Emergency room RN minimums in Texas

Specialties Emergency

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I can't seem to post this any where else. I am trying to get my hands on some state minimum requirements in the state of Texas for the number of RN's working in the ER. Everything I have ever heard is that there is a state mandate minimum of 2. Can anyone point me in the right direction that provides documented proof of this?

Thanks.

Starsky

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Specializes in Case mgmt., rehab, (CRRN), LTC & psych.

Texas has no mandated nurse/patient ratios for the ER, or in any area for that matter. You could have two patients, or twelve patients, or any number in between.

California is the only state in the union with legally mandated nurse/patient ratios for licensed nurses employed in acute care hospitals. The other 49 states have no nurse/patient ratios that have been enacted into law.

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we would all laugh if someone asked us "hey do you guys work under promised nurse-to-pt ratio?". our ED is supposed to be run with fully staffed 12-14 nurses per shift. Does it happen most of times at least, absolutely not. there were even times when this 50 bed ER was run with less than 6 nurses... in short, unless you go to Cali, just like the commuter said, there's no such thing as mandated ratio. that means 1:2 and 1:1 for critical is laughably non-existent from what I have seen.

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I think OP is asking what is the minimum number of staff that is required to be working, not patient ratios

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Ok I am at a loss here. I didn't ask anything about nurse ratio's and actually never said anything about ratio's. I am looking for the statement MINIMUM to be staffed in a hospitals ER... in the state of Texas.

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Specializes in Emergency & Trauma/Adult ICU.

I think what other posters are getting at, OP, is that the basis of any regulation that a certain minimum of nurses must be staffed is usually an underlying principle of nurse:patient ratio. However, it is possible that there is regulation in Texas that mandates a minimum number of staff present in certain care settings. I am not in Texas ... but I would point you toward your state ENA chapter as a good source of information for your question.

Good luck to you.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
Ok I am at a loss here. I didn't ask anything about nurse ratio's and actually never said anything about ratio's. I am looking for the statement MINIMUM to be staffed in a hospitals ER... in the state of Texas.

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 2013

The American Nurses Association (ANA) supports a legislative model in which nurses are empowered to create staffing plans specific to each unit. This approach aides in establishing staffing levels that are flexible and account for changes; including intensity of patient's needs, the number of admissions, discharges and transfers during a shift, level of experience of nursing staff, layout of the unit, and availability of resources (ancillary staff, technology etc.). Establishing minimum upwardly adjustable staffing levels is statute may also aide the committee in achieving safe and appropriate staffing plans.

States with Staffing Laws

13 states currently addressed nurse staffing in hospitals in law / regulations: CA, CT, IL, MN, NV, NJ, NY, OH, OR, RI, TX, VT, and WA.

  • 7 states require hospitals to have staffing committees responsible for plans and staffing policy – CT, IL, NV, OH, OR, TX, WA.
  • CA is the only state stipulates that in law and regulations a required minimum nurse to patient ratios to be maintained at all times by unit.
  • 5 states require some form of disclosure and / or public reporting – IL, NJ, NY, RI, VT

Nurse 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.

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Ok, lets completely drop the term RATIOS... I understood way before I posted this that there is are NO set ratios and that is why I never asked the question regarding ratios.

I truly don't care about any other states and I do know and have read California's law regarding their ratios. Again, lets drop the term ratios.

I have an ER, again I am in Texas and there is NO again NO language that states ratios, but state surveyors have said a minimum of TWO rn's must be in the ER. They can not show me that in writing. I have read and have a copy of the Texas Administrative Code Chapter 25 Hospital Licensing and it states there must be one qualified medical personal to administer emergency drugs.

Again I never said ratios, I was hoping that someone in this forum could answer the question regarding RN minimums seeing that the state surveyor can not show me in writing where anything says two.

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Specializes in Emergency, Telemetry, Transplant.

I have no idea what the law is in TX, but I don't like idea of being the only RN in an ED at a given point in time. (Do I get a 'like' for not using R***o? :woot:)

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Specializes in Emergency.

OP -

Just for clarification: Your asking if TX has any law or regulation that states: an ED must have at minimum 2 RNs dedicated to the ED at all times, irregardless of the number of patients in the ED at that time. Is that correct?

I assume in TX the state surveyers have something to do with licensing your facility? You mentioned they told you about this supposed minimum, but could not reference any law or regulation. Did you get written up for this? Are they planning on getting back to you with the specifics? Do they have an office or other way for you to get ahold of their supervisor and get clarification on this issue?

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That is correct, the state surveyors are the ones that said the hospital should have a minimum of two - which we actually have 3 but are planning to go down to two. There was no write up but they couldn't point me to anything that said two. Naturally every time you drop the number of scheduled RN's they start losing their mind. So if the state surveyor says two I want to be able to point to the documentation that says two when my RN's are losing their freaking mind. They are used to having three so they have facebook and texting time and now they actually have to do more work. Sheez... nurses! haha

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Specializes in Emergency, Telemetry, Transplant.
That is correct, the state surveyors are the ones that said the hospital should have a minimum of two - which we actually have 3 but are planning to go down to two. There was no write up but they couldn't point me to anything that said two. Naturally every time you drop the number of scheduled RN's they start losing their mind. So if the state surveyor says two I want to be able to point to the documentation that says two when my RN's are losing their freaking mind. They are used to having three so they have facebook and texting time and now they actually have to do more work. Sheez... nurses! haha

Now I am a bit confused. You are dropping from 3 to 2 RNs. It is the RNs freaking out? You want to make sure the state only requires 2 RNs (not more)?

Is that an accurate summary?

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