What's a safe nurse to patient ratio?

  1. I've only been 8 months in the ED and had been assigned 9 patients/beds the other night after telling the charge that I felt ill and was coming down with something. No peds (separate peds ER); but, a Level I trauma center, so in the holding section mix, I had both a MI post-MVA and a CVA/MI/seizure pts that were post trauma room, along with a COPD exacerbation (pt. had hx of 3 prior intubations), HTN crisis, a C-Differ, a chronic vent/trach pt with pseudomonas who needed frequent suctioning and an active upper GI bleed. By the way, no PCA to assist. This certainly wasn't safe for the patients nor my license. I am certain I did not document all my interventions since I ran for 10 hours straight like a chicken with the head cut off . Every time I got a chance I went to the charge and asked for assistance. He said that he would be by shortly to help and never showed. At the end of the shift, having managed to get more than 1/2 my patients up to the floors, the charge comes over and gives me a speech on how I should better manage my time. When I asked him to give me specifics and how I should do things, the subject changed. He did graciously put in for payment for no break.

    In general, I have felt that a 4:1 ratio is the very maximum for patient safety when it comes to these type of patients. Management insists that there should be no less than a 1:6 ratio or the nurse is poor at time management and prioritization.

    By the way, I did come down with the flu (mild-Thanks to getting the flu shot this year for the first time) and just called in sick for tonight's shift. So, I really don't know if it was me not being up to par that night or that my hospital just expects way too much from the nursing staff. Being relatively new to the ER, I would love to hear your honest feedback on this. How much is too much?:Reindeer:
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    Joined: Sep '05; Posts: 2,006; Likes: 2,269


  3. by   Wise Woman RN
    With that kind of acuity, even 4:1 sounds like a lot, especially with no ancillary help... good luck...
  4. by   bill4745
    Our ER is 4:1, with a charge RN with no patients, a float RN, and 2 techs for 20 pts. Even this is often not adequate.
  5. by   weetziebat
    I certainly don't think any nurse, hoping to do right by her/himself and the patient, can adequately care for more than 4 patients on a hospital floor. And sometimes that is too much. We uesd to go by acuity, but that got to be such a joke it was ridiculous. We went from 4 to 8 or more after that was instituted. Administrative greed always wins out...
  6. by   RunnerRN
    I know we have a variety of charge RNs in my dept. Some are overly helpful and protective, others don't seem to care if you barely have your head above water as long as you're getting your patients to their rooms. Would you feel comfortable going to your NM and talking about this night? I don't think a 20yr experienced RN could have done well with that load, let alone an 8 month ED RN.
    Were you as assertive with the charge as you could have been? Did you ever really say "This is completely overwhelming and I'm not providing good or safe care. I NEED HELP." The only reason I ask is because I tend to assume my charge gets it and understands what I'm saying when I just ask for help. Often they're overworked too, and just hear "She's a little busy, I'll try to get down there."

    Good luck! I consider a safe NP ratio to be somewhere between 3 and 6 to 1 nurse depending on acuity and arrival times.