Nurse To Patient Ratio's in ER

rjflyn, ASN, RN · May 31, 2005

Have you asked for their input. WIth that small of ER i'm sure the staff is pretty close. Your correct saying that thats not alot of pts but what kinds of pts are they? Do you have to hold pts? Can someone ie house supervisor come down and help if needed?

Now personally any more than 3 or 4 pts to one nurse based on the kind of patients I am use to seeing is about right. This allows for the occasions where one nurse might be needed for one on one care for periods of time. The others can cover my patients and I am not getting hit with another before I get the newest one assessed and tx started.

Rj:rolleyes:

I recently took over as the Nurse Director of a 14 bed ED. We have a fairly light patient load with and average of 35-45 patients a day. I know this is redicuously low for this size ED but the ED is new and they actually planned for the future for once. I am seeking a "ideal" staffing ration ( I know I seek the Holy Grail) but the staffing levels we presently have are killing the budget and I feel are out of line with present patient load. We normally staff 3 nurses on 7A, 3 nurses on 7P with a 11A-11P triage nurse. I am thinking of reducing the 7P level to two nurses, two nurses from 7A-11A, and two 11A-11P nurses. I will also add a ED Tech from 11A-11P. Is this still two much staff. I am boucing off you guys before I incur the wrath of my department.

kaycee · Jun 4, 2005

We are a 13 bed ER that see's >60 pts a day. We cover daylight and evenings with 3 nurses, with a fourth coming in from 1p-9p to cover the busiest times. We have a tech and a secretary working 7-3 and 3-11. On nights there are 2 nurses and a secretary. We are starting to see alot more pts on nights so we may add a tech or even another nurse if the numbers keep rising. We have a steady daylight charge(which is me) and a steady 3-11 charge. The shifts vary from 12's to 8's as long as the shifts are covered.(we self schedule). I work 4 10hr shifts to help cover shift change from days to evenings which is usually crazy.

It sounds like you may have a little more staffing that is needed at this time. If your volume grows with the size of your department you may need to increase your staff to where it is now.

pickledpepperRN · Jun 4, 2005

This is what the State Department of Health Services had determined is the MINIMUM for safety. I did a cut and paste to onlu include the Emergency department. They consulted witht e Emergency Nurses Association (ENA). Perhaps they could assist you too.

http://ccr.oal.ca.gov/cgi-bin/om_isapi.dll?clientID=109386&E22=Title%2022&E23=70217&E24=&infobase=ccr&querytemplate=%261.%20Go%20to%20a%20Specific%20Section&record={6295F}&softpage=Browse_Frame_Pg42

70217. Nursing Service Staff.

(a) Hospitals shall provide staffing by licensed nurses, within the scope of their licensure in accordance with the following nurse-to-patient ratios. Licensed nurse means a registered nurse, licensed vocational nurse and, in psychiatric units only, a licensed psychiatric technician. Staffing for care not requiring a licensed nurse is not included within these ratios and shall be determined pursuant to the patient classification system.

No hospital shall assign a licensed nurse to a nursing unit or clinical area unless that hospital determines that the licensed nurse has demonstrated current competence in providing care in that area, and has also received orientation to that hospital's clinical area sufficient to provide competent care to patients in that area. The policies and procedures of the hospital shall contain the hospital's criteria for making this determination.

Licensed nurse-to-patient ratios represent the maximum number of patients that shall be assigned to one licensed nurse at any one time. "Assigned" means the licensed nurse has responsibility for the provision of care to a particular patient within his/her scope of practice. There shall be no averaging of the number of patients and the total number of licensed nurses on the unit during any one shift nor over any period of time. Only licensed nurses providing direct patient care shall be included in the ratios.

Nothing in this section shall prohibit a licensed nurse from assisting with specific tasks within the scope of his or her practice for a patient assigned to another nurse. "Assist" means that licensed nurses may provide patient care beyond their patient assignments if the tasks performed are specific and time-limited

(8) In a hospital providing basic emergency medical services or comprehensive emergency medical services, the licensed nurse-to-patient ratio in an emergency department shall be 1:4 or fewer at all times that patients are receiving treatment. There shall be no fewer than two licensed nurses physically present in the emergency department when a patient is present.

At least one of the licensed nurses shall be a registered nurse assigned to triage patients. The registered nurse assigned to triage patients shall be immediately available at all times to triage patients when they arrive in the emergency department. When there are no patients needing triage, the registered nurse may assist by performing other nursing tasks. The registered nurse assigned to triage patients shall not be counted in the licensed nurse-to-patient ratio.

Hospitals designated by the Local Emergency Medical Services (LEMS) Agency as a "base hospital", as defined in section 1797.58 of the Health and Safety Code, shall have either a licensed physician or a registered nurse on duty to respond to the base radio 24 hours each day. When the duty of base radio responder is assigned to a registered nurse, that registered nurse may assist by performing other nursing tasks when not responding to radio calls, but shall be immediately available to respond to requests for medical direction on the base radio. The registered nurse assigned as base radio responder shall not be counted in the licensed nurse-to-patient ratios.

When licensed nursing staff are attending critical care patients in the emergency department, the licensed nurse-to-patient ratio shall be 1:2 or fewer critical care patients at all times. A patient in the emergency department shall be considered a critical care patient when the patient meets the criteria for admission to a critical care service area within the hospital.

Only registered nurses shall be assigned to critical trauma patients in the emergency department, and a minimum registered nurse-to-critical trauma patient ratio of 1:1 shall be maintained at all times. A critical trauma patient is a patient who has injuries to an anatomic area that : (1) require life saving interventions, or (2) in conjunction with unstable vital signs, pose an immediate threat to life or limb.

(b) In addition to the requirements of subsection (a), the hospital shall implement a patient classification system as defined in Section 70053.2 above for determining nursing care needs of individual patients that reflects the assessment, made by a registered nurse as specified at subsection 70215(a)(1), of patient requirements and provides for shift-by-shift staffing based on those requirements.

The ratios specified in subsection (a) shall constitute the minimum number of registered nurses, licensed vocational nurses, and in the case of psychiatric units, licensed psychiatric technicians, who shall be assigned to direct patient care. Additional staff in excess of these prescribed ratios, including non-licensed staff, shall be assigned in accordance with the hospital's documented patient classification system for determining nursing care requirements, considering factors that include the severity of the illness, the need for specialized equipment and technology, the complexity of clinical judgment needed to design, implement, and evaluate the patient care plan, the ability for self-care, and the licensure of the personnel required for care....

nursejennie76 · Jun 5, 2005

I recently took over as the Nurse Director of a 14 bed ED. We have a fairly light patient load with and average of 35-45 patients a day. I know this is redicuously low for this size ED but the ED is new and they actually planned for the future for once. I am seeking a "ideal" staffing ration ( I know I seek the Holy Grail) but the staffing levels we presently have are killing the budget and I feel are out of line with present patient load. We normally staff 3 nurses on 7A, 3 nurses on 7P with a 11A-11P triage nurse. I am thinking of reducing the 7P level to two nurses, two nurses from 7A-11A, and two 11A-11P nurses. I will also add a ED Tech from 11A-11P. Is this still two much staff. I am boucing off you guys before I incur the wrath of my department.

Where I work there is always a no more then 1 nurse to 4 patients ration. Each nurse is assigned a quad of rooms and those patients that coem into those rooms are hers, of course everyone pitches in if someone gets busy but it seems to work great. Jennifer

blueinplaid · Jun 6, 2005

I am laughing hysterically as I read these posts. We are a 70 plus bed ER. I start my shift decently, with about 4-5 patients, however as the day goes on I can have 10 to 12 patients, some drinking for cat scan, some waiting for the admitting docs to come in to see, all the time the list grows. We have four docs in the afternoon with a nurse assigned to each Dr. As the charge nurse calls patients in, she assigns them to the next doctor on the list. It gets pretty hectic sometimes let me tell you. During winter I thought I was going to go crazy. About half the time we have a nurse that is a "float" who assists those of on teams, but it still isn't enough to be able to provide the patient care I would like. To make matters worse, we've incorporated a computer system that we are all desperately trying to chart on between patient cares....but I digress. We have usually 2 lab techs who start the IV's and draw labs. On ideal days we have three, on bad days none. We also have a monitor tech. We have "admission" nurses who take care of patients while they are waiting to go to their rooms....(admission nurses are us, just not working the desk that day). It sounds all well and good, except that about 5 o'clock admit nurses cant take more than 6 patients and that means they sit on the desk while the new patients keep building up....i'm all vented out now, thank you. :coollook:

luvinursing · Aug 21, 2010

ok, 3 RN days, 3 RN pm, with tech 11-11. hmm, change that to 2 RN days, 2 RN nites, and 2 11-11 rns--so NO techs at all, 2 rns on til 11am, then TWO more come on until 11p. See, it seems like they have it too easy, until they DON'T! that's fine, so long as when spit hits the fan at 9am YOU take the floor and HELP. Killing patients to save a buck is NOT cost productive.

**canoehead, BSN, RN** · Aug 24, 2010

I worked at a 7 bed ER that saw 30-35ppd. I think luvinnursing has a pretty good plan for you. I noticed the state guidelines posted above definitely didn't apply to my state. We had a nurse and a secretary after midnight, and just a nurse if the secretary called out.

With 14 beds you may become the observation unit for the hospital, unofficially, and end up maxing out your staff with patients that could be better cared for on the floor. I would recommend you take one of your larger rooms and make a family waiting area inside, with a TV and sofa, maybe a fridge. During a crisis you could roll a couple stretchers in there pretty fast.