9:1 ER ratios in NY?

RNFiona · Aug 25, 2013

It's all true. I worked all over NYC for many years. You need to be able to handle volume there. Just remember it's acuity that counts. I am in Cali and yes there is 4:1 ratio but when you get four very sick pts at the exact same time, all untriaged it can be way more challenging than having 10 triaged lower acuity pts. NYC hospitals usually have an ambulance triage nurse and they also tend to alternate when assigning pts,( i.e. if you have 10 nurses you will get every 10th pt). And a lot of the EDs in NYC tend to have pods based on acuity. The higher acuity pods may have a lower ratio etc. I actually prefer that to the way Cali does it.

BARNgirl · Aug 28, 2013

It's all true. I worked all over NYC for many years. You need to be able to handle volume there. Just remember it's acuity that counts. I am in Cali and yes there is 4:1 ratio but when you get four very sick pts at the exact same time all untriaged it can be way more challenging than having 10 triaged lower acuity pts. NYC hospitals usually have an ambulance triage nurse and they also tend to alternate when assigning pts,( i.e. if you have 10 nurses you will get every 10th pt). And a lot of the EDs in NYC tend to have pods based on acuity. The higher acuity pods may have a lower ratio etc. I actually prefer that to the way Cali does it.[/quote']
Thank you, Fiona, for your insightful post!

RNFiona · Aug 28, 2013

anytime

turnforthenurse, MSN, NP · Aug 28, 2013

9:1 sounds crazy. Where I work our ratios are 4:1 which seems to be the standard at most EDs. Yes, there is a difference having 4 critical patients vs. 9 more stable patients, but I have had patients triaged as a level 4 when they really should have been a level 2. Not to mention those patients can sometimes be more of a pain to deal with because they complain about why it is taking so long for the provider to come in, etc. And also depending on your providers, those stable patients may be getting discharged left and right, so it can make for a very busy shift.

RNFiona · Aug 28, 2013

It would never work in a NYC ER... Way too much volume and not enough nurses... Someone has to take care of them

RNFiona · Aug 28, 2013

Again I focus on acuity not volume... Higher acuity pts should have lower ratio

dance4life · Aug 29, 2013

NY has no ratios so you could end up with more.

Patients wait days for a bed too.

aamy · Sep 8, 2013

9:1 is absurd in an ER. IF it was in a fast-track area, that might be acceptable. Are there fast-track areas in these facilities? I would never take a job in an ER with that type of ratio, unless my family was starving. Just my thoughts.

RNFiona · Oct 4, 2013

9:1 is absurd in an ER. IF it was in a fast-track area, that might be acceptable. Are there fast-track areas in these facilities? I would never take a job in an ER with that type of ratio, unless my family was starving. Just my thoughts.

Again....in the better run ERs in NYC, pts are assigned by acuity and you are not slammed all at once. The sicker the pt, the less patients you get. Most NYC ERS do have a fast track . Also...the pts are triaged before you get them. I work in Cali now and in my current facility it is not uncommon to be slammed with 4 untriaged half dead pts at the same time. With no one to help you. So then all your orders come in at once, dispositions come in at once and then you are yelled at to " get rid" of your pts so you can get 4 new half dead pts. In NYC they are spaced out and turnover is slower so you actually have more time to take care of them and get all of your charting done. I never EVER focus on volume, I focus on acuity. And yes, pts can be mistriaged. That's why it is important to not only have a strong triage nurse but to go "eyeball" a new pt right away, no matter what the triage note says.

Guests · Oct 4, 2013

I'm a Cali-nurse in a large urban ED.

We go off at 4:1 for lower acuity patients and 2:1 for ICU players... or 1:1 or 1:2 if they're really that busy.

During lunches and breaks, a dedicated relief nurse takes over the assignment and ratios are maintained.

The stories that I hear from the old timers (pre-ratios) are horrifying.

dance4life · Oct 5, 2013

9:1 is absurd in an ER. IF it was in a fast-track area, that might be acceptable. Are there fast-track areas in these facilities? I would never take a job in an ER with that type of ratio, unless my family was starving. Just my thoughts.

Nah, don't do that. I worked somewhere unsafe and now I have some kind of documentation error with narcotics that is being complained about on on my license. They won't even give my agency details. The board and an attorney says it could take years but, still DON'T DO IT! NOT WORTH the worry that you worked so hard for.

I don't even work ER and I couldn't imagine having such high acuity patients in that number. When I get over 8 in Med Surg I would like to pass out never mind and ER nurse.