8:1 ratios in the ER???

Specialties Emergency

Published

Hey everyone, I heard this today from a very expirenced RN at my new job. Where I previously worked the ER RN's had 4-5 patients and maybe (maybe) in a real pinch they'd have 6 pts. Where you work is it common to have 8 or more pts???? Both hospitals are located in the same town and are both very urban. I understand that the ER is extremely unpredicatable, but 8??? That seems like way too many...and I don't think it's a management thing either (ie. not being given enough staff for nights, etc) b/c this hosptial has much much much better management, NMs,VPs (and is very nurse-centric) than the one with the 4-5:1 ratio. I really wanted to stay on that this new job, but I'm not sure if I could ever handle 8 ER pts, even if they were minor care. Opinions please??????????????

i just took report on 17 patients last night, wheres my roller skates?

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Specializes in Emergency.
i just took report on 17 patients last night, wheres my roller skates?

NO way. No management should ever allow that. If the even attempted everyone and there brother would be getting a call from my union rep to the state BON to the senior hopital administation on call, with written complaints to follow. That just plain neglegent and criminal as far as im concerned. I dont even like taking report on 8 to 10 pts with 2 RNs.

Rj

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Specializes in Emergency.
i just took report on 17 patients last night, wheres my roller skates?

NO way. No management should ever allow that. If the even attempted everyone and there brother would be getting a call from my union rep to the state BON to the senior hopital administation on call, with written complaints to follow. That just plain neglegent and criminal as far as im concerned. I dont even like taking report on 8 to 10 pts with 2 RNs.

Rj

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Here in Australia, we have just agreed through enterprise bargaining that we have a ratio of 1:3 plus triage and shift co-ordinator. obviously it gets out of control sometimes and with the additional of intubated or critically ill patients we sometimes operate on a higher ratio whilst the manager finds us more staff

cassie

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Specializes in Emergency Room.
Ive had as many as 20 patients on a busy night, you need to learn to multi-task, it makes you a better nurse. you might not get to fluff every pillow, or flip every patient, but youll be suprised how good u get at it.

i hate these nurses who complain when you get more than 5 patients. you are there to run your butt off. ive worked in all types of er's. busy and not so busy. the less busy er's with nurses with 4-5 patients complain more than the truely busy ones. i guess if you have time to complain, you arent that busy. non-busy er's are boring.

just my $0.02

i'm curious to know how many beds are in your ED, because if you have 20 patients how many does everyone else have and how can you document properly on 20 people in an ED? my ED policy is to document every 2 hours which would be impossible w/ 20 patients. i would not take a job in any ED that required one nurse to take care of that many pts. i have had as many as 8 in our minor emergency because the acuity is low and i have had 5 very sick pts at once. some of you nurses are amazing and i admire you for taking that kind of load but i would worry about making a mistake and administration turns the other way when mistakes happen. i see it everyday.

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i'm curious to know how many beds are in your ED, because if you have 20 patients how many does everyone else have and how can you document properly on 20 people in an ED? my ED policy is to document every 2 hours which would be impossible w/ 20 patients. i would not take a job in any ED that required one nurse to take care of that many pts. i have had as many as 8 in our minor emergency because the acuity is low and i have had 5 very sick pts at once. some of you nurses are amazing and i admire you for taking that kind of load but i would worry about making a mistake and administration turns the other way when mistakes happen. i see it everyday.
You MOVE YOUR ***. MULTITASK..PRIORITIZE run run and run, never sit down. U work as a team and get things done. quick assessments. you develop the ability to just glance at a person and know whats wrong with them. you also multi-task, while interviewing a patient, u can stick a line in and get the ekg, and medicate them all in one minute. lots of nurses like to do one thing at a time. you have to be an adrenaline junkie to work there, and we have a high turnover rate. you have to become bulletproof, and Bellevue nurses pride ourselves on being able to have anything thrown at us and we can just shrug our shoulders and say "bring it on". We get all the crap that the rest of the big $ hospitals dont want, including all the bad trauma and homeless and psych patients.

Our medical adult ER sees over 100k per year, and the Urgent Care is above that. (lots of BS) We have a separate peds ER and psych ER, and a 15 bed EW (emergency ward -ICU) right in the ER and our own CT scanner and MRI and xray department. At times it seems like an assembly line, but we have lots of ancillary and support staff also.

i noticed in other less busy ER's that I work in, that if you actually have the time to count how many patients you have, you are not busy enough. If you get used to having less than 5 patients, then nurses complain about the sixth. if you usually have 10 and get an 11th, youll complain.

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Specializes in Emergency Room/corrections.
i read this topic with wonderment and in amazement because a 8:1 ratio in my ER would be a dream! most nights we can have 10-12 pts each (a mixture of acute and non-acute pts) in rooms and the hallway because our urgent care center closes at 8pm. :angryfire ...so all the minor stuff gets grouped with the acute pts.....it sucks but that's the reality of a non-unionized hospital too.....there really should be fair distribution of the pts based on acuity though.....

we have 7-8 patients per RN in our ED, but we dont have a "fast track" so, in some blocks of rooms you will have your average clinic bs patient. It can get hairy to have 5 critical patients in one section, but it happens...we have a union hospital, the state average is 5:1 but we usually have 7-8:1.

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It is so educational to lurk here. When I was transported to the ED with a GI bleed, there were at least three nurses and the ED doctor attending to me the entire time. The two doctors who managed my care after I was transferred to the Critical Care Unit also saw me while I was in the ED. This discussion about staffing ratios really makes me appreciate the resources the hospital used on me to ensure a successful outcome.

I sent a thank you letter to the hospital after I had been released. Reading that hospital nurses rarely know how their patients do after being released prompted me to write to the ED and the Critical Care Unit months later. I was able to tell them that I had made a more than full recovery.

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Ive had as many as 20 patients on a busy night, you need to learn to multi-task, it makes you a better nurse. you might not get to fluff every pillow, or flip every patient, but youll be suprised how good u get at it.

i hate these nurses who complain when you get more than 5 patients. you are there to run your butt off. ive worked in all types of er's. busy and not so busy. the less busy er's with nurses with 4-5 patients complain more than the truely busy ones. i guess if you have time to complain, you arent that busy. non-busy er's are boring.

just my $0.02

No thanks, the patients deserve better, and so do we...

We can all multi task (EKG, IV, LABS, MONITOR, O2, TRIAGE - all in 10 minutes) and see an MI in a crowded room...I learned all that inside of 2 years in the ER...big whoopie...

I enjoy spending quality time w/ my 4:1 ratio...

That's what it's all about...

Thanks to lawyers, mandated ratios are coming, just like EMTALA did...

It's a good thing...We need to figure out how to attract more nurses to the profession...

Sean

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Our state mandated ratios are 4:1, but yeah right..our ER still isn't at it....the hospital supposedly gets fined and we're waiting for all of our new grads to come off of orientation...at least thats what management keeps saying...we typically have 6-9 patients each, and while yes you figure out how to handle it...when the state law says you should only have 4, and you know that other ER's are at that, it makes you soooo mad and frustrated every day that you have to deal with that many patients. Who needs the stress? I would rather give my patients good care, than go home every night and say..."well at least no one died!"

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Specializes in ER, PACU, OR.

Well ours used to be three per nurse when I was in the ER. Then it went to 4 per nurse after I left. Now it is 8 per 2 nurses. 1 Nurse has to cover all 8 during lunch, dinner, breaks etc now.

out.....

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Rarely do we ever take more than 4 patients...5 is the absolute maximum, and that's only if ambos keep coming to the door...our ED closes beds first. Now when winter comes and all that flu, pneumonia, and other fun bugs are being shared by our patients, that might be a different story.

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