I am not an ER nurse but I do assist ER nurses when they fill out PRF (Professional Responsibility Forms) for such things as workload and safety (pt. & nurse) problems.
Can anyone tell me -
* what is the "normal" nurse to pt. ratio in the ER?
*what are the "acceptable" times for the EHS (Emergency Health Services, aka: ambulances) to wait for triage?
* "who" is assigned to these ambulance pts. for care/responsibility?
I sincerely appreciate any help you can offer. Some of the problems we are experiencing in our hospital are - MAJOR gridlock, a nurse in the "back" may have up to 20 pts. and of course...as is everywhere...pt.'s are very acute (some ICU status, vents, etc.), ambulance attendants are supposed to monitor v/s and report to nurses but, on at least one occassion...a "problem"got overlooked, NO NURSE is "assigned" to these ambulance pts., we have had 6 - 7 ambulances waiting up to 8 hours to triage...meaning...the one day, there was no ambulance available to the community at large for the hours of 1100 hours to 1500 hours.
1 charge nurse ( no assignment but floats to help out)
1 triage nurse w/ a tech
1 RN for a -4-6 pt ratio- this can be dreadful-depending upon acuity- our equipment is portable so types of pt's can end up anywhere (we don't have speciality rooms)
Our state average (PA) is supposed to be 5:1. In our ED we have anywhere from 6-8:1 depends on acuity of patient.
Ambulances are allowed to proceed directly to the bed (if we have them open) and if they are all full and pt is stable and ambulatory they drop them off in triage. If the pt is not stable we find a bed and line them up in the hall somewhere. Response time to the bedside by an ER nurse is usually less than 5 minutes, we try to get the EMS crew out the door and back in service.
Our state average (PA) is supposed to be 5:1. In our ED we have anywhere from 6-8:1 depends on acuity of patient.
Ambulances are allowed to proceed directly to the bed (if we have them open) and if they are all full and pt is stable and ambulatory they drop them off in triage. If the pt is not stable we find a bed and line them up in the hall somewhere. Response time to the bedside by an ER nurse is usually less than 5 minutes, we try to get the EMS crew out the door and back in service.
Not sure if we have a state ratio limit (IL) but we are usually staffed for 4:1. Nights they go up to 5:1. Minor care they are 6:1.Assuming, of course, that there are no "holes" in our schedule. Managers do try pretty hard to cover those...
But when we fill our beds, we start lining up the hallways...we even gave them "room numbers"...it just got too confusing! I try VERY hard not to use "hallway" beds unless forced to do so...crushing CP, etc...but the Gods are not always so kind!
We, too, triage squads to the waiting room...just LOVE when people say" I called an ambulance so I could get treated quicker"...Yea...nice try
Our managers and TC and RNs in for meetings, etc do come out to help during those times...but we are only 14 beds in our main ED...we get backed up fast. We do try to get the squads out right away, too...Nurses are at the bedside on arrival...either the primary or the charge nurse
Some days, though, it sure does feel like a juggling act!!!
We close ED beds. If we don't have enough nurses to cover the beds, they're closed until we can get someone in. Period.
The max a nurse takes is 6, and that is under extreme conditions, and only if those 6 are there for something very simple. We put them in the hallways. Normally our ratio is 4:1, except in our minor care unit, where it's 8:1. Peds ED is usually 3:1. Our psych ED is planned to have 6:1.
We saw 90,000 people last year in smaller than 400 bed hospital. I have worked in Baltimore where no one was allowed to go on divert, but everyone was well passed max capacity.
Our hospital tried to build a satellite ED, but was turned down by the state, mainly due to politics.
This has nothing to do with Canadian or American healthcare. It has to do with a shortage of quality nurses and administration's refusal to spend money to expand facilities.
We close ED beds. If we don't have enough nurses to cover the beds, they're closed until we can get someone in. Period.
The max a nurse takes is 6, and that is under extreme conditions, and only if those 6 are there for something very simple. We put them in the hallways. Normally our ratio is 4:1, except in our minor care unit, where it's 8:1. Peds ED is usually 3:1. Our psych ED is planned to have 6:1.
We saw 90,000 people last year in smaller than 400 bed hospital. I have worked in Baltimore where no one was allowed to go on divert, but everyone was well passed max capacity.
Our hospital tried to build a satellite ED, but was turned down by the state, mainly due to politics.
This has nothing to do with Canadian or American healthcare. It has to do with a shortage of quality nurses and administration's refusal to spend money to expand facilities.
Amen my friend, Amen
I would only add to that that at least at our hospital, administration also refuses to take on the physicians. We are a 200-bed community hospital. Our ED has 14 beds in our main ED and 6 in our fast track. We see about 38,000-40,000/year.
The problem is so complex...it's not just a bed issue...
Most of our docs close their offices at 4...
Almost none are open on weekends
No more "sick visits" held
NO pediatrician in our ENTIRE COUNTY who accepts public aid patients
One free clinic in the county...open once a month
Guess where all those patients end up
Attendings that refuse to discharge patients along nationally accepted LOS guidelines
Attendings that inappropriately admit
Attendings that "admit thru the ER" so they do not have to come in to see their patient
Lab that is downsized so much that now we "send out" half our labs to our sister hospital...and wait for results...and delay dispositioning of patients
Psych beds closed due to lack of funding
I could go on forever...And I haven't even mentioned the nationwide Nursing shortage
THAT IS PERCISELY why I am leaving the "beautiful" West coast of Canada..........by the way.....they HAVE the money - just choose to put it in Upper Mgt and Ceo's salary - my, but we truly are "polite" canadians...grrrr!
And I still want to know how you "close beds" in your ED?
You can't exactly send people away...
At our hospital - Peace Arch Hospital in White Rock, B.C., Canada...we cannot "close" beds...they say that we have a "duty to care"...they just keep pouring in the door...irregardless of staffing issues or in-house availability to accomodate them. It's scary. The nurses in our ER say they are in constant stress, worried about their licenses "in case" something goes wrong because of the workload and of course...very worried about their pts. safety/well being.
As I have mentioned before...we tried the "diversion" route but because EVERYONE in the lower mainland is in constant gridlock, pt. override, etc....."diversion" is now a dead issue.
My heart goes out to this nursing staff. I don't think I could take that kind of stress day in and day out...and like one of the nurses said...if something happened to one of her pts. because of such a situation...she'd put her walking papers on the managements desk the same day. What a shame.
And yes...as one nurse put it...they "do" have the $ ... but choose to put it into more management, CEO's etc. :angryfire
From the EMS side, our dispatchers give us 10 minutes to transfer a patient, we can ask for extra time if the ER is busy, which gives us an extra 10 minutes for a total of 20. If after 20 minutes we are still haven't transferred the patient, the EMS supervisor will be headed to the hospital to speak to the Director of Nursing or the on-call equivalent. Generally we never have a problem, but those days do occur. We are a system with 6-8 BLS units, each averaging one patient every 45 minutes...24 hours a day to one of 5 hospitals. That doesn't account for the out of city agencies bringing their patients to the same ERs.
The majority of the time, the ER's are clogged with people who should be at the doctor's office. The PD won't lock up drunk's until they are sober, so those sh*tbirds end up in the ER's as well.
Someday I will be on the receiving end at the ER so I have learned to be "Persistent, but tolerable" when transferring patients.
I work in the second busiest ER in the Birmingham, AL area. I am THE triage nurse. Sundays seem to be the worst day. At times I have 16 in the waiting are that have already been triaged and are my responsibility. I do whatever I can do for them while we wait on a room in the ER. This means the patient often goes to xray before they go to a room. I treat fever, stop bleeding, recheck vitals, EKG etc. If there are no rooms in the ER and an ambulance arrives, I often have to triage those too. As far as who has how many patients... We have 6 trauma beds split between 2 nurses. We have 22 exam rooms, usually the nurse will have 4-5 each. On weekends we have a PA that comes in and does clinic aka fasttrack stuff. She'll have 6-7 patients and one nurse to help her. We have a charge nurse and usually a float nurse, usually have 3 techs working. Sometimes I get lucky and even have a triage tech! By afternoon we'll have 3 docs and a PA on weekends. We also have only one unit clerk. (I don't know how they do it!!) Since we're in a recession, the traffic here seems to have slowed down a little bit. Making some patients nonemergent has helped too.
Specializes in ER, Trauma, ICU/CCU/NICU, EMS, Transport.
I work in the second busiest ER in the Birmingham, AL area. I am THE triage nurse. Sundays seem to be the worst day. At times I have 16 in the waiting are that have already been triaged and are my responsibility. I do whatever I can do for them while we wait on a room in the ER. This means the patient often goes to xray before they go to a room. I treat fever, stop bleeding, recheck vitals, EKG etc. If there are no rooms in the ER and an ambulance arrives, I often have to triage those too. As far as who has how many patients... We have 6 trauma beds split between 2 nurses. We have 22 exam rooms, usually the nurse will have 4-5 each. On weekends we have a PA that comes in and does clinic aka fasttrack stuff. She'll have 6-7 patients and one nurse to help her. We have a charge nurse and usually a float nurse, usually have 3 techs working. Sometimes I get lucky and even have a triage tech! By afternoon we'll have 3 docs and a PA on weekends. We also have only one unit clerk. (I don't know how they do it!!) Since we're in a recession, the traffic here seems to have slowed down a little bit. Making some patients nonemergent has helped too.
Are you at Brookwood?
If so, we're coming in July to do a CEN review class at Brookwood - we're looking forward to it!!!!
needsmore$
237 Posts
1 charge nurse ( no assignment but floats to help out)
1 triage nurse w/ a tech
1 RN for a -4-6 pt ratio- this can be dreadful-depending upon acuity- our equipment is portable so types of pt's can end up anywhere (we don't have speciality rooms)
1 LPN/RN to fast track w/ NP
occasional float RN
Anne