Nurse Patient Ratio in Emergency Department

[wheatbread, RN]

Hi, any nurses here from California that are working in ED. How's the nurse patient ratio?

[delrionurse]

Worked ER in a southern state, terrible. 1:6. Intubated, STEMI's, strokes, ROSC/CPR's, septic shock, SVT's. With no tech, doing the full work up, doing your own triage. No nurse available to help because they're drowning in their own assignment. I heard Cali is better with staffing and they get breaks!  I'd like to know.

Just an aside, I wonder if the CEO's, CFO's really know what doing a complete work up by yourself with a possible STEMI is really like. 

[Nursemateo, RN, EMT-B]

ED patient ratios here in CA are better overall but definitely ranges depending on where you are in the state and if the hospital is union or not. The average I've seen is 1:4. Some facilities are 1:3, and I've seen up to 1:6 at others. The one thing that is done well is most hospitals have sufficient float/break nurses and plenty of techs to help lighten the load. I traveled for a while in the Midwest before working out here, and my worst experience was flexing up to 1:8 with no techs and no phlebotomy available!

[delrionurse]

Nursemateo said:

The one thing that is done well is most hospitals have sufficient float/break nurses and plenty of techs to help lighten the load.

I've read about this when searching for a job in California. I guess if the law requires it then the organization has to comply. In my current state, there is no such thing as a break nurse. Never.  Breaks are unheard of. My take on this is all southern states are like this. Cali also have a pay transparency law. They have to tell you how much the nurse makes on their website or on the job description. 

 

[RickyRescueRN, BSN, RN]

Title 22 in Californias Labor code requires that ERs are staffed 1RN : 4 patients maximum and the ratio is dependent on acuity so if a patient is critically ill then its usually 1 RN to 1 patient or 1 RN to 2 patients at maximum. Trauma patients are automatically 1:1 in the initial phase/ reception phase . These ratios are legislated and were won for us by the California Nurses Association Union. Recently Oregon joined California in legislating Nurse to patient ratios. Also , in California labor law requires that a nurse or most other hourly workers for that matter are offered a 15min paid break within the 1st 4 hours of the shift, followed by a mandatory 30min unpaid meal break before the end of the 5th hour of work . If it is not offered before the end of the 5th hour of work the nurse is entitled legally to 1 hour late meal break penalty equivalent to 1hr of base pay. Additional 15minute paid breaks are offered  in the afternoon (10 hour workers , usually at 2pm ) 12 hour workers usually at 2pm and another at 4pm . If required to be on call after a 12hour shift the nurse must be offered an additional 15minute break before the end of the 12 hour of work. 

Hope this helps.

[FiremedicMike, RN, EMT-P]

1:4 here, we also always have at least one "resource" (float) nurse who backs up the entire department.

 

[delrionurse]

FiremedicMike said:

1:4 here, we also always have at least one "resource" (float) nurse who backs up the entire department.

 

Maybe nurses would stay if department were like that. 

[FiremedicMike, RN, EMT-P]

delrionurse said:

Maybe nurses would stay if department were like that. 

We have our issues like everywhere else, but at least our staffing model is solid