Emergency room RN minimums in Texas

NurseOnAMotorcycle, ASN, RN · Oct 17, 2014

^sarcastic much

I just came back to this thinking that I had over reacted. I re-read the entire thread and have decided that my post is exactly how I think it should be and I will leave it there just as it is. I guess I'm just a mean nurse.

Sassy5d · Oct 18, 2014

Any time/any part of nursing, if you drop staffing.. They are going to freak.

Safety concerns much? Sheesh, I bet those dumb nurses really complain when you lecture on core measures and patient satisfaction..

Oh, btw, that doesn't do much for your job security when your department tanks on all levels.. Treat your staff poorly, they perform poorly. Who gets fired?

Editorial Team / Moderator · Oct 20, 2014

I am just going to go out on a limb and guess that the OP is not a nurse.

Sheez... management!

I side with the ENA, who supports a position that a charge nurse and triage nurse should not be counted in staffing. In a perfect world!

suiteums, MSN, RN · Jan 8, 2015

Amen. Nurseonamotorcycle

BrnEyedGirl, BSN, MSN, RN, APRN · Jan 8, 2015

I had forgotten about this. In my ED, I can't think of any medications that require a "double check;" however, with some meds it is nice to have another set of eye to make sure I have programmed the pump correctly, drawn up the right type/dose of insulin, etc.
Blood, however, takes independent verification in every institution.

Wow,...we have many, many many meds that require a double check in my ED,..I can't even document things like succ, or insulin gtts without a second nurse to sign in and verify with me. How would you waste narcs with only one nurse? I'm assuming the OP is in a very small ED, but I can't imagine it ever being safe to have less than two RN's. How do you take lunch, pee, take someone to CT, run a code etc with only one RN?

chivon101 · Mar 20, 2015

There is no State requirement. There are plenty of Free standing ER that functions as a regular Emergency department, that staffs only one nurse. I have worked at one before and currently working at one now. We have a doctor there always and a tech who is a paramedic, but this isn't the case at all places. So to answer you questions you can staff an ER with 1 nurse depending on the size of the ED. But most are free standing ER that don't except ambulances, but a stemi, stroke or anything can walk thru the door. In my opinion, I think you should be a nurse with a strong background to do this. I have worked 7 years at a level One ED and this is my PRN job.

Editorial Team / Moderator · Mar 20, 2015

There is no State requirement. There are plenty of Free standing ER that functions as a regular Emergency department, that staffs only one nurse. I have worked at one before and currently working at one now. We have a doctor there always and a tech who is a paramedic, but this isn't the case at all places. So to answer you questions you can staff an ER with 1 nurse depending on the size of the ED. But most are free standing ER that don't except ambulances, but a stemi, stroke or anything can walk thru the door. In my opinion, I think you should be a nurse with a strong background to do this. I have worked 7 years at a level One ED and this is my PRN job.

How do you count narcs or give meds that require a second RN with only one nurse? You can be the strongest RN around, but you are still only one person.

EmergencyRN22 · Mar 21, 2015

I agree. Also, as you noted insulin, then there's heparin, lovenox, and blood products. Then you also need a fellow RN to waste/return meds and narcotic count.

The the lowest I've seen in our 23 bed ER would be two staff RNs and a charge. Unfortunately, we normally have a tech (paramedic with 30+ years) in triage from 0700-0900 until we have 1-2 more RNs come in. Then our thru care/ fast track will open up with another 2-3 RNs come in at 11. Some days we are staffed well with 4 + a charge at 0700 with more coming in at 9 and 11.

I dont work nights so I'm not familiar with their normal staff.

For most days, that staffing model works alright. We will always get those occasional days were the flood gates open.

txerrn6942 · Mar 21, 2015

In the freestandings, our MD counts narcs and double checks meds with us.

GucciBeaR143, BSN · Mar 23, 2015

We are trying to tell you. Texas has not minimum staffing ratios. The only state with mandated staffing is California. Massachusetts has just passed a mandatory law for ICU staffing at 1:2 max patients.
Texas has staffing laws per se....as of 2013Nurse Staffing Plans & Ratios
Texas also has safe harbor laws that you do not have to care for too many patients...http://www2.mysanantonio.com/client_pdfs/TXSafeHospital-Nov2010CEU.pdf
Emergency dpeartment do not staff according to how maby patiens are there because it is a fluctuating number. Depending in the size of the Emergency department. It would be unlikely that there wold be less than 2 nurses. However if the nurse is "alone " there is another in house somewhere for back you or the supervisor is ER nurse #2 but that would have to be a small department. ER's are staffed to average patient visits per shift.
What are you asking for ....to best help you I need specifics.

Thank you, this has been most helpful =)

turnforthenurse, MSN, NP · Mar 30, 2015

As stated before, Texas has no mandated nurse to patient ratios...as for the minimum number of staff that need to be on, I think that depends...for most ERs I would say at least 3 to 4...you need a triage nurse and at least 2 nurses in the back at all times. Is that at all safe? Absolutely not...at least not in my ER. Now on inpatient units, the minimum number of nurses is 2 where I work.

chivon101 · Jul 5, 2016

How do you count narcs or give meds that require a second RN with only one nurse? You can be the strongest RN around, but you are still only one person.

You are not usually medicating with things like insulin and heparin at a freestanding ER..... You transfer out. That's how. Narc is completed at shift change with two nurses. You need to be strong to be able to manage and not freak out but I never said it was safe.