that can be done with the current building.

    Our triage has bullet proof glass, with actual police officers and a metal detector. It’s difficult to believe that a trauma center in SF doesn’t have that, well I guess it’s not that hard to believe, because neither did Cleveland, Houston, or San Diego.

    If you build it, they will come……..word is that even though new/bigger ERs are being built, they are STILL overcrowded.

About Me

My name is Kim, and I'm a nurse in the San Francisco Bay area. I've been a nurse for 33 years; I graduated in 1978 with my ADN. My experience is predominately Emergency and Critical Care, and I have also worked in Psychiatry and Pediatrics. I made the decision to be a nurse back in 1966 at the age of nine...

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