what is your nurse to patient ratio?

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In our ED we generally have a 4 to 1 ratio (sometimes 5-1) We have few techs or CNA's.

How do you handle your four patients when one is has a hgb of 6 and is agitated and trying to get out of bed, one is in SVT, one has a blood sugar of 40 and the mother of the 14 year old pregnant girl is demanding more pain medication because she is nauseated.

Seriously, what do you do in this situation?

:uhoh3:

We just recently switched to 3:1 with a potential hallway patient. And most times we have our own tech. The attrition rate in our ER was so overwhelming d/t the previous ratios of 6 or 7:1, that management finally saw the light. I believe that honest and staight-forward exit interviews from the nurses that quit were the key to makeing work something to look forward to.

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Specializes in ICU, CCU, Trauma, neuro, Geriatrics.

The hospital where I work has been full lately so the ER has to keep patients for a longer time. The ER staff is getting a bit difficult to talk to, guess they are stressed. I have received two patients in the last week without a report as the nurse didn't have time. Well that is not a good thing as family wants to know stuff and I dont have a clue so now I have this patient for the next 3 days and I am an idiot in their minds.

I am seeing that the ER nurses need more staffing and better support staff, I am not bad mouthing the ER nurses. I have received many patients from them recently that had to wait 24 hours or more for a bed on a unit. ER is a short term unit and that is what the nurses expect, it is not a 23 hour observation unit, it is not a short term telemetry unit, it is not a place to get a bath or regular meals. But that is what the ERs have become. Do you have a social worker to deal with issues, probably not outside of rape or abuse. After the first 4 to 6 hours after being seen a patient should be admitted to a unit or discharged.

Guess I am just understanding your frustration.

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I work nights in a busy ED in Washington, DC....my personal limit is 6 patients (which I frequently have), but I have taken up to 7 at a time once....yeah, transfusing 3 GI bleeds at once is no fun. I would LOVE to only have to worry about 4 patients.

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Specializes in er, icu, geriatrics.

4 patients per 1 nurse would sure be nice. In our er, which is small, we have 9 beds. However from 11:00pm to 7:00am when there is only 1 nurse, 9 beds can be alot. We don't even have a charge nurse. The positive side is that the ambulance service is based out of our emergency room, so we generally have 1 emt-p and 1 emt-b to assist.

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4:1?!!! I am in a travel position right now in NYC where a GOOD day is 11:1. On MOnday the nurses were up to around 17:1. Acuity isnt even considered. I obviously will NOT be returning to this hospital after my contract is up. I would LOVE to have a 4:1 ratio!

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The techs where i work now dont do much of anything. I dont even know why they are there. In another hospital I worked in, the techs drew blood, did EKGS, transport, assisted the doc with sutures and ortho. It depends on the hospital I guess.

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Our ER as been extremely busy lately. I don't know how you Veterans do it. Or how I can do it until I retire.....lol.

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What do the techs in the ED do? Are they CNA's? What's their job/responsiblities? Just wondering becuase there is an opening in Emergency where I am for a person with CNA training so the job description goes.

Our techs get discharge vitals, call patients back to rooms, put them in gowns, put them on monitors, get EKGs, O2 if needed, Caths, splints, cart set ups (suture cart, gyn cart, ENT cart), draw blood, transport patients to the floor, and helps stock in their "downtime"! :lol2:

But we truly do have an exceptional ER tech. She is eager and always ready for what you need her to do. she is the only tech on duty 11a-11p for 16 beds plus 5 hall beds. . . . .we couldn't do it w/o her!

I have been wondering if our ratios were "safe" lately. We only have 3 nurses from 3a-7a for 16 beds. One nurse is in triage, so really that leaves 2 nurses for 16 beds. We are a small, rural hospital and we can't pull from any other floors because we only have 1 med-surg floor and a 4-bed ICU. So, potentially 8:1. Are there "standards".

I am thanking God that I don't work in a place that gives me 11:1. It's not humanly possible!

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Specializes in ER.

Where is that hospital that has that crazy ratio 11:1, 17:1.

I'm a traveler and I don't want to be any part of that:chair:.

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We just went to "TEAM NURSING" last night. Grady is a large, inner city hospital, Level I trauma center, that has had wall to wall hall beds, up to 70 waiting to be seen, and constantly understaffed hell of a place to work but can be highly interesting and always a challenge place to be. The new concept of Team Nursing here seems to be handle more with less, and y'all deal with it. If you complain, as one of our nurses did, you are seen as "not a team player, who won't give it a chance". I happened to overhear the charge nurses talking about her. She had a point. They divided up the areas into major zones , and assigned twoor three nurses to each, with a tech. These zones have many beds with various acuity. The techs that we have are not used to being a real part of the team and don't function well as such. Ask them to do something and you are likely to be told, I am busy, and they walk off. Many of us are really not happy with this new concept......which seems to be more work with less nurses, no real accountablility as no one is assigned to a set number of rooms. Granted there are many nights where we have had to take 7 or 8 patients (rooms and halls) simply because there were too many call outs. We do what we have to do with what we have. And we understand that. And our managers understand and they don't ride us or nitpick us to death like some other places. But what they are doing now is assigning nurses to big blocks of patients and one is a team leader and you are all accountable for all the patients in your zone. It didn't work. It doesn't work. One of my favorite nurses to work with (always upbeat, still smiling at the end of the shift) walked out so frustrated, I am concerned she may not come back. I don't want to go back either. She told me there is a lot of info on the net about team nursing and how it doesn't work. Not that teamwork doesn't work but the concept that management has about teamwork. I have done a search this morning and have found very little real information. She told me about this site too, so I am looking, and asking. I did a search here and didn't find anything related to it. So I am asking you. Have any of you worked the Team Nursing and how did it work in your emergency department? And how can we make it work for us? I have worked here for many years and the one thing I know is that things always change, but not always for the better. We are poor, cannot compete with the other, better paid places, but we do have a wonderful group that tries hard to care for those in our charge, we have a wide nationality and we do make do with what we have, but this change is making us unhappy and we are in need of much encouragement. If you know a better way, please, help us.

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4 to 1 ratio? 2 techs per Nurse? Where are you guys at? I am new in the ER, been a medic for 12 years, but that isn't helping me right now. I feel like I forget everything when I walk in the door. I get so stressed out...I literally hate it. Our ratio can be 7:1. Front is 7 to 1. Middle is 4 to 1, those are trauma and the back 7 to 1. Very little extra help. I made the wrong career change!

Anyone have words of encouragement?

You didn't make the wrong career move, you might be at the wrong hospital though. That doesn't sound safe and I would be looking around to get the heck out OR invite one of the heel clackers down to spend a day in your ER and observe ;)

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We just went to "TEAM NURSING" last night. Grady is a large, inner city hospital, Level I trauma center, that has had wall to wall hall beds, up to 70 waiting to be seen, and constantly understaffed hell of a place to work but can be highly interesting and always a challenge place to be. The new concept of Team Nursing here seems to be handle more with less, and y'all deal with it. If you complain, as one of our nurses did, you are seen as "not a team player, who won't give it a chance". I happened to overhear the charge nurses talking about her. She had a point. They divided up the areas into major zones , and assigned twoor three nurses to each, with a tech. These zones have many beds with various acuity. The techs that we have are not used to being a real part of the team and don't function well as such. Ask them to do something and you are likely to be told, I am busy, and they walk off. Many of us are really not happy with this new concept......which seems to be more work with less nurses, no real accountablility as no one is assigned to a set number of rooms. Granted there are many nights where we have had to take 7 or 8 patients (rooms and halls) simply because there were too many call outs. We do what we have to do with what we have. And we understand that. And our managers understand and they don't ride us or nitpick us to death like some other places. But what they are doing now is assigning nurses to big blocks of patients and one is a team leader and you are all accountable for all the patients in your zone. It didn't work. It doesn't work. One of my favorite nurses to work with (always upbeat, still smiling at the end of the shift) walked out so frustrated, I am concerned she may not come back. I don't want to go back either. She told me there is a lot of info on the net about team nursing and how it doesn't work. Not that teamwork doesn't work but the concept that management has about teamwork. I have done a search this morning and have found very little real information. She told me about this site too, so I am looking, and asking. I did a search here and didn't find anything related to it. So I am asking you. Have any of you worked the Team Nursing and how did it work in your emergency department? And how can we make it work for us? I have worked here for many years and the one thing I know is that things always change, but not always for the better. We are poor, cannot compete with the other, better paid places, but we do have a wonderful group that tries hard to care for those in our charge, we have a wide nationality and we do make do with what we have, but this change is making us unhappy and we are in need of much encouragement. If you know a better way, please, help us.

I don't have any advice necessarily. I was curious if you guys are held to any of the national "time" standards like antibiotics within X amount of hours for CAP; STEMI (door to balloon time, etc.) ?? With ratios like that and no help, I would be pulling my hair out if management still expected us to be working within those time limits.

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