How do you manage staffing in the ER?


I'm in med-surg right now, thinking about ER. Don't like the mind-numbing routine, paperwork, and "customer service" nonsense of med-surg. But I do like it when we have a rapid response or a code, and I liked learning ACLS. So I figure I'll give ER a shot in the near future.

I'm curious, though: How do you mange staffing? On the floor you go by your present census plus however many potential admissions are on the books.


79 Posts

Specializes in ED. Has 3 years experience.

The number of nurses we have on a day to day basis is fixed, despite the number of patients we have in the department. From 1a-9a we have 4 nurses, and then another comes on at 0900. At 1000 we get another nurse for the main ED, and we also have a fast track nurse come in. We stay with this number until 2200 when we lose a nurse and then another nurse leaves at 0100.

It's all about different patient trends in the department. While no two days are EVER the same, there are generally overall trends in the number of patients an ED will have at a given time and this is what is used to determine how many nurses are needed. Please forgive me if my post is difficult to was one of those days where I could have used about 5 more nurses...BUSY...and I'm exhausted! Good night! Hope this answers your question!

Specializes in ED, ICU, MS/MT, PCU, CM, House Sup, Frontline mgr. Has 15 years experience.

op: ers have varying shifts that start and end throughout the day and night. they trend/staff the shifts based upon census stats. some days/nights of the week and some time of the days/nights of the shift are busier then others. eds that staff correctly will have an er that is fully staffed to care for the needs of the patients within that community. however, sometimes people call in sick and one shift at a particular time of the day or night there are too many nurses on the floor. on such occasions nurses willing to pick up extra shifts are called in to cover the shift that is short or nurses can be asked to arrive later in the day or night or are sent home early if census is too low.


1,850 Posts

I agree with both of the above. Fixed staffing is one of the things that I like about the ED, and is why I never get staffed like nurses on the floor do when the patient census drops.

Editorial Team / Moderator

Lunah, MSN, RN

33 Articles; 13,748 Posts

Specializes in EMS, ED, Trauma, CNE, CEN, CPEN, TCRN. Has 15 years experience.

I am a critic of flex staffing in an ER! But we have to do it, for the budget. I am fond of saying that organizations need to commit to a certain level of ED staffing, and just suck it up. It's about patient safety. Invariably whenever someone gets "flexed" out, the floodgates open with sick-sick people. Once we flex someone out, we don't call them back in, either. Ugh.


1,361 Posts

Specializes in ICU, ER, EP,. Has 17 years experience.

If you're looking for a ratio.. we take 4 patients... only one trauma or code room per nurse with three other rooms. They very well may end up all ICU patients, or they'll all be minor and you have the proverbial revolving door.