Nurse to patient ratio

Editorial Team / Moderator · Mar 21, 2016

Depends on acuity. 1:1 â€” dying/trying to die/super sick, 1:2 â€” sick sick, 1:3 â€” regular sick, 1:4 and beyond â€” not sick/could have stayed home.

Harley's mom · Mar 21, 2016

I have had up to 12-14! And I'm talking on heparin drips , abdominal pain, DT's and more! So unsafe. It was a travel assignment and after that I left the ER for a while feeling defeated.

Editorial Team / Moderator · Mar 21, 2016

I wrote what I feel is safe, not what I always get or have seen. Sometimes my numbers up there are in fantasy land!

Lev, MSN, RN, NP · Mar 22, 2016

I think 1:3 is good ratio for the main ER. My ER's ratio is generally 1:4 in the main ER, can go up to 1:5 depending on staffing. We generally see ESI 1-3 in the main ER except when fast track is closed and there are 4s waiting. If they send 4s back we can get up to 7 total patients.

MedicalPartisan · Mar 24, 2016

In my level 2 trauma center the standard ratio is 4:1, trauma 1:1 (2 trauma rooms assigned to a nurse per shift but it's a team effort so they'd never be left to care for more than one unstable patient at once), procedural sedation 1:1, low acuity / ESI 4 or 5 get's a 6:1 but they also get a dedicated LPN and tech along with the mid-level PA/NP (charting on these patients is cake because we are permitted an 'agree with mid-level assessment' assessment on these patients rather than charting our own), and the behavioral section of the ED gets a 6:1.

Our ED does not have assigned sections for techs or LPNs so they're kind of just pulled anywhere needed. IMO it'd be nice to have them assigned to pods like other health systems in the area but I guess it would be quite perturbing to have one tech sitting around on one side because they're not needed at the moment while another pod tech is running crazy.

Woah... Major digress, sorry about that. I do not think our ratios are 'unsafe'. A 3:1 would be phenomenal (I think this may be the case in some parts of the country that have unions), but everyone always wants more staff and less workload. Yes, it absolutely sucks at times. No, there doesn't seem to be enough time to do XYZ but it's manageable. I think if you're overtired and burntout it'd be easy to make an error, but this is the case for any ratio. More than safety (because I don't think that's an issue here), what I really dislike about the workload and ratio is the fact that my time nursing is spent at the computer ticking each and every checkbox that TJC, DCF, and Medicare wants because if not, we get reimbursement penalties. It's ironic because as time goes on we spend less time with the patient and there is a crucial amount of emphasis placed on satisfaction nowadays but you hardly have the time to REALLY talk to your patient, REALLY educate them, et cetera. There's not many nurses I've talked to that don't feel this way. We work hard and seemingly run around every blasted minute of that 12 hour shift, but the vast majority of the time, I'm at the computer charting. It sucks.

TL;DR: Unsafe per se? No. But it's hard work and there is absolutely potential for error, but this can happen at any ratio. Would I absolutely love 3:1? Sure. But I understand the 'way things are' (relative to reimbursement, FTEs, good benefits versus an easier workload with more staff and not-so-good benefits, et cetera, et cetera). 5:1 would be unsafe. 3:1 would be the sweet spot for the front-liners. 4:1 is the sweet spot from an admin perspective without creating an unacceptable margin for error.

LadyFree28, BSN, LPN, RN · Mar 25, 2016

Our ratio is usually 1:3 or 1:4; sometimes in the bay we can go 1:2, but sometimes we have 1:3 and be assigned to the resus/trauma room; usually one person in the bay is the documenter and will have a 1:3 assignment as well.

For fast track it's 1:7; but on "bring a friend day" I can perpetually have 1:11 for at least half my shift.

Anna Flaxis, BSN, RN · Mar 25, 2016

I am just curious........What do ER nurses feel is a safe nurse to patient ratio?

I don't think that ED nurse staffing should be based on ratios. The ED is a dynamic, ever changing environment and it's just not possible to predict what the census will be on any given day or at any given time. There are predictable patterns, and staffing should be flexed to fit those patterns, but basing ED staffing on set ratios is not very practical.

Why do you ask?

sweetlilwolf · Mar 25, 2016

Level 1 trauma center it was 1:3 except in trauma room then it was 1:2 or 1:1

sweetlilwolf · Mar 25, 2016

Our ratio is usually 1:3 or 1:4; sometimes in the bay we can go 1:2, but sometimes we have 1:3 and be assigned to the resus/trauma room; usually one person in the bay is the documenter and will have a 1:3 assignment as well.
For fast track it's 1:7; but on "bring a friend day" I can perpetually have 1:11 for at least half my shift.

Gotta love 2 for 1 days or family days right! Lol

MedicalPartisan · Mar 25, 2016

Gotta love 2 for 1 days or family days right! Lol

We don't allow patients to be in the same room, regardless of relation, with minors being the exception. Does your facility?

sweetlilwolf · Mar 25, 2016

We don't allow patients to be in the same room, regardless of relation, with minors being the exception. Does your facility?

Depends on the situation husband and wife in MVA one is okay other not so hot we'd let the one sit with the other once we've cleared them they might not be discharged just yet but I wouldn't make a family member wait to see another loved one if said patient isn't doing so hot.

And really this meant hey I'm checking in for xyz so the friend I bring with goes oh we have to wait well I'll check in too for this problem I've had for months....