8:1 ratio in the ED?

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Specializes in stepdown.

Hi everyone! I just interviewed at an ER in NYC on friday and they unofficially offered me the job! My goal has always been to become an ER nurse and I really want to do it as a new grad. The hospital orientation is 6 months long with a preceptor and 2 weeks of strictly classroom. It is a teaching establishment that is going for magnent status and is in the process of adding onto thier ER.

All of that makes me want to sign up and believe that I can become a great ER nurse. The terrifying thing is that the ratio is 8:1. I believe that they have it split up into critical and non-crital then they have a seperate asthma room, fast track, and ICU transfer....

Am I crazy to consider this? There is something exciting about being apart of the changes and the chaos.... But I don't want to risk my license when I'm just starting! I would think that the residents and attendings would really help out since it is primary nursing. What are some questions that I should ask before accepting the position? Thanks so much.

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Specializes in ICU, ER.

8:1 is ridiculous, even for an experienced ER RN. (My ER is 4:1). Your idea that residents and attendings would help out is probably a fantasy. You really should reconsider.

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Specializes in M/S/Ortho/Bari/ED.

I work as a new grad in a small community non-trauma ER, and we don't even have an 8:1 ratio. Not even for the uncomplicated Fast Track patients. We try to keep it at 4:1, and I still working up to that!

If it were me, I would not be comfortable with that ratio just on the basis that as a new grad it's hard enough learning time management and prioritizing with a smaller number of patients. You could face the possibility of being totally overwhelmed and that is never good for a new grad.

Could you ask to speak to other new grads working there now and ask them what their experience is?

Just a thought...

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Never in a million years would I accept that, even at an urgent care...

Last UC I worked was 14 beds...3 RNs (one triage) 1 LPN, and 2 MAs...

ER should be 3:1, or 4:1 for less acute pts...

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Specializes in ED, ICU, PACU.

An 8:1 ratio is dangerous for the patients and for your license! The Emergency Nurses Association recommends a 4:1 ratio for a reason. You should ask your prospective employer about the turnover at their facility, especially when it comes to new hires. There are many places that will tell you about the ones that have been there 5, 10, 15 years. Those aren't the ones you really want to hear about-they are the batch that won't go anywhere no matter how bad it is because they are vested and want to collect a good pension someday. Also, another thing to find out is if the place uses travelers and agency nurses-not a good sign if they do. Do a walk through and look at the nurses and their attitude, especially on a Monday and Friday afternoon. I will bet they look exhausted and burnt out. Think twice, because all that glitters isn't gold. This comes from someone who is making plans to leave a facility that sounds very much like what you are describing.

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Now you know why they offered a new grad the job.

How good of a nurse can you be with 8 patients, I mean really? Don't play roulette with CEO/management. They're betting that none of your patients will crash. and if you have a patient who does, well, its your license they'll cash in as they will undoubtedly charge you with negligence. They will have already made enough money off their many nights of 8 to 1 recoup their lawsuit loss.

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Specializes in Adult and Pediatric Vascular Access, Paramedic.

I interveiwed as a new grad in two different ERs, one of them had an 8:1 ratio and the other had a 4:1, as you can probably predict I accepted the job for the ER with 4:1 becuase even as a new grad I was wise enough to know that 8:1 was rediculous!

Sweetooth

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Specializes in Emergency Room.

the most i have taken care of at once was 6. and 3 of those patients were just waiting for beds or discharge. and the other patients were very low acuity. i would not take a ED job with a 8:1 ratio. and if i were you i would ask the manager (or who ever interviewed you) why the ration is so high compared to other ED's. i would be curious to know their explanation.

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Specializes in ED, ICU, PACU.
the most i have taken care of at once was 6. and 3 of those patients were just waiting for beds or discharge. and the other patients were very low acuity. i would not take a ED job with a 8:1 ratio. and if i were you i would ask the manager (or who ever interviewed you) why the ration is so high compared to other ED's. i would be curious to know their explanation.

Funny you should ask. I asked the same thing of my manager and the answer was that (back in the old days) the nurses (meaning her and a lot of the older staff) had 10-14 patients with all levels of acuity right after their orientations. That 8 patients is an easy load....good time management skills solve problems if there are any with only 8 patients.....you have plenty of help here if you feel overwhelmed (btw can't get help from most and certainly not from the aides).....if you are a hard worker you will find a way to manage...this is the standard patient load in the area....you aren't confident enough in yourself....most times it no more than 5, only rarely do you see 8-10....we are so short staffed now, things will get better as we get more nurses (no jobs even posted for more nurses)....

Hey, at least she was honest about the patient load. Many aren't that upfront.

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

There is a reason the ENA recommends 4:1 ratio. 8:1 is asking for a horrible catastrophe of which you will be left holding the bag. That is the trash bag that your new license will be thrown in.

If I were a patient and found out that my nurse had 7 other ER patients to take care of I would be raising holy hell.

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Specializes in Peds, ER/Trauma.

I have worked at several ER's as a traveler and as regular staff, and I would NEVER accept a job with a 8:1 ratio. Like others have said, it is simply not safe- you're putting your patients, your license, and your sanity at risk. I would RUN from this hospital and look for something else.

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the 4:1 ratio everyone is talking about is only a law in California ERs. It is a totally different ballgame in NYC ERs. Reading your post and seeing the 8:1 ratio you were told is not a surprise to me, in fact it might even be higher. Sad but true. This however does not make it right or safe by any means. So you have a decision to make. Frankly as a new grad in the ER with that ratio, it would scare me too. If your heart is set on being in the ER, look for a hospital that offers a new grad program in the ER. There's one at New York Presbyterian Hospital - Cornell. The new grads are on orientation for one year, they are never left alone to carry an assignment and split their time between classes, time on the unit and learning how things operate throughout the hospital by shadowing on different units. Look into it.......just my thoughts and opinion.:nuke:

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