Is your charge & triage RN included in nurse/patient ratio grid?

Specialties Emergency


Our charge and triage nurse is counted in the nurse/patient ratio. Ours is 1 nurse/4 patients. We have approx 40 beds and see approx 100 per day plus.

Most nights 0300-0700 and 0700-0900 our charge has to take a zone due to lack of staff/increase patients/increase acuity.

Many times we use a NA to watch triage during those times for a nurse can give pt care and calls for RN when patient arrives!

All of charge nurses are basically burned out!

Press Ganey scores are low...mostly due to increase wait times in triage and for MD to eval or f/u on busy nights.

We are asking for charge and triage nurses not to be counted because they are not giving patient care in a zone, but they are being counted in the nurse/patient ratio.

We have 3 zones with 4 telemetry bed, 2 zones with 5 minor medical and 1 MH bed and fast track with 14 beds. Only our fast track gets 2 nurse/emt assigned.

I'm preparing to write up suggestions and need back up of how other ER's are staffed. Any advice or suggestions will be much appreciated.



our charge nurse takes a full load and is counted in the ratios. we don't have a triage nurse per se. when you walk through our ED doors, you walk into the main hub of the ER, not a waiting area. each patient is met at the door by a nurse and semi triaged right there on the spot. the patient is then directed to the appropriate area of the ED and a further triage is done in the room.

in your case, it doesn't seem "fair" that 2 nurses are being counted into patient ratios if they aren't giving care. but whoever said life was fair? :chuckle especially in the eyes of the powers that be.


2,099 Posts

Specializes in Corrections, Psych, Med-Surg.

"We are asking for charge and triage nurses not to be counted because they are not giving patient care in a zone, but they are being counted in the nurse/patient ratio."

Well, if you figure that these people are being counted in order to please nurses who are doing the direct patient care, then by "asking" you will likely get what you want.

If, on the other hand, you figure this is the case because the facility does not want to hire adequate staff and still wants to appear to be following prescribed guidelines, then your "asking" will have no effect at all.

Anyone willing to bet which is the actual case?


80 Posts

Thanks for your replies. When we speak to upper management about what can be done to decrease the burn out/stressed out nurses and staff they appear to be truly concerned.

The nurse director of ER explains the nurse/pt ratio as one nurse caring for 4 patients. I told her to me it is common sense that the charge and triage nurses are not giving patient care to 4 patients...except when the charge nurse is force to take a zone! She agreed with me during our conversation, but still asked, "Karen tell me what we can do to make changes?" she also said there are studies being done on nationwide ER's about the charge/triage nurses counting in the patient care grid ratio.

I just want to have any information I can find to help make a change.

"We will get exactly as much crap as we will take." This is so true and I'm tired of taking the crap!!! Thanks sjoe! May I use your comment?

Rena RN how many beds in your ER??

renerian, BSN, RN

5,693 Posts

Specializes in MS Home Health.

When we were short we did not have a charge nurse we just did our own thing for our patients. Worked fine. I think it stinks to make a charge person take a full load.


we have 20 actual rooms. we have 5 slotted hallway "rooms" and use our conference room for some psych type stuff. we have the ability to split our 2 trauma rooms to take 4 patients instead of 2.

renerian, we often assume charge nurse duties if the ER is rockin' and charge doesn't have time to call the floors for bed, etc. especially if he/she has a load of patients.

i am clueless when it comes to how ratios are figured. i'm a new nurse. but i'm certain that we never have the staffing to cover a 1:4 nurse/patient ratio.


80 Posts


Please tell me more about your ER. How many beds,rooms/zones, how many patients does one nurse usually care for?

Our charge is called CTF, meaning charge to float. The other nurses depend on charge to assist in codes, get the IV on hard sticks, help them in anyway to keep pt care flowing.

This is the first ER that I've worked in. I've been there 3 1/2 years. I don't know how other ER's operate, but I now that this one could be much better.


I'm also clueless when it comes to how they staff ratio's/grids, but I'm now on a mission to learn and to improve my ER before I'm totally burn out. I love ER nursing, but something has to change.

Sarah, RNBScN

477 Posts

Our ER has the following:

3 beds trauma ( 1 RN on days or nights)

6 Obs/Ex

1 Gyne


2 Hold beds

(Areas above is staffed with 2 RN's on days 1 starts 07 - 19 and the other starts at 10 - 19 BUT are pulled for breaks and such, on nights it is 1 RN)

4 # beds

3 Minor beds

1 consult room

1 family room - no bed just couch for pts. to see crisis worker, etc.

3 chairs in ambulatory

(These areas above are covered by 1 RN on days).

1 charge nurse

1 triage nurse

Dayshift staffing is:

5 RN's

Nightshift staffing is:

3 RN's

Very unsafe...we can't get staff because the hospital won't hire...only hire casuals for a bandaid solution.

Hope this helps.

ernurse728, LPN

130 Posts

We have a 25 bed main ER plus 2 trauma rooms, a seperate psych area that can take max of 3 pt's, 12 fast track beds, and we usually have up to 4 pt's in the hallway at any given time. We see about 260 pt's per day and we a nurse to triage out front and a charge nurse. We also have a nurse to triage ambulances but they pt's as well. Our ration is 1nurse/4pt's. Hope this helps. The charge nurse and triage nurse do not take teams of their own. There is no way that would ever work.


15 Posts

We have 24 beds in our emergency department. OUr charge use does not usually take more than 2 patients during the day and sometimes none. The charge person does take a full load between 7p and 7a because our staffing decreases. We have a nurse stationed in triage between 7a and 11p. The triage nurse is not counted in nurse to patient ratio, but the charge nurse is.


80 Posts

Thanks everyone for your responses! I can see staffing is terrible in ER's all over. This will help give me information to help fight the staffing battle and to stop counting our triage and charge RN's in the ratio for actual pt care.

I need all the information that I can gather to present the best battle that I can give them!

Thanks again,



16 Posts

Our ER is 20 beds and we staff 1/4. our charge doesn't take patients until 2300. Charge helps with pt flow, finding beds, handling family situations, codes, and helping "take over" if somesone starts "drowning" Our triage nurse leaves at 2300, but it's really not a problem most nights because we have a 1500-0300 nurse on duty. and by 0200 it is usually pretty quiet. Our Fast Track is a whole separate area with 1 RN to a max of 8 patients. Works well for us.

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