I work in a 24 bed ER (plus up to 7 hall beds at any time if needed) in a town with a population of approximately 65,000 people. Our daily census is about 150 patients, sometimes less, sometimes more. We recently switched from a 3:1 RN to patient ratio to 4:1. There is a total of 3 medics for the entire ER from 11am-11pm and one medic from 7am-11am and 11 pm-7am. Same ratio for the nurse techs we have working. It seems like since the change moral has gone completely bad and everyone is always stressed out and we are all worried about losing our license. The director of the ER and managers assure this that we still have it pretty easy (although none of them dare set foot on the floor to help out) and that is the national standard for RN's working in an ER. Just wondered if anyone has any input and what are the RN to patient ratios where you all work?
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.
Last edit by Emergency RN on Jun 30, '10