ER nurse to patient ratio

Specialties Emergency

Published

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?

Specializes in CEN, CPEN, RN-BC.

In my old hospital we were 4:1... we were expanding our ER, adding something to the tune of 10 or so beds. Administration never mentioned anything about our ratios changing and we all assumed there would just be extra nurses assigned to staff the new beds. The day we started using the new rooms was when we found out our acuity shifted from 4:1 to 5:1. :no:

When I worked in a larger, level II county facility, your ratio was dependent on where you were located. In the urgent care pod, 4:1 was the goal, 5:1 was the reality. I remember a short night running 15:1 with 2 techs and an LVN. It worked, but was a stressful 12 hours. The last two places I've worked strive for 4:1 with adjustments based on acuity of patients. I've also had the experience of never being able to rely on techs, so your mileage may vary.

Specializes in Emergency Dept, ICU.

4:1 is the max I think anyone should have in an urgent/emergent section. (PERIOD). I would love to see a 3:1, but come on now let's not get crazy:eek:

I worked in a medium sized ER that I no longer work at because at night it quickly from to 1:4 up to 1:7 after 11pm.

Specializes in Med/Surg, ICU, ER, Peds ER-CPEN.

we are a small 10 bed unit with 2 RN's dayshift and 2 night shift, a triage nurse who works 8a-midnight and we have a unit clerk who helps tech wise, ours is around 5:1 with Triage having up to 4 fast track/RME pts

Specializes in Urology.

I work in a 30-42 bed ER (given if we use hall space and ancillary rooms) that see's about 65,000 pts a year. Our assignments vary on shift. They can be 3:1, 4:1, or 5:1, sometimes you might even have 6 or 7 patients. We are not a trauma center.

Specializes in ED.

We are 6:1 in a trauma center which is way too much. We often hold critical ICU and CCU sections and then have all of our other patients. Completely ridiculous and unsafe. At one time it was not so bad when we had float nurses who helped out, but lately that has not been the case.

Specializes in ER/PICU.

We are doing the same although our medics have been leaving slowly but surely. Staffing has been cut for economic reasons. What hurts is when we are at max patient load with NO back-up, NO "float"RN. Gettint the same from our managers. The er is a "dumping ground" for every MD and clinic in town not to mention the only place many can go to recieve care.

Specializes in Trauma/ED, SANE/FNE, LNC.

4:1 is a dream!! when I worked in a trauma center we would work mods and have 2 RN's for 9 patients because we did a lot of major trauma, then I went to a non trauma center (who received trauma frequently) and our ratio went to 6:1 and up to 8:1.

Specializes in Peds, Tele, ICU, ER, Orthopedics, Psych,.

We are not a trauma center, but do receive occasional minor trauma. We have 16 regular beds, 5 fast track beds (open 11A - 11P), and 1 code/trauma room. We also have 6 hallway stretchers that often get used. If we have a float nurse on (usually 3P - 3A - though they often stop floating at 11 pm and take over the area then charge nurse will have when they leave at 3 AM), they will do the hall beds if they are occupied. So essentially our ratio's are 4:1, or up to 6:1 if no float nurse. By the way, our ER see's about 30 - 35,000 a year. I think you were very lucky to have a 3:1 ratio!!!

Specializes in Er,Icu,Ccu..

I come from an Er that sees 160-200 a day and we have a 3:1 ratio. Occasionally if we are short staffed it may go 4:1. It is a tremendous difference. I am currently doing a Cali assignment in a Er where it is a busy 4:1. Meaning as soon as you have a bed for an admit the triage nurse or charge will put your admitted Pt In hallway and throw a triage Pt in the room. It is basically a clusterfuck all day long chasing our tail. Things are missed and forgotten and Pt care is a joke. Management needs to realize that even the money they save in less nurses, they are losing it because the discharges and getting a patient to a room assignment is delayed big time. I see the difference and in the 3:1 ratio ER we are getting Pts in and out 60 to 80 minutes quicker....Which means more pts seen quicker and more money...on top of a higher satisfaction level from the patients because we actually have time to talk to em and happy nurses...which make good nurses...and for all you nurses that sit and take a 5,6,7 to 1 ratio. That's your own fault, bring it up if they don't listen, quit or move to another unit. One thing in life I have learned is you have to ask for what you want. Things don't get changed if you just accept the ********. Hospitals can't work without nurses and if they lose staff and have to hire expensive travelors and registry maybe they will come to their senses and fix the issue.

and for all you nurses that sit and take a 5,6,7 to 1 ratio. That's your own fault, bring it up if they don't listen, quit or move to another unit.

Easy for you to say! If you have ratio that high in the ED, what makes you think it's any better in another unit??? Besides, I absolutely hate working anywhere but the ED and would never work anywhere else unless I was forced to in order to have a job.

And, it's not like there is a hospital in the area that's any different, and that's assuming that they have an opening and would choose to hire me over another applicant. They are all the same anywhere it's close enough for me to even consider driving. And don't even suggest that I move. Not possible at this point in my life. Sometimes you just have to suck it up and make the best of a bad situation.

Specializes in Emergency.

3:1 is the norm in my ED, with an occasional 4:1 ratio. I consider myself to be good at what I do, but I don't feel that I could sustain a 5:1+ patient load safely if they had high acuity. At one time, we had a "clinical decision unit" where once you got a patient started with IV fluids and labs,if they were stable, they were transferred there to await lab results and get hydrated, etc. Those nurses had a higher ratio, understandably.

Our facility is all about Press Gainey scores and we usually rank in the 90 percentile. Lower ratio translated to higher satisfaction score. This is instance where the surveys have worked to the nurses advantage.

+ Add a Comment