What is the nurse to patient ratio where you work? I work at a busy trauma center and we max out at 10 patients per nurse. At 4-6 patients I feel okay (depending on acuity). But when it reaches upwards of 8-10 it can be overwhelming and sometimes it feels downright unsafe! I am not the only nurse who feels this way.
The scariest part is a good deal of them end up being ICU/Step-down. To me it makes NO SENSE that the ICUs have a strict nurse-patient ratio (1-4 patients per nurse depending on the floor and acuity) meanwhile we can have 10 "mystery" patients because you never really know what's going on until they are fully worked up.
Lately with it being winter we have been getting 20-30 patients per area, with 3-4 nurses per area at night. We have been getting stuck with holds because the floors are full including the ICUS/SDUs. Patients have been in the hallway to the point you can barely walk through and it's a downright fire hazard/capacity issue.
Last night I had 8 patients and I had a cardiac arrest come in. I had some help from the other nurses but I thought to myself , "this is ridiculous!" It's physically impossible to take care of the patients adequately when we have that many. I love my job and I love being busy but I obviously do not like when it starts to feel unsafe. My co-workers have expressed the same concern. They are crazy busy on days too but they usually have better staffing and have a few float nurses helping out with triage/discharges/lining patients etc. But they seem to not give a damn about us on nights and we are always short. I care for my patient's and do my absolute best every shift but I can only be in one place at a time. I leave each morning being absolutely exhausted mentally and physically.
Do you guys have similar issues at your facilities?
Wow those are scary! I'm in a busy level II trauma center with a total of 30 rooms. For the most part, we have a 1:3 ration and sometimes 1:4. We have a fast track area w specific nurses to those rooms so it may be a little more. So our 3 or 4 patients can be anything. We have awesome teamwork where I am and help eachother out a lot. Your staffing levels seem horrendously unsafe.
That is crazy. Max we get is 5:1. And it's a busy level 1 trauma center. I sometimes get behind once I get the 5th pt. I could not imagine 10. I would shoot myself
I work in a 68 bed Level I trauma ED, we have 3-4 rooms depending on the time of day. We have a fairly new ED and our department has done extensive monitoring on the flow times through the ED. It is a fact in our ED that when each nurse has 3 rooms pt's move through the department faster and we cut down waiting times!
That is crazy. Max we get is 5:1. And it's a busy level 1 trauma center. I sometimes get behind once I get the 5th pt. I could not imagine 10. I would shoot myself
Without disclosing too much, I'm in the tri-state area.... not far from NYC.
Wow! That seems very unsafe. I work in a very busy level II trauma ER. We have a 3:1 ratio with the exception of the fast track area that is 5:1. Mistakes still get made and there are still long wait times some days so I can't imagine what it would be like to have 10 patients.
The ED in which I work has a 1:4 ratio. Never more, never less (except the trauma nurse, 1:2); even on short days. We block rooms if we don't have enough nurses.
The ED in which I work has a 1:4 ratio. Never more never less (except the trauma nurse, 1:2); even on short days. We block rooms if we don't have enough nurses.[/quote']
What happens when all staff is at full ratio and medics are inbound with a cpr in progress?
What happens when all staff is at full ratio and medics are inbound with a cpr in progress?
That's not too common but it does indeed happen. We'll normally bump one of the stabilized trauma patients to another room. Even if we're at capacity, there's always someone up for dispo and we can shuffle things as necessary after they've been discharged/gone to the floor. If things get too crazy there's always the option to go on trauma bypass. There are three other hospitals in the area (and I think we're actually the only ones who never take that route). One of the other health systems went on EMS bypass the they day simply for being "too busy". Don't know who was charging over there but I guarantee EMTALA will have something to say if it gets reported.
Staffing levels where I work are a little thrown off because we use the team nursing model. 2 RNs for 7 pts usually with a medic to assist for the main ED and 2 RNs for 11pts sometimes with a medic for the minor care area. usually if we have hall beds the charge nurse cares for them but it depends on the charge nurse, the hall beds are usually non-violent psych pts with a sitter or people about to be discharge or sent up to the floor. during the winter we usually have at least one float nurse to assist with the super sick patients. This is on days tho and night shift usually gets screwed over on staffing level. they hardly ever have a float nurse or medics to help out.
I live in oklahoma and the ed is a level three with a level 2 trauma center a mile down the street. We see a lot of patients that are homeless or that will not be able to pay even though we are a for profit hospital. We have a residency program here so there are always at least 3 residents and two attending doctors, sometimes more. Our staffing levels feel safe unless we have a bunch of ICU holds which is not uncommon in the winter where we may have 8 or 9.
Bed availability has been getting worse lately. I'm stuck watching 3 ICU holds with 4 tele holds which one can argue 1 or 2 of them could be upgraded to a unit hold. Thankfully I'm still on orientation with my preceptor but seriously 7 patients? Yet even tele floor nurses go up to 6 and MICU nurses are 2 to 1? An ED Tech isn't enough help to watch all of that in this day and age. I'm not in a trauma center though.
devulms21
29 Posts
Wow those are scary! I'm in a busy level II trauma center with a total of 30 rooms. For the most part, we have a 1:3 ration and sometimes 1:4. We have a fast track area w specific nurses to those rooms so it may be a little more. So our 3 or 4 patients can be anything. We have awesome teamwork where I am and help eachother out a lot. Your staffing levels seem horrendously unsafe.