patient ratios in the ER

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I am an RN in a 37 bed Emergency Room in the second largest city in Illinois. We have recently been told by management that we are going from a 3:1 patient ratio to a 4:1 plus a hallway patient next month due to the "bad economy". Let me first begin by saying we see from 80,000 to 100,000 patients a year and are currently being staffed with 13 nurses per shift on an ideal day, to a low of 10 nurses on the weekend. We all work 12 hour shifts, 3 days per week. Needless to say, there is poor moral and discontent circulating the floor. We have hired 14 new nurses in the past year to rectify the nursing shortage we previously had and finally have shown a significant decrease in "left without being seen" percentages and an increase in our patient satisfaction scores to an alltime high.

My question is are there any regulations that determine how many patients can be assigned to an emergency room RN and what can be done to change the current mandate by upper management? I have strongly voiced my opinion to management and the changes are non-negotiable. Realistically we cannot refuse the assignment and under current situations most of us will be burned out in the near future. Wondering if anyone else has been through a similar situation and how was it handled?:banghead:

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Specializes in Pediatrics, Med-Surg.

I currently work in a nonprofit facility in NYC. We currently see approximately the same amount of patients that you see at your facility. Our staffing is usually 8 nurses on a good day. Our facility is broken into zones, there are 3 zones, 3 beds in each zone. there is one nurse assigned to each zone. On a busy day the beds are sometimes doubled so at any given time a nurse can have from 7-14 pts. We also work 3 days a week 12 hour shifts. As far as low morale or being burned out. Please thank God that you only have 5 pts max. I wish we could say the same.

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Specializes in ER.

1:4 or 1:5 is pretty much the standard I have seen. I can't imagine having 7-14 patients like the previous poster mentioned. Wow! Talk about unsafe!

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Thanks for the insight and may I never have to work in an ER that I personally am taking care of 7-14 critical patients at one time... :(

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Specializes in Emergency Dept, ICU.

1:4 is pretty much standard these days and the recommended staffing from the ENA. In california 1:4 is law I believe.

I have seen it as a 1:7 or 1:10 in a fast track (minor setting). I still think that is too high though.

You guys will be able to handle 1:4 + hall in what you are describing, but I'm sure moral will be low.

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Specializes in ER, Trauma, ICU/CCU/NICU, EMS, Transport.

We're discussing this on another thread also, you may want to check it under:

Specialty/Nursing Specialties/Emergency Nursing/Nurse-to-patient-ratio

Hope this helps.

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Specializes in ED.

Aside from CA, I don't think there are any states that have a limit on nurse to patient ratios. When I started I would have eight, nine, sometimes even ten patients. I might have a regular section with 8 pts and then one or two more pysch patients or drunks in the hall. New management has done of good job of reducing our ratios. I now typically have 6 non-fast track patients.

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Specializes in ED, ICU, PACU.
I currently work in a nonprofit facility in NYC. We currently see approximately the same amount of patients that you see at your facility. Our staffing is usually 8 nurses on a good day. Our facility is broken into zones, there are 3 zones, 3 beds in each zone. there is one nurse assigned to each zone. On a busy day the beds are sometimes doubled so at any given time a nurse can have from 7-14 pts. We also work 3 days a week 12 hour shifts. As far as low morale or being burned out. Please thank God that you only have 5 pts max. I wish we could say the same.

Yep. Have had those ratios in NYC and LI ERs-seems pretty standard for there. Best I had was 1:6; but, that was right after orientation and quickly went to 1:8. Got burnt out, moved away and had to switch specialties a while because of the burn out. 1:4 plus a hall bed would seem like a vacation.

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Specializes in Emergency, ICU, CCU, Ortho.

I work in an inner-city hosptial in Buffalo, 35,000 patients a year, average about 100 a day. We have a ratio of 1:5. Hall beds are the responsibility of the CN. Our hall use in total minutes went from 16% to 0.6% in two years once the CN's took them. We also opened a PRN express section staffed by a PA and nurse when warrented. In our busy season (jan-feb-mar) we often feel completely overwhelmed.

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Specializes in ED, ICU, PSYCH, PP, CEN.

Have worked in ERs where I had up to 14 pts at a time. The ENA recommends 4.

Unfortunately I am afraid that more is going to be the norm in the future. Things are just going from bad to worse anymore.

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