8:1 ratios in the ER???

  1. 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??????????????
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  2. 37 Comments

  3. by   traumaRUs
    I think 8 pts is quite a few! However, I would definitely talk to some nurses that work there.
  4. by   SWFlorida
    It would depend on their acuity level. In most ER's the traffic level can be very unpredictable. Its not like you can pull in extra staff out of thin air. Sure you can call in the on-call staff, however even then things can be really busy. There are times where you may have a very heavy load.

    In our ER a nurse may handle 4 pts but their levels may be very acute. Other nurses will help however in general you bear the responsiblity. I have had 3 cardiacs and a truama all at one time. They will all be on monitors and one may be getting TPA and one may be being tubed. You better believe that if i am that busy the nurses in the minor care area of the ER may have 8 or more pts. You just do the best you can.

    In ER's they don't make appoinments, it would be convenient if they did.
  5. by   newfloridaRN
    We only have 3-4 patients at most in our ER, but if we have an ICU or an acute patient, the charge nurse will help out till we get that patient to the floor.
  6. by   jaimealmostRN
    Quote from SWFlorida
    In our ER a nurse may handle 4 pts but their levels may be very acute. Other nurses will help however in general you bear the responsiblity. I have had 3 cardiacs and a truama all at one time. They will all be on monitors and one may be getting TPA and one may be being tubed. You better believe that if i am that busy the nurses in the minor care area of the ER may have 8 or more pts. You just do the best you can.
    OK, this makes a little more sense. So in a minor care/observation area one could have 8+ pts, but in the more acute sections 4ish? What is the most you have had in that area (acute)? Actually if I thought about it before I freaked out, I would have realized that there are only 9 beds in the more critical adult section of the ER, so I don't think one RN would be assigned to all those. oops.
  7. by   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.....
  8. by   SWFlorida
    The bad part about the whole situation is that most of the low acuity pts really dont need to be in an Emergency Room. They should have gone to see their primary care dr or gone to a clinic. But it is more convenient for them to visit their "doc in a box" the local ER.

    If pts go to their primary care dr they are expected to pay upfront or at least their co-pay. This is not required for an ER visit. Another abuse of the system.

    "Mrs Jones, I see on your chart that you have had back pain for 12 days. Now what made you decide to visit the ER trauma center at Midnight on a Friday night?"
  9. by   MrsWampthang
    Quote from SWFlorida

    "Mrs Jones, I see on your chart that you have had back pain for 12 days. Now what made you decide to visit the ER trauma center at Midnight on a Friday night?"

    Oh but with all the hoopla over "customer satisfaction" we're not supposed to ask that! We are told that it doesn't matter why they are in our ER, we treat them! :angryfire Got to keep those too stupid to live "customers" happy you know! :angryfire

    Pam
  10. by   rjflyn
    Makes me wonder what California's ratio law has them seeing and taking care of.

    Where I work its typically 4 per nurse at the most. Personally it should be based on acuity. If one has a level 1 pt it should be one on one, no more than 2 pts if they are level 2 and then it gets cloudy from there because of each nurses ablility and skill. The bad thing is our ER is typically full between 11A and 3A with the level one and two pts and the 3-5's sit and wait, unless our minor care is open then some of those go there- but with the histories these pts have and the workups they get, the cant go there either. Plus we admit 25-30% of the pts we see.
    Rj
  11. by   stretch thin
    Acquity? Does the management really look at that? I know at my hospital, it's a body with a degree. They don't care how many they pile on one nurse. I have been argueing with management regarding a aquity scale vs the nurses we have. I know often times we hold ICU pts because the ICU nurse can't have three-somes, but yet we have 4-5-6 pts and sometimes even 7. I know personally, being the charge nurse/transfer coordinator at night, it's often difficult to handle all of that plus take a team. I'm not one of those charge nurses that sit on their butts. I feel so bad because I don't think I give good care and that's why I went into this position. IE. Stretchthin!:uhoh21:
  12. by   SWFlorida
    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.
  13. by   veetach
    Quote from Pamela_g_c
    Oh but with all the hoopla over "customer satisfaction" we're not supposed to ask that! We are told that it doesn't matter why they are in our ER, we treat them! :angryfire Got to keep those too stupid to live "customers" happy you know! :angryfire

    Pam
    This makes me happy that I am work in an ER where we can actually still ask questions like this (and believe me, we DO) Our hospital seems fairly satisfied with our Press Ganeys, so far anyway....

    As far as nurse to patient ratio goes, this is a topic I am interested in, because we are converting from "team nursing" to primary nursing very soon. we are supposed to end up with anywhere from 6-7 patients per RN. BUT we do not have a fast track so some of those will obviously be non emergent, clinic patients...
  14. by   Medic946RN
    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.

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