8:1 ratios in the ER???

Medic946RN · Jun 7, 2004

In the ED i work they try to keep it down to four pt per RN, but when were getting slammed you might end up with more, the triage nurse and charge nurse try not to pummel any single nurse with a lot of serious patients, we "spread the wealth" as it were. I have had ten pt's at once but they were all minor fast trackers. So it wasn't all that taxing. One of our nurse supervisors said our facility was getting turned down by a a lot of West Coast travel nurses because we don't mandate a maximum of 3:1 like the recent legislation in California. But Maryland has a nurse to patient ratio law up before the State House. It requires a 4:1 in ED and PCU and 1:1 or 2:1 in

special circumstances. It bound to have a negative impact on the nursing shortage. But this is what happens when the profession of medicine/nursing get sandwiched between corporate bottom lines and state legislators. I'm at an ambivilent place about this. There are certain hospitals in my area that routinely run short staffed and pt care suffers, so as nurse and a pt andvocate I want good conditions, good pay, and safe pt practice. So I'm for reducing the pt load. But in my experience whenever the government gets involved in healthcare things never come out good.

NYCRN16 · Jun 10, 2004

In my ER, on an average night I have about 8-14 patients, regardless of acuity level, and most of the time they are almost all chest pain, abd pain, ect. We do team nursing, 3 nurses on a team, and *somehow* there are nights where I wind up with 11 sick patients and my teammates have like 3 or 4 patients. It all depends on who is triaging, certain nurses dont like to give thier friends too many patients! :angryfire More often than not though, we all are carrying a load of 8-12 patients every night. If I had 4 patients a night I would be in heaven! Do these places exist in NYC?? If so, please let me know where they are, and I am there! :smokin:

sbnurse04 · Jun 17, 2004

I work in a level 1 trauma center, and up until recently the nurses have had usually 4 rooms each, with each room having the capability of two pt. Now, because of staffing situations the nurses are having an average of 6 rooms, to care for a total of as many as 12 pt. usually all of our rooms are not doubled, but the situation is there that the nurse would potentially have 12 pts.

eak16 · Jun 17, 2004

totally depends on acuity

in the level 1 trauma ED where I did my practicum, there were three high acuity rooms (one nurse and four patients in each room, with floats coming over when you got slammed with traumas), an ICU hold area often with ICU float nurses, urgent care (separately staffed) and then the zone with everything else- non-critical ab pain, drunks sleeping it off, non-critical orthopedic injuries, peds, gyn, etc. They had two nurses for up to twenty-eight patients! It seemed to work just fine, the nurses weren't complaining, but most of those paitent were in hallways and got rather minimal care.

critcarenurse16 · Jun 21, 2004

It seems unsafe to not impose a pt/staff ratio in the ED for acute and critical care beds. Most places do this in the ICU's right??? So why not have ratios in the place where the pt recieves initial eval and tx???? The bean counters make me sick! :angryfire Just hope they don't have the nurse with 4-5+ acute/criticals.

tlf91 · Jun 21, 2004

A great tool when the ratios are chronically high , overburdening the staff and at unsafe levels is the hospital incident report. The admins wont be putting you on their christmas card lists however you will be amazed how staffing your ER properly will be the admins top priority. Silence on the part of the nursing staff when pt load gets too high is the same as saying "I accept this assignment as safe and within my realm of good pt care" By filing an incident report (make lots of copies and make certain one makes it to risk management) you are saying that you accept the assignment under protest, the pt load and acuity are at an unsafe level and you will not be held responsible for a bad outcome. Generally this gets the lawyers at your hospital to spit coffee all over their morning reading. The problem WILL be addressed.
Don't just complain among yourselves, be proactive. You are the Pt advocate and they deserve good care.

This is very true and good advice. At the very least, you have it in writing. Make sure you go through the chain of command and notify someone of the situation at the time it is occuring. Most of the time, the administration will at least get the info. BUT..........beware. In a Charleston WV HCA facility they fired a nurse for this. She would not discharge a patient from the ER with a 6.7 k+ level. The ER MD ordered discharge after giving 1 dose Kaexelate PO. Pt also had renal failure. After the MD would not listen to her , she called the primary who admitted the patient. Supervision was aware. The call to the PCP was made from the supervisors office. She was fired for " not following the chain of command " after the Primary Physicians stormed administration for unsafe conditions in the ER due to unsound decisions by the ER docs. The HR director basically told her that she caused the Administration alot of problems and they wanted her fired. The one thing that will help her in court is the fact that she documented the calls and notification on the incident report. Awaiting the trial date at this time. Now here's the kicker.......... WV nursing board told her that she did the appropriate thing and if she had not she would have risked her license.

So, I guess the lesson to be learned is that a hospital can fire you for raising a stink about an unsafe environment. This may hurt your feelings and pride. But the nursing board can take your means of living. If you do nothing and it is found that you knew and did nothing. They can take your license or at the very least make you miserable to have one. Protect yourself because the hospital will be the first to say they had no idea that there was a problem because you did not tell them. They wonder why no one wants to go into Nursing and why Nurses are leaving the field. Go figure...................

jaimealmostRN · Jun 21, 2004

So, I guess the lesson to be learned is that a hospital can fire you for raising a stink about an unsafe environment. This may hurt your feelings and pride. But the nursing board can take your means of living. If you do nothing and it is found that you knew and did nothing. They can take your license or at the very least make you miserable to have one. Protect yourself because the hospital will be the first to say they had no idea that there was a problem because you did not tell them. They wonder why no one wants to go into Nursing and why Nurses are leaving the field. Go figure...................

This is so sad. But it is so much easier for a nurse to get a new job than to get a new career once their license is revoked. I'm not sure if I mentioned this in my first post, but the hospital that has 8+:1 ratios is a great hospital but without a union. The pay is nice, the environment is nice,etc. About 2 seconds down the road is another hospital that is unionized. The pay is nice and the ratio in the ED is 4-5:1. A few years back, at the ununionized 8:1 hospital, a pt. died on one of the "wall" beds (the ones on the wall, used when all the rooms are filled up). I don't think it was super busy, but no one noticed for like an hour or something. :uhoh3:

RNin92 · Jun 21, 2004

My ER is staffed pretty well.

We see about 100 pts a day. We are a Level II.

We have a triage nurse 20 hrs a day and an EMT in triage 24 hrs a day.

We have a charge nurse 24 hrs/day

We have 4 RNs until midnoc, then 3 until 0300 and then 2 (plus the charge and triage RNs)

There is one RN in fast track until 1600 then we go up one RN.

There's also one EMT in the main ED and one in fast track until 1600, then we go up one in the main ER.

Our patient load is 3-4...occasionally a 5th if it is EXTREMELY busy.

Our fast track hs 6 beds..so the ratio there is 6:1 until 1600, then 3:1

So when I read the OP talk about 8...oh my.

We are not union...not sure how I feel about that...I think nursing has to be united...but the teamsters were a bit over the top!

As a charge nurse, usually do not take a patient load...but when we hit the ground running...that's when I start to take pts, too. I would never give a nurse her fifth patient and I have none.

My managers, the Trauma Coordinator and our nurses who are working in a nonclinical role that day come out to take pts if it is crazy...you know...often!

We have many other issues at my hospital...but staffing is pretty good.

RNFROG3, BSN, RN · Jun 22, 2004

I come froma a level II trauma in Indianapolis. We aren't downtown so we pick from the community and I think half of the USA(maybe slightly exaggerated!) I work 7p-7a on weekends.

On a good night I have 4 RN's till 7 am and 3 RNs till 3 am.

We have 7 monitored beds and 3 shock rooms , 3 suture/minor injury rooms,19 treatment rooms.

On a bad night I have had 3 till 7 am and 1 till 3 am.

I personally was charge nurse (what a joke it was balls to the wall and don't stop to breath), the 10 treatment rooms and the 3 suture rooms. Plus triage and help anyone who had questions or needed sombody to assist, the telephone and whatever crops up as it always does. After 200 we only have one doc. It was very hairy and I wondered why I do this? Fortunetly I have the week to recover and it isn't like that every weekend or I would be fried.

TraumaInTheSlot · Jun 30, 2004

Ive had as many as 20 patients on a busy night, you need to learn to multi-task, it makes you a better nurse. you might not get to fluff every pillow, or flip every patient, but youll be suprised how good u get at it.

i hate these nurses who complain when you get more than 5 patients. you are there to run your butt off. ive worked in all types of er's. busy and not so busy. the less busy er's with nurses with 4-5 patients complain more than the truely busy ones. i guess if you have time to complain, you arent that busy. non-busy er's are boring.

just my $0.02

jaimealmostRN · Jul 1, 2004

Ive had as many as 20 patients on a busy night, you need to learn to multi-task, it makes you a better nurse. you might not get to fluff every pillow, or flip every patient, but youll be suprised how good u get at it.
i hate these nurses who complain when you get more than 5 patients. you are there to run your butt off. ive worked in all types of er's. busy and not so busy. the less busy er's with nurses with 4-5 patients complain more than the truely busy ones. i guess if you have time to complain, you arent that busy. non-busy er's are boring.
just my $0.02

:chuckle You're right, the more time you have to complain, the more free time you have. I guess since graduation is fast approaching (thank god!)and I'm not affraid of IVs or anything, patient ratios is my sore point! I not so concerned about fluffing pillows, but I am just worried one of my patients will quickly go bad when I am not there or I'll just miss something really crucial about one will I"m seeing the other 300.

TraumaInTheSlot · Jul 2, 2004

i just took report on 17 patients last night, wheres my roller skates?