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Nurse Patient Ratios in the ED?

Hello all,

I am in the process of designing a system under which ED nurses will be responsible for a specific number of patients at any given moment.

I know it may sound like a pipe dream to anyone who has worked in an ED, but, the system I have in miind is based on acuity, and not just numbers.

I know that we are all capable of a lively discussion around this topic, and I look forward to your responses!



traumaRUs, MSN, APRN, CNS

Specializes in Nephrology, Cardiology, ER, ICU.

The ENA recommendation is 1:4. However, you can't always judge acuity right off the bat because pts can go downhill quickly.

In the ER where I work, we have 13 beds. Three of which are designated as urgent care beds. We run U/C from 11/11p with a MD and one RN. During our busiest times which is 11/11p we divide up the rooms so that there are 3 rooms per nurse....Now we have worked codes in every room there, some are so tiny you cant whip a cat in them but if its empty and you get a critical ambulance pt in it goes in the empty room so acuity can change at any given moment. On most days when we are fully staffed we have a total of 4 Rns three with rooms and one float that goes between U/C and the ER to assist with and help where ever needed and a triage RN too.....There are times and pts where you need all 4 RNs there to help out for a given amount of time....But then another problem has arose in the face of short staffing in the ICU we are now holding pts in the ER for up too 28 hrs d/t either no beds or short staffed....so on top of taking care of what comes through the door you also have ICU pts to take care of as well......

in our emerg dept

critical care- 4-6 pt's (we are pushing for 3-4 max)

decision making and admitted waiting for beds- 5 pts

Trauma: 2-3 pts

Resucitation- 2-3

Ped's Resus/special procedure/2 isolation rooms- 4 pts

Sub Acute- 3-9 pts

Fast Track anywhere from 1-10

Our staffing ratio is really bad at the ed that I work in and seems to be getting worse.

we have a 15 bed ED, staffed with 3 nurses, one doc.

Per "state" one of the 3 nurses is a "triage" nurse which leaves our staffing ratio 7to1. Most of the other hospitals in our sector are always on divert which leaves us so open to ambulances I can't even describe it. Last week we had 3 working codes come in by ambulance within 5 minutes of each other. staffing as above. Our administration still doesn't see the need for additional nursing staff for our ED. Our ICU staffing is 3to1, our tele staffing is 5 to 1 and our med surg staffing is the same as the ED 7 to 1.

I know that alot of the nurses are looking elsewhere. Talk about BURNOUT.!!

Recently had two travelers quit their assignments because they were told our staffing ratio in the ED was 4 to 1.....What a joke. :rotfl: Would love to find a way to make our administration wake up and realize that there is more to the ED than money

I work for a "for profit" hospital in Mesa, AZ

mommatrauma, RN

Specializes in ER.

48 bed ED..3 trauma beds and 6 fast track...for the MOST part...we have a 4:1 to 5:1 ratio...Trauma is 3:1 This is not set in stone and we work well on a very acuity based system...We have a supportive staff 90% of the time that will pick up an extra patient when another nurse has sicker people...Trauma is same way...we 98% have dedicated trauma nurse...our trauma-2 nurse has only 3 pts in the main ED, usually not too sick so that she can be easily freed up in the event of a 2nd or 3rd major trauma...if she gets pulled into trauma, the rest of the staff usually absorb her patients to free her up for trauma...We are a busy ED seeing approx 65,000-67,000/year...We have a fair amount of trauma, mostly penetrating...so we often are shipping our traumas right to the OR...which makes for faster flow to free up our trauma nurse to go to the full body CT Scan of our drunk that drove himself into the tree...

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