What's your average nurse to patient ratio?

  1. 0
    Right now I am averaging 1:7+ (nothing less) and am getting very close to quitting. It truly is becoming unsafe since critical care patients requiring 1:1 are part of the mix.

    I just had a CVA who got the order for tPA 5 minutes before the closing window cutoff time (docs/residents/students couldn't decide what they were going to do and how they were going to do it...) Thank God I did a decent assessment, asked questions of the family (since the docs weren't keeping me informed) and knew there was a confirmed time of onset of sxs, allowing me to prepare ahead of time and not be the one that was blamed if we missed the time frame for administration. The patient actually received the initial bolus with 1 minute to spare. Of course, in cutting it that close, the patient did not have any relief in symptoms. While this was occuring, I had 6 other patients that had no nurse. I notified the charge nurse that I was aware that hospital policy required 1:1 for the tPA patient and someone would have to care for my other patients. Her answer was that there was no one to spare and I would have to find a way to be in compliance with hospital policy, while not abandoning my other patients-since I was at fault and should have not prepared ahead of time and just let the time for administration expire.

    After she said that to me, I decided I will be leaving this ED as soon as possible. I don't want to get into another situation like this again, so am I asking too much to find a place that has safe pt to nurse ratios and professional management?

    What is your patient to nurse ratio? Is it manageable? Do you actually get some help from the aides or do they sit around reading the paper and give you that dirty look if you ask for help? If it is less than 5:1, do you need additional staff? I am willing to move or do traveling because I love emergency nursing, think I do it fairly well; but, hate having to risk patient lives and my license because of poor management, cost cutting of nursing staff while putting millions of dollars into the aesthetics of the buildings...

    At the least, thank you for giving me this opportunity to vent.
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  3. 21 Comments so far...

  4. 2
    i:7 is an unsafe ratio IMO, especially when one of the patients should have been 1:1. I would be looking for another position.

    I usually have 4 patients on nights on the oncology/BMT unit. This can get crazy some nights when a couple of kids spike fevers and need cultures drawn while there are others vomiting, needing routine blood work, meds every hour, chemotherapy and blood product administration. On nights we get the kids who are going down for procedures or radiation in the morning ready so that day shift can just send them off. Everyone helps each other out, and that is what makes the workload managable on most nights. If I ever felt that it was truly unsafe I would be out of there in a heartbeat.
    MikeyBSN and loricatus like this.
  5. 1
    I start orienting to the floor next week. The hospital I'm at has a ratio of 1:6 or 1:7 I think, but they work in RN/LPN teams.
    loricatus likes this.
  6. 1
    The ER I work in is 1:4 99% of the time. Once in a while I might have 5 if one of my very stable patients has to sit in the hallway to finish up. Most of our aids are pretty good, but there is always one or two that clock in and then dissappear for their entire shift. I have seen that everywhere.
    I was on here a couple of weeks ago because I had been given 7 rooms at an ER I went to for agency.
    I checked with many, many people that I come in contact with and they all say 7 is way too much, 4 is the norm.
    Now some people really dig the desparate situations and choose to work at the
    ERs where you have an unlimited number of patients. ANd there are places like that around here. But it is not the norm.
    I and my other ER nursing friends are not nuts and we want to work in a safe, reasonable environment. We love our licenses and want to keep them.
    I love the ER I work at. It is really well run, the docs and people are great. It is almost always a joy to go to work.
    PM me if you are interested in more information on jobs available in my area since you say you are interested in relocationing if needed. We have tons of hospitals around here. And a couple new ones are opening.
    I too love the ER and don't want to do any other kind of nursing in the foreseeable future.
    I do plan on doing some travel nursing. ER of course
    loricatus likes this.
  7. 1
    You need to find out if the ratio you have descibed is planned and permanent or temporary because of open positions, LOA, etc. If is is permanent I would begin looking for other employment and let the managers of the facility know why. yoou are doing so and would not recommend your current place of employment to your collegues when asked.
    loricatus likes this.
  8. 3
    Quote from gonzo1
    the er i work in is 1:4 99% of the time. once in a while i might have 5 if one of my very stable patients has to sit in the hallway to finish up. most of our aids are pretty good, but there is always one or two that clock in and then dissappear for their entire shift. i have seen that everywhere.
    i was on here a couple of weeks ago because i had been given 7 rooms at an er i went to for agency.
    i checked with many, many people that i come in contact with and they all say 7 is way too much, 4 is the norm.
    now some people really dig the desparate situations and choose to work at the
    ers where you have an unlimited number of patients. and there are places like that around here. but it is not the norm.
    i and my other er nursing friends are not nuts and we want to work in a safe, reasonable environment. we love our licenses and want to keep them.
    i love the er i work at. it is really well run, the docs and people are great. it is almost always a joy to go to work.
    pm me if you are interested in more information on jobs available in my area since you say you are interested in relocationing if needed. we have tons of hospitals around here. and a couple new ones are opening.
    i too love the er and don't want to do any other kind of nursing in the foreseeable future.
    i do plan on doing some travel nursing. er of course

    loricatus,

    i agree with most of this, the er where i work is much the same, and we can't be the only two ers that work the same way.

    the only times i can remember having more than 4 patients, it was because of a choice i made. sometimes my four are taking a while to work up, or are waiting on a floor bed with none in site, or might be an overnight obs patient for chest pain.

    when these things happen, i will frequently try to put some of the minor/fast track stuff in the hall to get them seen and discharged. (i work nights, and our fast track closes at 10pm.)

    i really have a hard time sitting still, esp when i know that work needs to be done. if i can find a doc willing to see a bunch of minor stuff, then i will line them up in any spare space i can find.

    of course, i only do this when i have the time -- not when i have a critically ill patient i'm taking care of. and, it is always voluntary -- never because someone tells me i have to take the patients.

    i wouldn't go as far as saying that i love to go to work, but most of our docs are pretty good to work with. management isn't too bad. we do have problems some nights getting beds in a timely fashion. we also have problems with supplies -- lately it has been oxygen sat probes, and (as of last night) suture trays.

    we're better off than most hospitals in the area as far as ratios. and i really do love our manager. some of the middle managers, though, leave some to be desired. no place is perfect, though, right?

    anyway, seven patients per nurse on a regular basis is insane -- i'm not going to go so far and say it isn't safe, because with many of the patients we see, 7:1 is safe -- stds, coughs, utis, and menstrual cramps arn't exactly life-threatening emergencies, and a nurse can safely give care to seven of these types of patients. even toss in a hypertensive crisis, and you can make it.

    but much more than that, and you have very neatly crossed the line into "unsafe." and that line is very easy to cross, and just not worth the risk.

    the other problem is "timely" care. with the extreme push to decrease ed los, it can be very difficult to take care of seven non-critically ill patients and get them discharged as quickly as management would like. so even if you can safely take care of your six patients, plus a hypertensive crisis, those other six patients arn't going to be seen and dispositioned as quickly as they could be.

    anyway, my understanding is that ena recomends a 4pt:1 nurse ratio. though that isn't a legally-mandiated ratio like there are in california; since the ena is the professional organization for emergency nurses, that is a standard that has been set. your employer is foolish for violating a national practice standard on a regular basis.

    (hope this all makes sense -- it is time for bed and i don't always convey my thoughts clearly when i'm tired)
    kmoonshine, loricatus, and Altra like this.
  9. 2
    4:1 none acute. 3:1 acute side. WE also have a "float nurse" there to relieve us during break. So unless she is in the trauma room, she's also helping.
    GleeGum and loricatus like this.
  10. 3
    We have 3-4 patients per nurse nearly all of the time. We also have a flow nurse that expedites discharges, tasks, meds, etc. Our charge RN does not pick up patients, but if we get slammed and have people in overflow beds, they will pitch in and help. On a good night, we have between 6-8 RN's that take rooms, along with 4 EDT's (some are great with helping out, others think "gee, no one asked me to do anything, so I'll just sit here...")

    There are times when we get really busy - we see around 250 patients per day. We also get alot of trauma/gsw's that just walk in off the street, so we need to be ready to go - which would be difficult if we had 7 patients each. I sometimes struggle with 3 patients, depending on what is going on with them, and there are times when 4 patients are a breeze.

    Sounds like you already know that your situation is unsafe. I couldn't work in an ED with those types of ratios. Perhaps you should consider finding new place of employment.

    BTW, whenever I am stuck in a room or overwhelmed with a situation, our charge nurses have always been helpful. If I say "hey, I'm really overwhelmed here", their response is "what can I do to help you". And if I am stuck in a room with something like an acute MI going up to the cath lab, they will always have the flow nurse cover my other rooms without me having to ask.
    GleeGum, Altra, and loricatus like this.
  11. 1
    1 nurse and 1 tech for 6 beds. Generally with this pod system they try to assign a good mix of acute and non acute pts, but that doesn't always happen. If you are the only one with beds open, you get whomever. It works out pretty well for us.
    loricatus likes this.
  12. 1
    I'm currently a functioning as a traveler and at this hospital we have "5 to 1 ratio" normally, minimal additional help, maybe 1 tech for 15 beds charge will not accept pt's nor help out, no floats either. Last night I had 3 ICU patients and 2 stepdown's to admit. One of the ICU patients I held for 5 hours because the ICU couldn't accept 2 patients at a time and they have a 1:1 ratio.

    Night before last two nurses didn't show up so I ended up with 15 beds (told the charge I couldn't handle that many and her response was well I'll make sure you get every 4th pt and hopefully they will not be too sick) in these 15 was three psych rooms where pt's were in 4 point restraints, requiring 1:1 care per hospital policy, told sorry you have to do 15 min checks on them. I also had the code room down a hallway from all the other rooms and kept critical patients in it all night.

    My last hospital had 3:1 or 4:1 usually with charge which would help out, 1 tech per 10 rooms and a float.--BIG difference and I miss that.

    Anyway I am going to make sure with my next assignment that this doesn't happen again and I have reported the situation to the state hospital association, Board of Nursing and JCAHO.
    loricatus likes this.


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