I am an RN for a ER in NYC. I am also a new RN, having been practicing for 15 months, so I am pretty new. In the 15 months that I have been practicing, I can say I love being an RN. What I don't like is that there's no RN to patient ratio. The most patients I have had in one go is 14. For an RN who only has 15 months of practice, I think it's crazy wrong. Let's put it this way, how often does administration think we can round on 14 patients, of which 4 are level 2 patients, how are awaiting ICU beds. 5 of those patients are on 1:1 observation, and because they are psych patients. On top of it, 1 of the 14 needs a blood transfusion. Mind you, 9/10 we don't have PCTs because they are moved to other areas within the ED, that means that I am also working to cover for the duties of a PCT, not to mention, I am also a waitress. Which leaves no time to perform as an RN, because I have not become a task nurse. I don't have time to look at blood work results, or imaging results. How can I provide proper patient care, when I can't even hardly see my patients again after performing the initial assessment? Then we have to do our own vital signs, which I don't mind doing, but when I am searching for a BP machine and a thermometer, I can't find one that works. So, I spend most of my days searching for supplies, or equipment that works. In my short practice I am realizing that hospitals are a business, and RNs are squeezed to the max in order for admins to say money, so they can get more money to deposit into their bank account. This is all on our backs. Is that nursing?
Nov 5, '17
I have heard the ratios in NY were bad. Yep. By the way, PCT duties really belong to the RN - it's just a good day when we have extra help!
But I don't think anyone can argue with the fact that your situation is not safe.
Nov 9, '17
Hey Beldym...I just wanted to first say I am NOT an ED nurse..I do however work in a huge 1000 plus bed teaching hospital in NYC. Its in a underserved part of the city so the ER is always busy with everything from heart attacks to patients wanting a pregnancy test because they have no primary care physician so the ER becomes their first place to go when a medical need arises no matter how minute(hence patients coming in for a pregnancy test). In addition to an adult ED with a recussition room(6 beds I think) we also have a fast track, CPEP(psych ER), Peds ED and geriatric ED. So needless to say it gets crazy in our ED. Ive had chief residents come transport patients to my floor. My friends that work in the ED are quite overworked and mention patient ratios similar to yours. A friend of mine has an average of 12 patients at any given time. She says RNs constantly do vitals, help patients to the bathroom, transport patients basically anything a PCA or tech is supposed to RNs do as well. Census is just too high for RNs to not do these things in the ED(rest of the hospital too..I transport patients and help them to the bathroom all the time). I guess its just the way it happens in the biggest city in the world. Emergency rooms are just too busy city wide.
Nov 10, '17
Unfortunately yes that does seem to be the state of hospital nursing. I had a very good friend that just finished several travel assignments in ER at several different hospitals in NY and he said the ratios were around 12 to 14 pts to one nurse just like what you are experiencing. Definitely not safe, but makes the hospitals a better profit. I work in the ER at a smaller hospital and we take level 2 traumas--normal assignment is one nurse with four pts. I've heard NY is the worst with staffing ratios--can you start traveling assignments to other states since you almost have 2 yrs experience? The ratios would be so much better for you then what you are going through now, more money, and you would get to travel. I work with someone that takes a travel assignment for 3 to 6 months and then takes 4 months off.
Nov 10, '17
This is an excellent example of why nurses need to get involved in politics at the state level. Yes, yuck! Or at least with your state nursing association. Consider working on ratios as advocacy for patients.
Nov 18, '17
14 patients!? Wow that is insane. I work in an ER in NJ and our ratio is 5:1 and if we have a heavy critically ill patient or trauma patient usually someone will cover the rest of our pod for us so we can focus on that one patient (we also make the top 50 list of highest ER volume in the country, so it's definitely not a small or rural hospital). I guess we are very fortunate based on reading these responses, we have lots of staff and patients are moved in and out as quickly as possible so there is no backlog. I'm sorry you are going through that, I can't even imagine how challenging that must be, I would be looking for a new job, that's just not safe.
Nov 18, '17
Wrong thread! please delete
Last edit by campesina on Nov 18, '17
: Reason: wrong thread
Nov 27, '17
14 patients to 1 nurse? I would not work in that department! That is so unsafe, for the patient and the nurse!
The ratio should be 3:1 for trauma centers, trauma patients being 1:1 until stable or transferred, and 4:1 non- trauma.
Nov 28, '17
I am moving to NY in the next 6 months. I am planning to switch specialties to ICU. I do not want to work in a NY ER because of the ratios even though I love the ER and it is my specialty.
Hey I'm an ER nurse in an inner city Detroit hospital and it is quite similar to what you have described. Management has instilled a "soft cap" which basically means when it gets busy, there is no cap. You have patients sitting in the chairs/waiting area because we don't have enough rooms to safely examine and care for people - even chest painers who should be on the monitor immediately. Our ED techs are always sitting with behavioural health patients and not used to their full potential. I am constantly doing task after task. It is truly unsafe and I fear for my license every shift. Even our traumas and vented patients do not get 1:1 or 1:2 care. With a vented patient I have had 3 other patients I had to tend to as well. Needless to say, I wasn't able to provide quality nursing care to the other 3 patients. It is quite mind boggling to think that these hospitals/healthcare corporations don't think long term because these are situations that are law suits in cue with potentially a lot of dollars on the line.
I have some colleagues who have moved on to other surrounding Detroit EDs where ratios are 1:3 and 1:4
I am definitely trying to get my experience in the inner city Detroit ED and get out. Never working for a for profit hospital again!
This is surly unsafe, 1:14 patients at the same time with high acuity patients, did you raise your concern to the nurse manager ? or administration ?, I know in some states like California the nurse to patient ratio in the ED is 1:4 and 1:1 or 1:2 depending on criticality. I am still not able to figure out how this ratio is decided ( for sure the less number of patient you have the better care you can provide) but how is a maximum number of ED patients chosen and to what acuity ? do we continue using the triage acuity for these patients ? how do we classify them ? if we are able to answer these questions I believe we can present data that the administration will have to accept to change the ratio.
Just because a patient is on a ventilator, doesn't mean they are an automatic 1:1. However, the ratios in New York are absolutely insane and I feel bad that they have to go through that.
Must Read Topics