ER nurse to patient ratio

Roy Fokker, BSN, RN · Jul 10, 2011

Heck, when I'm covering a colleague for break, my ratio sometimes goes to 16:1. It really depends on the charge RN and how they distribute the load. If the charge is someone good (who looks at acuity and clinical needs) then it isn't so bad. But if you have a charge who only stupidly looks at numbers, then sometimes you can get 5 or 6 ICU type pts on multiple drips.
My ED believes in the patient satisfaction BS of bringing in every simple ache and pain so that there is zero waiting room time; never mind that these non-emergencies are then overcrowding the ED and using up gurneys and staff attention.
We don't have EMTs or Medics either; our CNA/PCTs do work, but there just aren't enough of them. Often, when a 1:1 suicidal patient comes in, the district CNA is then tied up sitting with that one patient and the nurses will be left to fend for themselves.
All that said and done, the problem I see more than anything else is ED throughput. I'm of the opinion that no matter how bad it gets, if there are beds to admit patients upstairs, then it is manageable. Once the beds upstairs are no longer available, then it always becomes difficult. I've been saying this for years, but ED's need to have a flexible holding area that can accommodate these occasional ED admit overflows. They can go to an on-call system to get the nurses, but of course, that costs money.

We must work in the same ED! :eek:

4:1 is what the assignment board at work says.

Reality, naturally is quite different. We work 2 RNs to a pod on the acute section of the ED and if my partner nurse has a critical patient or someone coding etc., I'll try and pick up the slack.

I think it's also a HUGE factor in who you're working with. Some shifts, I swear I'm better off working by myself because I'm pretty much doing it all anyway! :uhoh3:

cheers,

Freedom42 · Jul 10, 2011

I work in a 36-bed ER that includes 14 beds for behavioral patients -- they've got to be triaged on the medical side and cleared before they can move over. Three of our beds are for quick care. We don't see a lot of trauma. The immediate communities total 65,000 people; we draw a lot of traffic from outlying areas as well. On a typical day, we'll see 130 patients. Most of the time, the ratio is 3:1 or 4:1. We do not have EMTs, and we occasionally -- maybe once a week -- have an aide. If there's a big crush, the nursing supervisor and charge nurse will pick up patients. If there's a really big crush, we'll beg for an aide. One night last week, we had 21 patients in beds at 4 a.m., with three nurses, one doc and no extra help. Only one patient was for psych; everyone else was high acuity. It was unrelenting.

I think what really makes things stressful in the ER is what the charge expects you to do for a patient before they're admitted to the floor. I have no problem with starting orders and getting things done while waiting for a bed; of course, I expect to provide patient care and help that beleaguered nurse upstairs. But I don't appreciate the charge who expects me to start every med, change fluids and put in a Foley, etc., before moving when there's a bed immediately available. That's when the ratio goes up to 5:1 and becomes really challenging.

Mini-Murse · Jul 11, 2011

In the ED I volunteer at (and hope to get a tech job, then a nursing job in), the ratio is 4:1, with 1 tech per 8 beds; the techs start IVs, draw blood, and run cardiac enzymes, as well as assist the nurses in whatever else they need. It's a small ED, 25 beds with 2 overflow, but it's popular with squads, so they stay hopping every day.

Guest03/15/15, BSN, RN · Jul 17, 2011

At my facility - its normally 3:1 with each RN having their own paramedic assigned to them. Occassionally we are 4:1 if we have a call-off.

daisydoll · Jul 20, 2011

At my facility - its normally 3:1 with each RN having their own paramedic assigned to them. Occassionally we are 4:1 if we have a call-off.

3:1 with your own medic? That is unheard of!

At mine it can vary from 3:1 in the more acute areas to 5:1. There are a total of 62 beds which includes hallways, not including trauma which is a separate area. There are usually 2-3 techs/medics per 15-20 patients. If there is a code or trauma the tech or medic can get called away and you might not see them for hours.

Guest03/15/15, BSN, RN · Jul 20, 2011

3:1 with your own medic? That is unheard of!
At mine it can vary from 3:1 in the more acute areas to 5:1. There are a total of 62 beds which includes hallways, not including trauma which is a separate area. There are usually 2-3 techs/medics per 15-20 patients. If there is a code or trauma the tech or medic can get called away and you might not see them for hours.

From what was explained to me (Im still orienting ) is that they had the 3:1 ratio as a trial some time ago. They discovered it increased patient satisfaction, decreased ER stay time, decreased the time to transfer an admitted pt, and fewer med errors. By increasing staffing and decreasing patient load - the pt's (according to the surveys) stated that theirs were better met, pain treated faster, and just less time waiting. By having our own medic we spend less time waiting for transport to take patients to their awaiting beds, less time time waiting for lift help, and other things. The trial run proved to the hospital system that if they increase staffing we can "turn over" pt's more quickly. In the end - the move proved to benefits the hospitals pocket ...and we all know that what they care about. :rolleyes:

VICEDRN, BSN, RN · Jul 22, 2011

I just left an er that was 6 or 7 to one. It took months of trying to get another er gig so I am not critiquing anyone who finds themselves in those shoes. My new er is 5:1 or 4:1 in critical or 2:1 in trauma bays...psych is 6:1. Am really not complaining considering where I came from...

LMH2687 · Jul 12, 2018

We are 3:1 currently where I work, but I believe my facility is pushing for 4:1 ratio since the secretaries have recently been given the responsibility of tracking acuity levels. We're supposedly one of the top 3 busiest hospitals in the state, even as a level 3 trauma center, so I don't agree with the change. Those that do, what kind of support staff do you have and how is your triage process? We see patients quickly with avg visit

We have techs but the only requirement is a high school diploma which doesn't do me any good as a second set of eyes when they don't even know what normal vitals are. Our techs main responsibilities include transporting, EKG's, and urine collection. We have may have 1 or 2medics that are techs but theyre not allowed to do anything wihin their scope of practice as a medic when they're a hospital employee in a tech role. With >60% brand new nurses on nights, we're barely treading water as a dept with 3:1 because they simply cannot keep up with having to do full triages and full work ups on back to back pts. we see 180-220 per day with more than half of that on the evening and night shift where all the new nurses are.

HermioneG, BSN, RN · Jul 27, 2018

I work in a level 1 trauma center and we work in both adult and peds. We have a 2:1 ratio in the trauma rooms and then 3:1 for the rest of the department. During very rare situations we have done 4:1 but that's typically if one is a hall patient waiting for transportation back to a SNF but is otherwise discharged, etc. Our leadership is very careful not to do 4:1 and our managers, educators, and even director have been known to come out to the floor and lend a hand when things get rough. It does happen, though, when we are really short staffed and I've noticed how much harder it is when I have had a true 4:1 list.