ER nurse to patient ratio

[MGHERRN]

I work in a 24 bed ER (plus up to 7 hall beds at any time if needed) in a town with a population of approximately 65,000 people. Our daily census is about 150 patients, sometimes less, sometimes more. We recently switched from a 3:1 RN to patient ratio to 4:1. There is a total of 3 medics for the entire ER from 11am-11pm and one medic from 7am-11am and 11 pm-7am. Same ratio for the nurse techs we have working. It seems like since the change moral has gone completely bad and everyone is always stressed out and we are all worried about losing our license. The director of the ER and managers assure this that we still have it pretty easy (although none of them dare set foot on the floor to help out) and that is the national standard for RN's working in an ER. Just wondered if anyone has any input and what are the RN to patient ratios where you all work?

[PAERRN20]

Yes 4:1 is the ENA recommendation. I work in trauma center and sometimes we go 5:1 or even 6:1.

[GitanoRN, BSN, MSN, RN]

Unquestionably, 4.1 ratio is the norm lately, however, when your working in the ER one never knows what the shift may bring. Having said that, I recall my days in the ER/Trauma I had 42yr. male with a laceration on his upper Rt.arm with history of CHF and another pt. of mine went into respiratory arrest, while in the middle of the code, the CHF pt. went into cardiac arrest ...therefore, one can't never tell if the ratio @ a high pace ER/Trauma is the norm. Wishing everyone a great week.....Aloha~:redbeathe

[AntMarchingRN, RN]

5:1 is common with us. Our Ed has a front and back section with a basic in the middle. Nurses in each section usually help each other out, when possible, and if we have to take more than 5 its based on acuity and who can an extra with less critical needs.

It wont be easy, but you will adjust. Ask for help when you need it/can get it. Good Luck!

[solneeshka, BSN, RN]

Not an ER nurse, but I've never heard of a facility with a ratio as light as 3:1 in the ER. We're a level 1 trauma center (very high acuities) and our ER nurses have 5:1. Did an ER internship in nursing school at a facility that was a level 4 trauma center (mostly tummy aches and sports injuries) and they had a 4:1 ratio. You will get used to it! The ratio is appropriate, it's just not what everyone's used to. That will change, you can do it!

[cookienay]

We have 4:1 ratio in our 45 bed ER (with a 10 bed overflow area that we open PRN). While not a trauma center, we are a regionally recognized center for cardiac care and the busiest ER in our state (as far as volume goes). To me 4:1 with techs AND medics sounds sorta dreamy.

Good luck!

[AggieQT]

We have an average of 4:1 ratio, sometimes 5:1... BUT we don't have EMTs and our techs are only allowed to place pts in rooms, splints and restock rooms... seriously... so the nurses do EVERYTHING... it can be done and with your license intact... its all about prioritizing, and teamwork :)

[GM2RN]

I've never heard of a ratio as light as 3:1 either, and I'd be thrilled to have only 4:1, plus you have techs and medics!!! I work in a 29 bed ED and never have less than a 5-bed assignment, sometimes 6-7, and we never have more than 1 tech working at a time, unless we get really swamped and can convince the supervisor to give us temporary help.

[coolpeach]

We are a level two trauma center, and 4:1 was are lightest load. Normally you got 1 code room/ two trauma rooms/ and a medium room on the big room list so 4:1. If you got the medium rooms which are serious conditions, and traumas, but not codes, and majors you had 4 rooms and up to two in the hall so 6:1. If you had the small rooms (colds, lacs, vag bleeds etc) it was 7:1.

[Emergency RN]

Heck, when I'm covering a colleague for break, my ratio sometimes goes to 16:1. It really depends on the charge RN and how they distribute the load. If the charge is someone good (who looks at acuity and clinical needs) then it isn't so bad. But if you have a charge who only stupidly looks at numbers, then sometimes you can get 5 or 6 ICU type pts on multiple drips.

My ED believes in the patient satisfaction BS of bringing in every simple ache and pain so that there is zero waiting room time; never mind that these non-emergencies are then overcrowding the ED and using up gurneys and staff attention.

We don't have EMTs or Medics either; our CNA/PCTs do work, but there just aren't enough of them. Often, when a 1:1 suicidal patient comes in, the district CNA is then tied up sitting with that one patient and the nurses will be left to fend for themselves.

All that said and done, the problem I see more than anything else is ED throughput. I'm of the opinion that no matter how bad it gets, if there are beds to admit patients upstairs, then it is manageable. Once the beds upstairs are no longer available, then it always becomes difficult. I've been saying this for years, but ED's need to have a flexible holding area that can accommodate these occasional ED admit overflows. They can go to an on-call system to get the nurses, but of course, that costs money.

[emtb2rn, BSN, RN, EMT-B]

We have 4 areas with different ratios, which are normally staffed as:

Emergent - 4:1, occasionally a hallway (hallway pts in emergent are "light" pts), rarely 2 hallways.

Urgent - 3:1, ahh but this where the hallway pts go, so 5:1 common, 8:1 is max, very rare.

Fast Track - depending on staffing, 5:1-8:1. Can go 10:1 if the rn can handle it. Some can, some can't.

Psych - 8:1 max

We have 1 tech in each area. The urgent area usually has 2 techs from 3-11 and the triage tech can help out elsewhere if needed. We also usually have a float RN 11-11.

[jenfromjersey]

I would LOVE, LOVE, LOVE to have a 3:1 ratio with techs who have the same? and medics or EMTs? Seriously? We start out the shift with a section that has 5:1 ratio. We start the morning with 5 nurses. so that's a max of 25 patients which includes a mix of physical rooms and hallways. This doesn't include our fast track which opens at 9am and has capacity for 6 stretchers, 2 recliners and 6 chairs. It is staffed with 1 nurse until 1pm when a second nurse comes in. At 11am 2 nurses comes in to do additional hallways and provide a second triage nurse.

We have techs..normally if we are staffed properly, we have 3 for the whole shebang. They need to stock all of the rooms and assist with vitals, lab draws, EKGs etc. As another posted stated, if a 1:1 suicidal patient arrives, they pull one of the 3 off the floor to sit with them and we are down to 2. No medics or EMTs in the ER. I've gone up to 6 acute patients in my present job, but honestly have worked in other ER's where I had up to 8. Again, as previous posters stated, depends upon the acuity and the charge person. If they really understand what is going on in your section, you get a break, but if they "pull to full" and have no clue, then your rooms fill up and you're screwed.

If I were you, I would be thrilled to have gotten away with such great staffing numbers for so long. Even with your increase in ratio, you are still better off with your support staff than most of us I believe.