Ratios? Do you have them in ER, or are they just for the floors?

We assign sections of 3 rooms but do pick up a hall bed as needed. I don't understand the recommendation by ENA for 4:1 staffing...do they give clarity on the triage acuity of these 4 patients?

I work agency as well and have never seen a dept that the nurses start with 4 patients routinely...on busy days yes but not always.

In my ED the most we get is 4 per nurse. But most of the time there's no tech or secretary so we're doing EVERYTHING. It's really easy to get behind and I don't know what I'd do if I had to handle more than 4.

In our main ED, we start our shift (7a-7p) with 6 nurses each with a 4 patient assignment. Based on the layout of the particular assignment you are given that could mean 4 physical beds (in a room with monitor and oxygen) or 3 physical rooms and a hallway bed (which with a lifepak sitting on the counter turns into a tele bed) and we always have 4 patients. Many days I am taking a 5th patient. If one of us has an MI going to the cath lab or really acute ICU with multiple drips then we picth in to help each other dig out. Generally however we are stretcher to the limits with a several hour wait just to be brought back.
Our promptcare area has 6 physical beds and multiple chairs and can flex to stretchers if needed. There are 2 nurses (most often LPN and RN) who work either 9a-9p or 1p-1a.

Each nurse where I work is assigned a pod, or section of 4 beds. If we're staffed well, we'll often have a nurse assigned to the hallway until 11 pm. After that, different people will usually pitch in to take the hallway pts if needed. Our trauma bay has 6 beds, and so until about 1 am they try to put two nurses in there to work together. After 1, you've usually got the trauma bay to yourself, but our dept is very good about helping each other out...and usually the only time that I feel like I'm "drowning" is if the whole department is just having a horrible day and no one has a spare minute.

Depends on the day and how much staff is scheduled. Tonight, I had a consistent 5 patients and 1 trauma room. Luckily, no traumas tonight.
I have had up to 7 acute patients at once. The goal is 4:1 ratio. Staffing usually does not allow for that.

Wow,..I think my ER is looking better and better all the time. If we don't have a lot of call ins, that aren't replaced we have a 3 to 1 ratio. We have a charge nurse that doesn't take rooms. Each nurse is assigned 3 rooms. Until 0100 we have two triage nurses. We also have several float nurses to help out and take hallbeds. We have four secretaries until 0300 when we drop down to 2 until 0630. We also have techs, usually 5 on nights. We often have an RN working pre treatment from triage until around 2300. It wouldn't be unusual for us to start our 7p-7a shift with 20 RN's. We are a trauma center, one of only two in our area. Not big city, but we see on avg 200 a day.

Of course there are times when we are holding pts, have 15 hallbeds and are short three nurse and two techs, but that doesn't happen very often. We do all work well together and when EMS brings in a pt there are usually 3 nurses in the room to get everything going. Our goal is to stay at the 3:1 ratio, doesn't always work but we're getting there!

I think set ratios in the ED is a bad thing unless it specifically addresses pt acuitiy that would constantly be updated, we all know pts are mistriaged. We're a 5:1 base. When staffing permits we drop 4:1, even then, it's murder. What kills me is that they have started a "fast track/clinic" where there is 1 LPN with a dedicated ERT and a mid-level with only 4 pts. What? So the sick people get a nurse with 4 other pts, and ERT who has 12 beds, and a Dr. managing the care of who knows how many other people and the sprained toes and lacs get 4:1 nurse and md care. Doesn't this go against the whole triage principles? It's so dumb. Oh wait, probably a number cruncher who never touches pts made this decision. It really makes me mad when I am in triage and I have an 82 YOA chest pain waiting 3+ hours to go back and med refills and boils and toothaches are whizzing in and out through revolving door. It means I can't even say to the family that we see pts on an acuity level because that's obviously not true. "Sorry, I could get you back as there is an open bed, but you're going to require a full work up and bed for probably 10+ hours and they only want me to get pts back who can be seen and discharged quickly. Come back when you're not sick!" Arrrgh!!!!

What??!!! I refuse to believe this! You're pulling our legs, surely! 5 Techs on nights!! 4 Secretaries till 0300!!

Whooooa!

Please tell us: How big is your ED (how many beds)? How big is your hospital (how many beds?) How many patients do you see in your ED during an average/month (and per/year)? I see you mentioned that you're a trauma center - are you Level I or Level II?

A 3:1 ratio?! Wow! That's something I can dream about....

cheers,

geeeze Roy,....keep your panties on,....ok,..I've been at this hospital over 10 yrs now,..I should know the answers to all of your questions but I don't. Let's see,...we have 13 rooms on the trauma side,..12 ED rooms,...and 8 fast track rooms,..the trauma side has 8 permanent "hall beds" (yeah I know,.not really hall beds), the ED side has 4 hall beds and fast track has none. We have 6 areas set up in triage to draw labs, start fluids etc. Fast track stays open until at least 11 and often it's open til 0300. We are a Level II (I'm told we aren't Level I because we don't publish research). We do have a trauma surgeon that is present at all class I and II traumas. We are also one of only two "real" ED's in the area. We average 200pts/day,..so that's what,.over 70,000 a yr. We have 9 floors,..42 rooms per floor,..so just under 400 beds,..but that doesn't include NTICU 25 beds,..SICU 20 beds,..CCU 30 beds and NICU 25 beds.

We are in the process of building a new ER,..100 rooms (not including hall beds) and a 20 bed holding/observation unit. I might add too,..this isn't a "county" or "state" hospital,...it's a "privately owned, not for profit facility". According to our population,..in comparison to similar populations,.our area is short about 5 hospitals! We occasionally find ourselves sending pt's 4hrs away for more specialized treatment,.ie pediatric cardiology.

Hope that answers your questions,..I'll search the hosp web site and update if my info is way off,..although I should be pretty close. It really isn't a bad place to work,..although the unit I worked on prior to ER is way understaffed! The great staffing is an ER thing and due to a new director that rocks!

Our ED consists of teams. Each team is assigned 4 ED rooms (and then there is always the hallway). Each team consists of an RN and one Paramedic. Team one has the highest acuity pts while, say, team 7 should have lower acuity pts. I think this system works pretty good. It is the charge nurse who will assign the pt to a team.