Nurse/Patient ratio in the ED?

emtb2rn, BSN, RN, EMT-B · Jun 28, 2012

It depends. If you're in fast track, 7-8 pts is fine. However, in the big show, that many pts as a normal everyday load is dangerous.

Outside fast track we staff at 4:1. Depending on the budget & census loads (i.e. Flu season) we may get extra staff 11-11 which lowers the ratio to 3:1. Although when we get slammed all bets are off.

Crux1024 · Jun 28, 2012

Exactly what was said above. 4:1 is the max on our main side and the fast care side is however many are there:1 (there are 1 to 2 nurses on that side and its kind of a free for all).

But, as EMT said....when its really slammed, that all goes out the window. Hall beds are conjured out of nowhere and people can have more pts, but thats rare (for us anyways).

sserrn, BSN · Jun 28, 2012

In my ER, 4:1 Max no matter what.

brainkandy87 · Jun 28, 2012

We have a 4:1 ratio. However, I've had 8 at one time before when we were short. I had a float nurse from another floor helping me give meds and do tasks, but I still had to chart everything, and honestly, I don't like non-ED personnel taking care of my patients. I voiced my opinion about it that night and, voila, that same float nurse I had ended up getting fired for bolusing someone with dopamine later that night after I'd left.

I can safely handle six patients as long as I don't have someone circling the drain, but how often do we have six patients in the ED and not have one that's critical?

emtb2rn, BSN, RN, EMT-B · Jun 28, 2012

In my ER, 4:1 Max no matter what.

How's that work? What happens when everyone 's at 4:1 & a couple of als buses pull up?

sserrn, BSN · Jun 28, 2012

at that point, a less critical pt would be put in the hallway if another open room was not available, and they would hang out there until another nurse's 4th pt. got discharged and then move to that room. Usually doesn't take that long to find another room with 35 beds. However, our regular staffing in Major is only 3:1, so that's an additional fallback mechanism to increase the Major nurse's WKL to 4:1 if necessary. Very rarely happens, tho, even with seeing 170-200 pts a day.

sapphire18 · Jun 28, 2012

Where I work it's 2:8/9, as in two nurses in a pod of 8 rooms and they work together whether they split up the rooms or share the rooms and just divvy up tasks (I like this way). Each pod has a hallway bed which is only used if necessary (which is often), making the workload 9 patients for 2 nurses.

NO50FRANNY · Jun 29, 2012

Walking wounded = up to 20

Acute = 4:1

Resus = All in brawl, 5 nurses for two trauma rooms and 7 resus bays, extras pulled from non-emergent areas if the you know what hits the fan.

VICEDRN, BSN, RN · Jun 30, 2012

8:1 in urgent care area

5:1 in moderate acuity area

4:1 in higher acuity areas with a floater shared between nurses.

had a job with 6-7 per nurse. it was awful.

sauconyrunner · Jun 30, 2012

We are 4:1 except for the fast track patients which is something like 6-10:1 nurse with her own Paramedic.

We are a non-trauma facility. Of course the occasional drop off trauma occurs.

If a couple of ALS buses pull up, we usually have had enough communication with them to move some people around to get our big rooms ready. We also work really well with the needed services, so that any emergent type pregnancy thing can usually offload in L&D, or with a proper EKG we can have the EMS guys deliver the STEMI directly to the Cath lab. No stopping.

buRNer · Jun 30, 2012

Acute areas "aim" for 5:1 but usually it's 6-7:1... Urgent care is a free-for-all.