Nurse-Patient Ratios

[NeuroNP]

OK, I know this will set off a firestorm, but I'm hoping for honest feedback. What is the solution to the nurse-patient ratio problem? I've worked as a tech in the ED and on a Telly Unit (floating occasionally to the units), so I've seen both points of view. Obviously, it's a bad idea to have an ICU nurse taking care of more than 2 patients and the other units (telly, step-down, floor) need reasonable ratios as well (I'm not sure what those "reasonable" ratios are). I've seen dangerous situations develop when the ICU nurse (or more typically the telly/floor nurse) has too many patients. However, when I got down to the ED, I realized that those patients just keep coming, especially in a Level I Trauma Center. So, sometimes they can get in the same situation when they have ICU "borders."

So what's the solution? Obviously, the hospital should stop accepting admissions (at least the non-emergency ones) until things can get under control, but then what? Anyone have anything in place at their hospital that works/helps? What do you do when the ER/PACU are full and ambulances are breaking down the door?

Anyone have some kind of "call" staffing where extra nurses could be called in to help decompress? We had a few instances where the ICU would take the patient even though he wasn't "stable" and they'd finish resussitating him up there to free up an ED bed for a fresh trauma, but other than that....

[USA987, MSN, RN, NP]

Staffing is so difficult when in a triage area (ie. ER, L&D, etc.). If someone presents we must assess them to determine their medical status...to turn them away would be a violation of EMTALA.

I work in L&D and are required to take 8 hrs. of call time per pay period. I hate to admit it though, there are times when all of our call people are working and we are still overwhelmed. I guess it's just the "nature of the beast"...........