8:1 ratios in the ER??? - page 3

Hey everyone, I heard this today from a very expirenced RN at my new job. Where I previously worked the ER RN's had 4-5 patients and maybe (maybe) in a real pinch they'd have 6 pts. Where you work... Read More

  1. by   angel337
    Quote from TraumaInTheSlot
    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
    i'm curious to know how many beds are in your ED, because if you have 20 patients how many does everyone else have and how can you document properly on 20 people in an ED? my ED policy is to document every 2 hours which would be impossible w/ 20 patients. i would not take a job in any ED that required one nurse to take care of that many pts. i have had as many as 8 in our minor emergency because the acuity is low and i have had 5 very sick pts at once. some of you nurses are amazing and i admire you for taking that kind of load but i would worry about making a mistake and administration turns the other way when mistakes happen. i see it everyday.
  2. by   TraumaInTheSlot
    Quote from angel337
    i'm curious to know how many beds are in your ED, because if you have 20 patients how many does everyone else have and how can you document properly on 20 people in an ED? my ED policy is to document every 2 hours which would be impossible w/ 20 patients. i would not take a job in any ED that required one nurse to take care of that many pts. i have had as many as 8 in our minor emergency because the acuity is low and i have had 5 very sick pts at once. some of you nurses are amazing and i admire you for taking that kind of load but i would worry about making a mistake and administration turns the other way when mistakes happen. i see it everyday.
    You MOVE YOUR ***. MULTITASK..PRIORITIZE run run and run, never sit down. U work as a team and get things done. quick assessments. you develop the ability to just glance at a person and know whats wrong with them. you also multi-task, while interviewing a patient, u can stick a line in and get the ekg, and medicate them all in one minute. lots of nurses like to do one thing at a time. you have to be an adrenaline junkie to work there, and we have a high turnover rate. you have to become bulletproof, and Bellevue nurses pride ourselves on being able to have anything thrown at us and we can just shrug our shoulders and say "bring it on". We get all the crap that the rest of the big $ hospitals dont want, including all the bad trauma and homeless and psych patients.

    Our medical adult ER sees over 100k per year, and the Urgent Care is above that. (lots of BS) We have a separate peds ER and psych ER, and a 15 bed EW (emergency ward -ICU) right in the ER and our own CT scanner and MRI and xray department. At times it seems like an assembly line, but we have lots of ancillary and support staff also.

    i noticed in other less busy ER's that I work in, that if you actually have the time to count how many patients you have, you are not busy enough. If you get used to having less than 5 patients, then nurses complain about the sixth. if you usually have 10 and get an 11th, youll complain.
    Last edit by TraumaInTheSlot on Sep 9, '04
  3. by   veetach
    Quote from nursie nurse
    i read this topic with wonderment and in amazement because a 8:1 ratio in my ER would be a dream! most nights we can have 10-12 pts each (a mixture of acute and non-acute pts) in rooms and the hallway because our urgent care center closes at 8pm. :angryfire ...so all the minor stuff gets grouped with the acute pts.....it sucks but that's the reality of a non-unionized hospital too.....there really should be fair distribution of the pts based on acuity though.....
    we have 7-8 patients per RN in our ED, but we dont have a "fast track" so, in some blocks of rooms you will have your average clinic bs patient. It can get hairy to have 5 critical patients in one section, but it happens...we have a union hospital, the state average is 5:1 but we usually have 7-8:1.
  4. by   mshultz
    It is so educational to lurk here. When I was transported to the ED with a GI bleed, there were at least three nurses and the ED doctor attending to me the entire time. The two doctors who managed my care after I was transferred to the Critical Care Unit also saw me while I was in the ED. This discussion about staffing ratios really makes me appreciate the resources the hospital used on me to ensure a successful outcome.

    I sent a thank you letter to the hospital after I had been released. Reading that hospital nurses rarely know how their patients do after being released prompted me to write to the ED and the Critical Care Unit months later. I was able to tell them that I had made a more than full recovery.
  5. by   hogan4736
    Quote from TraumaInTheSlot
    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

    No thanks, the patients deserve better, and so do we...

    We can all multi task (EKG, IV, LABS, MONITOR, O2, TRIAGE - all in 10 minutes) and see an MI in a crowded room...I learned all that inside of 2 years in the ER...big whoopie...

    I enjoy spending quality time w/ my 4:1 ratio...

    That's what it's all about...

    Thanks to lawyers, mandated ratios are coming, just like EMTALA did...

    It's a good thing...We need to figure out how to attract more nurses to the profession...

    Sean
  6. by   TaraER-RN
    Our state mandated ratios are 4:1, but yeah right..our ER still isn't at it....the hospital supposedly gets fined and we're waiting for all of our new grads to come off of orientation...at least thats what management keeps saying...we typically have 6-9 patients each, and while yes you figure out how to handle it...when the state law says you should only have 4, and you know that other ER's are at that, it makes you soooo mad and frustrated every day that you have to deal with that many patients. Who needs the stress? I would rather give my patients good care, than go home every night and say..."well at least no one died!"
  7. by   CEN35
    Well ours used to be three per nurse when I was in the ER. Then it went to 4 per nurse after I left. Now it is 8 per 2 nurses. 1 Nurse has to cover all 8 during lunch, dinner, breaks etc now.

    out.....
  8. by   Katnip
    Rarely do we ever take more than 4 patients...5 is the absolute maximum, and that's only if ambos keep coming to the door...our ED closes beds first. Now when winter comes and all that flu, pneumonia, and other fun bugs are being shared by our patients, that might be a different story.
  9. by   walnuttree91
    Does it ever occur to administration that more nurses would increase the speed of ER discharges/hospital admissions, leading to more patients seen/admitted, leading to increased revenues, allowing the extra staff to be paid for, not mentioning the increased satisfaction of both the nurses and patients?
  10. by   TinyNurse
    On my first and last travel assignment in an ER, I routinely had 8 patients, supposidly I had the "less acute" in my area, but routinely I was running insulin drips, having elevated K+, etc..............
    I would look for an open room, arrange with the charge and then move these patients up, TRY to give report to the other nurse, and they would have the nerve to ask me WHY, i moved someone with a K+ of 8 up to the front......................
    In staff nurse jobs the most I had was 3 patients and 2 hall beds.
    xo Jen
  11. by   LIFESAVERLINDA
    I work in a level 1 trauma center in the heart of a major us city,not to mention one the united states busiest emergency rooms,we have a total of four diffrent parts to our er,we have a medicine side which has at aleast 40 actual beds including hall beds,with rooms 1,2,3 being resucitation booths,in the same area we have a corner with 8 recliners and heart monitors we call chest pain area(there we do 3,6,9 troponin draws and ekgs)also in the same area we have the asthma room 8 chairs for nebs,also in the same area we have fast track which has 3 exam rooms and 30 chairs pts sit in and np or pa will call them into a room checkthemout then they go back to chairs for iv,or blood draws,and the nurses station is a joke its like grand central station,you are butt bumping and trying to open the pxysis while you trip over one another,on the other side is surgery side/trauma, we have our own trauma team and they manage the trauma bays which we have 6 and are all setup for level 1 traumas,and we have 30 beds which 3 are in the ortho bay,including a major burn room,and two of the rooms can be used for resucitation,not including 6 chairs in the ortho room,and 30 chairs in a room will call assessment room which are for folks to sick to leave in waiting room not minor enough to go to fast track,not sick enough for a bed, and we have our own psych er and ob/gyn er which have beds of there own not sure how many there? but with all that said our er generally has 85 full time staff nurses, right its 65 very short, usually a assignment you will be on one side or the other med or surg and on a team of a certain color which has nurse maybe two if you are lucky and a doctor all on one color team on med we have 3 teams/colors on surg we have 2/teams/colors,so usually there is one nurse on a team with anywhere from 20-30 pts/if you are lucky 2 nurses split the load and you still have anywhere from 10-15 between the both of you,plus each team has a basket which are for orders but before you do the stat or now orders you go and assess each pt mainly to be sure you know what they look like and if they are breathing, and in what condition,yep it gets pretty hairy at time the ratios are nutty when i was hired they told me 8 to one,shhh right that would be awesome,oh and we only have like one or two techs for the whole er,so we do all our own vital,ekg's iv's blood draws,abg's because we only have 1 rt..yikes....and if we get a level one in kiss him goodbye...we have to call the resp supervisor,oh and we dont have cat scanner in the er we have to go over the hill and thourgh the woods to radiology dept we have a small x-ray dept in our er and we take them over and they are supposed to bring our pts back...which never happens....i had search all over for my pt's b/c nobody brought them back,and then we usually have ambulances laft and right needing a bed so again we shuffle bodies around,sometimes we make ambulances drop off pts at triage if its something stupid or minor which happens alot,we have a huge population of homeless also we are the hosp for the jail and we have a police room where inmates sit and get treated in their shackles,any way its always mass kaos to a somewhat organized degree.i can rig up all kinds of stuff,i ve had to tape iv bags to the wall where there was no hook!...you just can't imagine,but i love i dont want to work anywhere else! believe it or not i'm actually getting to live my dream,i always wanted to work at this hospital! because everybody knows the best come from this hospital. and you always guaranteed a job anywhere with this on your resume,but i'm hoping to excel to my ultimate goal and be on the trauma team.if you have any questions about how i do it all,just post it!
  12. by   chip193
    Quote from jaimealmostRN
    Hey everyone, I heard this today from a very expirenced RN at my new job. Where I previously worked the ER RN's had 4-5 patients and maybe (maybe) in a real pinch they'd have 6 pts. Where you work is it common to have 8 or more pts???? Both hospitals are located in the same town and are both very urban. I understand that the ER is extremely unpredicatable, but 8??? That seems like way too many...and I don't think it's a management thing either (ie. not being given enough staff for nights, etc) b/c this hosptial has much much much better management, NMs,VPs (and is very nurse-centric) than the one with the 4-5:1 ratio. I really wanted to stay on that this new job, but I'm not sure if I could ever handle 8 ER pts, even if they were minor care. Opinions please??????????????
    I work nights, so that may explain the problem!

    First a little background. Our day and night staffs at 9 RNs for both shifts. As we're under construction, the department is, well, cut in half with a 200 foot hallway between the two parts (it's never a good thing when they have to use only existing space!). At night we drop to 5 RNs, or 4 RNs and an LPN.

    On one side of the department is the "Critical Care Area" During days, it is staffed by 3 RNs (4 if you include the charge). There are two trauma beds, three heart beds, three "real" step down beds, and four "acting-interim-temporary-hallway" step down beds. All are monitored. At night, this area drops to 1 RN (two if you include the charge) and an LPN (who is actually a "float" for the whole department).

    On the other side is an intermediate care area. Think of this as where future med-surg patients arrive. There are four monitored beds in the front, an Ortho monitored bed, and a GYN monitored bed. There are also five acting-interim-temporary-hallway beds, which are unmonitored. Days and Evenings staffs this with two RNs. Nights is one. And at night we pick up the Psych area from here.

    It's not uncommon when I take this intermediate care assignment that I take report from four nurses on up to 14 patients. Try that one on for size!!

    Chip

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