Nurse to patient ratio in ED

[1fastRN]

What is the nurse to patient ratio where you work? I work at a busy trauma center and we max out at 10 patients per nurse. At 4-6 patients I feel okay (depending on acuity). But when it reaches upwards of 8-10 it can be overwhelming and sometimes it feels downright unsafe! I am not the only nurse who feels this way.

The scariest part is a good deal of them end up being ICU/Step-down. To me it makes NO SENSE that the ICUs have a strict nurse-patient ratio (1-4 patients per nurse depending on the floor and acuity) meanwhile we can have 10 "mystery" patients because you never really know what's going on until they are fully worked up.

Lately with it being winter we have been getting 20-30 patients per area, with 3-4 nurses per area at night. We have been getting stuck with holds because the floors are full including the ICUS/SDUs. Patients have been in the hallway to the point you can barely walk through and it's a downright fire hazard/capacity issue.

Last night I had 8 patients and I had a cardiac arrest come in. I had some help from the other nurses but I thought to myself , "this is ridiculous!" It's physically impossible to take care of the patients adequately when we have that many. I love my job and I love being busy but I obviously do not like when it starts to feel unsafe. My co-workers have expressed the same concern. They are crazy busy on days too but they usually have better staffing and have a few float nurses helping out with triage/discharges/lining patients etc. But they seem to not give a damn about us on nights and we are always short. I care for my patient's and do my absolute best every shift but I can only be in one place at a time. I leave each morning being absolutely exhausted mentally and physically.

Do you guys have similar issues at your facilities?

[Gabby-RN]

I work at a busy level 1 trauma center 7a-7p. We start the day assigned with 6 rooms then go down to 4 at 11am usually. Sometimes we have more than 4 when we are holding a lot of patients waiting for rooms.

[bebbercorn]

-OP, we have similar ratios where I work but any codes or serious traumas go to the trauma/icu side. I never feel safe when I have more than 8 patients, I feel like a task donkey.

[Medic625]

We have 4 rooms per nurse with the possibility of 1-2 more hall beds per nurse in my ED. I'm a new nurse, so I find that any more than 4 patients seems overwhelming. I can't imagine having 8 or more! That's insane!

[CodeteamB]

I'm curious... Is there no division of acuity in your ER?

In my ER there is a possibility of going over 10 patients per nurse, but only in 2 areas which are quite low-acuity and requiring minimal nursing care (think fast track).

For a nurse in unmonitored areas the maximum is 6 patients, the norm is 3-4. For monitored patients we max at 3 patients per nurse.

A cardiac arrest gets at least 3 nurses to the one patient (the code team and charge). A person with other assigned patients is never expected to accept a code...

This is the norm in my area... How are things divided for you?

[NurseOnAMotorcycle, ASN, RN]

3-4 rooms and 2 hall beds.

[ttouslee]

I work in a small hospital, in ER we work with one RN and one EMT. At about 4-5 pts I will call the supervisor who then will come to help out. When a true cardiac comes in it is one on one, besides the code team.

[Emergent, RN]

Wow, that's a lot of patients! We have 4 rooms, with the help of a flow nurse (sometimes). We used to have an acute section with a 3:1 ratio, and a fast track with 5:1, but combined them for more efficiency.

[boyfactory]

This is exactly how it is where I work. It works well when we have a float nurse to help with the critical patients. Or checking in the ambulance patients.

I've been a nurse 7+ years and cannot imagine 10 patients of mixed/possible ICU/SDU condition. Unsafe, no question.

Wow, that's a lot of patients! We have 4 rooms, with the help of a flow nurse (sometimes). We used to have an acute section with a 3:1 ratio, and a fast track with 5:1, but combined them for more efficiency.

[1fastRN]

I'm curious... Is there no division of acuity in your ER?

In my ER there is a possibility of going over 10 patients per nurse, but only in 2 areas which are quite low-acuity and requiring minimal nursing care (think fast track).

For a nurse in unmonitored areas the maximum is 6 patients, the norm is 3-4. For monitored patients we max at 3 patients per nurse.

A cardiac arrest gets at least 3 nurses to the one patient (the code team and charge). A person with other assigned patients is never expected to accept a code...

This is the norm in my area... How are things divided for you?

We have trauma which has 3 beds, a prompt care area (sprains, minor lacerations, etc.), and then 3 main areas where the acuity can be anything from a belly pain to a cardiac arrest. There is no division of acuity at all in the main ER. Prompt care often closes at night so we can get a toe pain thrown in our mix as well.

When we get a MI/Stroke/Code the charge nurse and others often jump in to help initially. If it's a super sick patient we will get "skipped" but we are still often carrying a full patient load on top of that.

Our night staffing is terrible and we feel like the "forgotten shift". We are one of the top ranked hospitals in the region and our nurses are awesome but I sometimes can't believe our working conditions.

I'm so jealous of those of you with adequate and SAFE staffing/ratios. The sad part is, my mother used to work in the same ER 15 years ago and it was the same BS then! They are always talking about how they want patient satisfaction scores to improve but how can they expect that when our staff is spread so thin!

I am a new nurse and new to the hospital... I will be joining the unit based council to represent the night nurses (UBC is mostly day people). It's not so bad in the summer and I do have nights where I only have a couple patients, but it's winter and these people are VERY sick.

I love where I work but something has to be done! I like being busy but I want to care for my patients and I never want to feel overwhelmed or unsafe. After reading all of your responses I am even more discouraged.... Lately we haven't even been getting breaks. So on top of the safety issue I'm pretty sure there are legal issues as well. I do not want to change facilities... I want to change MY facility. I guess the only way to do so is to get more involved and speak up. I just don't understand why this isn't/hasn't been addressed.

Thank god my co-workers are amazing and will always jump in to help out when one of us gets a real sicky, but if we are all drowning equally it's not always easy.

[EDRN62772]

I work 11-7 in a community hospital ED. I am responsible for approximately 4-6 patients. The main ED area has 15 beds, 5 beds in our behavioral health area and 6 beds in the express care area. We function with 1 doctor, 3 RN's, and 2 CNA's. If a code, trauma, or stroke comes in, usually the nursing supervisor will come down to help.

[happyinillinois]

Very busy level 2 trauma center. 3:1 main ER, 7:1 behavioral health, 6:1 fast track. Sounds great except that those 3:1's are always very sick, CVA's, MI's. ICU holds. Large elderly and poor population with lots of comorbidities.