8:1 ratio in the ED?

Published

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.

Specializes in stepdown.

Thank you all for replying to the post. I have found that it is the norm around NYC as well. Ive spoken with 2 other hospitals and thier ratios are b/t 6:1 - 8:1. I called the recruiter I interviewed with and left a message stating I had time over the weekend to formulate more questions for management. Hopefully she will return my call soon. I will definitely keep everyone updated on what the answers to our questions are.

Thanks again for helping me talk through this big decision.

Up Vote Up Vote ×
Specializes in ER/ medical telemetry.

i am still on orientation as a new rn. our ed has a great tat, esp fast-track the nurse there and 1 doc during season ,will have 6 rooms, and off season 4 rooms.

they move them quick but this is only from 9a-7p. after 7 p the main er will blend them into the ed.

the nurses will take on 4 patients each and if more come in, the charge or hopefully an extra person will triage, assess & treat until a room comes open, to place them in (we try to keep them out of the halls.

i have only and truthfully been able to take on 3 rooms at a time, and have been orienting since the middle of june.

it is very fast paced, and i feel like i'm running. i prioritize, then i assess, treat,and many times my d/c's to the floor get put on hold, this is what they do not like in my ed.

example of very busy day:

i had a patient that had a bed that was ready at 1500 and i could not get up and out until 1900, i was busy with the other 2 rooms that had big time issues and my preceptor was stuck in the other room doing a consious sedation and could not leave her room, my charge was very

busy with issues,and administration had not come down to ask what was happening. after concious sedation was d/c'd then a respiratory distress came into that room #4 my preceptor had, and the whole ed was in there, so i triaged,and ordered all things to be ordered, then all my folks became behind again, and i had more orders up for my existing patients.

i discharged 3 more patients then more came behind again with more complicated issues.

some days it is not as bad, and others are days from hell.

i could never imagine having a 8:1 ratio i can't even keep up with my 4 rooms . now, if i were to double that,

i would have to leave the ed and look else where.

i know i will be on my own soon,and they are slowly letting me go. i am doing 3 on my own,and soon it will be 4, but i tell them i am not ready yet, because i am not safe yet. everyone thinks i'm ready, but i tell them not quite yet. i'm getting there, but i'm not ready to fly on my own yet.

i know that once i'm on my own it is my rear, and mine alone that i will be responsible for.

now, this is with just 3 patients that became involved no code, no real distresses, just ones that needed also to be admitted, and more stabalization. keeping up with 4 is enough...

i cannot even imagine a well seasoned nurse taking on that many (8) it could be dangerous! :nono:

so if your a newbie, find a different ed with a 4:1, it is not worth losing that precious licence!

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.

Up Vote Up Vote ×
Specializes in ER, Outpatient PACU and School Nursing.

we have a ER that is divided into the cardiac and medical side. Yes on the medical side you could have 8 patients on any given day just depends what time you come in and who you are working with. If I come in at 7am I am the only medical nurse until 9am maybe 11am. I have my charge nurse usually helping but its me until relief gets there. On the cardiac side maybe up to 3 since we have two nurses for 6 monitored beds. If I have a critical patient it might be lower. we also have a monitored bed on the medical side that is used for codes and overflow of cardiac patients. anyhow guess its right back to any given day scenerio! best of luck!

Up Vote Up Vote ×

i HAVE WORKED IN 3 DIFFERENT ERS. NEVER HAVE I HEARD OF 8:1 RATIO. THAT IS A HUGE RISK THAT I WOULD NOT EVEN CONSIDER. EVEN IF YOU HAVE A COUPLE OF NONCRITICAL PATIENTS, IT IS DIFFICULT ENOUGH TO MANAGE 4 ROOMS WHEN YOU HAVE GI BLEED, MI, DYSPNEA, AND ONE NONCRITICAL.

Up Vote Up Vote ×
Specializes in ER/ medical telemetry.

amen.

i have worked in 3 different ers. never have i heard of 8:1 ratio. that is a huge risk that i would not even consider. even if you have a couple of noncritical patients, it is difficult enough to manage 4 rooms when you have gi bleed, mi, dyspnea, and one noncritical.
Up Vote Up Vote ×

Don't do it!!!!! 8:1 is insane, not to mention unsafe. At those numbers, you are doing drive by nursing. It is like a drive by shooting, but without bullets. Someone is gonna get hurt or even die.

Up Vote Up Vote ×
Specializes in HEMS 6 years.
Hopefully she will return my call soon. I will definitely keep everyone updated on what the answers to our questions are.

What did she have to say regarding the staffing ?

Why do nurses allow themselves to be shackled to these working conditions ? It must be awful...I can not imagine 8 patietns... because you know you'll be getting at least 3 hallway patietns on top of your 8 when it overflows.

Up Vote Up Vote ×
Specializes in ER.

Absolutely no way in hell.

Up Vote Up Vote ×
Specializes in ER.

I was a new grad and started in the ER. I also was an EMT for 9 yrs prior. It's tough. You have to learn FAST! As for the 8:1...at least you received a ratio. I also work in an ER in NYC and it's crazy. Remember, in an ER it's not just the number of pts but the acuity. One night I had 10 pts, and when I refused the 11th, the MD wrote me up. I informed my charge nurse I was maxed out and she agreed but the MD didn't. I'm not trying to scare you, just inform you. If you decide to accept the position, make sure you get along with your preceptor and stay on orientation for the full 6 mos. Ask a lot of questions, write them down if you think of one when you're off. Make sure that before your orientation is completed, you have taken care of the sickest pt. Active MI's, CVA's that are receiving TPA, cardioverting. Everything. If something is going on in the ER but not your assignment, go and observe. Don't be shy. Good luck. It's crazy but awesome! I wouldn't work anywhere else.

Up Vote Up Vote ×
Specializes in ICU, ER, EP,.

Our ER will assign you 7 bays and you can get 3 stretchers and a hallway chair when it's hopping. Everyone works together and will do anything for each other. It's the only way to survive.

Yes it is doable, most of the time safe but bare bones and barely adequate for the patients. No time for teaching, give them a print out, sign here be on your way.

So there is no time for screening for needs..... the diabetic is back in because theres no $$ for his testing supplies and syringes. Try to get a proud pt. to fess up with a 5 minute interaction:uhoh21:

So it is drive by nursing, it's get them in and out in record time.... we're timing you. (literally). Not the best of circumstances and I'd keep looking a bit at other local ER's and compare their ratios too. It's NOT like that everywhere and it has to change. Don't think this is the norm.:nono:

Up Vote Up Vote ×
Specializes in stepdown.
What did she have to say regarding the staffing ?

quote]

I did ask. The 8:1 is on the medical side. On a typical schedule they have 13 nurses. I know that last year they had 70,000 visits and they sometimes have up to 120 people just hanging in the waiting room... I talked with some of the staff. One was an RN that had been there for 6 years and said that she wouldn't do anything different and she loved it. ERprincess, I woulld definitely stay for my full 6 months preceptorship and someone would have a ton of questions thrown at them:)

I haven't received the "official" offer yet. I've been getting my background check and my physical done while scoping out some other hospitals. The thing is though that I have applied to 9 hospitals in the past 2 months since receiving my license and I was only called back by this one. That is even with following up with calls, faxes, and going down to the places I applied to in person. New grad drama.. It's very disheartening and my husband and I really need me to get a job pronto. He works for a non-profit in the city.. meaning we hardly get paid enough to pay rent and get some groceries. We moved up here three months ago in hopes that I would pass boards and get a job within a month. High hopes and aspirations.:uhoh3:

Anyway, I look at this as a learning opportunity. I could take the job

and leave after a year if it's just way too much. I will have the "experience" everyone up here needs then. I know that the ER is where I want to be. I could talk about that for hours.

You guys are amazing. Thank you for listening to me and giving me much needed advice. I will keep the updates coming.

Up Vote Up Vote ×
Specializes in ER.

I'm glad to hear you are asking questions to the staff and your recruiter. That's great. Just remember, during or even after your orientation is completed, you're going to get overwhelmed and scared. It's normal. Even the most experienced nurses cry. the best part of being there though is that there is always someone there to help and comfort. We've all cried on each other's shoulder at one point or another. Then you move on. It's a great place to work if you're "id" part of the brain is the controlling part. You get your results instantly. It's great! And the freedom you have as a nurse is amazing. Depending on the physicians, usually you tell them what to order! It's pretty cool. In about a year's time, they'll be a point where you're going to say to yourself, "I can do this" and you will. The ER is like any other specialty, it's gotta be in you and either you'll love it or hate it.

As for the no call backs. Don't get discouraged. That happened to me too. It's nothing personal. THen after you accept this job and start, 3 hospitals will call and ask you if you're still interested! It's just the way it goes.

Oh, and what I meant with the staying on for the full 6 mos is somewhere around 4-5 mos you'll be handling your full load and your preceptor will just be back up. Then a nurse calls out, and they're going to try and take your preceptor away for the night. Dont let them! :nono: It's your license! You worked hard to achieve it (congrats) now you have to keep it. That's all. Again, good luck.

Up Vote Up Vote ×
+ Join the Discussion