[E.D.ucated]

Im in Houston, ours is 1:3 currently. My nurse mgr wanted me (just me!) to take 4 tonite for 12 hr shift. Im a new nurse (1 1/2 years) and I told her I was uncomfortable with this because Ive tried to do it and gave poor nursing care. She told me I had to do it if she told me to. Is this true? How many pts do most E.D. RNs take? We mix all acuities (stable, urgent, emergent, whoever's next) Thanks for info!

[2ndCareerRN]

In CA where I work we take 1:4 for gen ED. 1:1 for trauma. 1:1 for icu holds, unless you can get 2 in the same room, then they are 1:2. 1:4 for Telemetry holds, and then whatever medsurg holds we have usualy get thrown in on top of the telemetry holds.

2 nights ago we had 6 telemetry holds and 1 MedSurg hold with 2 nurses and 2 ICU holds that were 1:1 up front. That took care of 4 of the 7 nurses on the shift, leaving everthing that came in the door to the other 3. Luckily no traumas came in for 3 hours.

The holds are like that just about every night. Now that we have the mandatory staffing ratios, the floor won't take them. Of course, we can go over our staffing and still continue to take new patients.There is going to be some fallout from the ratios, and some won't be good.

bob

edit: But, this will come to an end for me very soon, 1 more 16 hour shift and this assignment is OVER!!!

[Deaconess]

Our official nurse/patient ratio is 1:3 but I have carried as many as 6 patients - seven if you count the one in the hall waiting for discharge or psych eval. Our more usual understaffed weekend night ratio is 1:4. Probably the worst night I had was when I had six rooms with one ICU hold (which we thankfully got downgraded during the middle of the night) and a very sick ICU pt (intubated, insulin gtt, chf, diprivan, crazy family). In such cases care gets prioritized in such a way that if you aren't dying, I don't see you. The other three nurses on the floor were in the same boat. One had a drop-off stabbing (which we all were working on at first) that went to the OR and the other had an ICU patient as sick as mine.
When all else fails, prioritization, prioritization, prioritization. Don't forget to get payed for your missed lunch.

[athomas91]

(5 yrs ago) as a new grad - the trauma side of the ed i worked in had 5 beds assigned to one nurse.....
most hospitals i have worked in have a 1:4 ratio..... but sometimes even as a charge nurse i have carried 9 patients....let's face it - you are in an emergency department - sometimes the staff isn't there but the patients are - and you keep taking em.....sometimes you don't have a choice...

magikgirl - remember the nite we each had about nine - 29 holds - over 40 in the waiting room?!?!?!? that sucked worse than anything i have ever seen....

[MrsWampthang]

Our patient ratio is 4:1. If we have a bad patient come in that requires 1:1 then the charge nurse is supposed to see that your other patients are taken care of. That doesn't always happen though. Usually though the other staff members will pitch in and help each other out.

The one thing I can tell you about taking multiple patients is to learn to prioritize. Learn which tasks need doing first, which can wait, which tasks are going to take awhile to do and which can be done fairly quickly.

Good luck!
Pam

[veetach]

our patient to nurse ratio is 5:1. However, once we start stacking patients in the halls, it can be higher. and that includes all types of acuity. We do team nursing so you can conceivably have 3 to 4 level 1 acuity patients if you get stuck with that.

I have worked 15 holds (10 of those monitored) with 2 RN's. It was not pretty. Our CCU patient to nurse ratio is 2:1, but it is somehow OK for our ED nurses to have 3 times that.... go figure.

[imagin916]

I am sitting here reading these posts about the ratio of 1:5 in your hospitals, if I have 5 patients that is a good night for me!! I usually carry around 8 or 9, the most I ever had was 12. We have a 4 bed "rescusitation" room that the most critical patients go to, but if there are no beds, than we must keep the patient on our assignment, and continue to accept new patients until we can free a bed in rescus. I guess I should go work elsewhere!?!

[LilgirlRN]

depends on what you mean... in the ed each nurse takes care of 4-5 pts at a time. i work triage, i may have15 people waiting to go into the ed and i am responsible for them while they wait. i may not have to do anything to/for them, its just the thought of all of them going bad at once that freaks me out!

[veetach]

Lilgirl, I know what you mean. When I work triage I can have as many as 30-40 patients waiting to be seen in the back. It can be an overwhelming deal!

The national average is a ratio of 4:1, the only reason I know this is that our ED just did a review of our nurse/patient ratio and found we were higer than the national average.

[SpnshEyes1975]

Our ratio is usually 1:5 or 6, but the nurses all do a good job with helping each other out in a pinch. If we have a code or a critical 1:1 patient they will help look out for each other. I've seen it worse even, but that is only because we are never allowed to go on diversion so if it keeps going, we have to suck it up and find room and pray it doesn't last long! LOL