8:1 ratios in the ER???

walnuttree91 · Sep 18, 2004

Does it ever occur to administration that more nurses would increase the speed of ER discharges/hospital admissions, leading to more patients seen/admitted, leading to increased revenues, allowing the extra staff to be paid for, not mentioning the increased satisfaction of both the nurses and patients?

TinyNurse, RN · Nov 6, 2004

On my first and last travel assignment in an ER, I routinely had 8 patients, supposidly I had the "less acute" in my area, but routinely I was running insulin drips, having elevated K+, etc..............

I would look for an open room, arrange with the charge and then move these patients up, TRY to give report to the other nurse, and they would have the nerve to ask me WHY, i moved someone with a K+ of 8 up to the front......................

In staff nurse jobs the most I had was 3 patients and 2 hall beds.

xo Jen

LIFESAVERLINDA · Nov 6, 2004

I work in a level 1 trauma center in the heart of a major us city,not to mention one the united states busiest emergency rooms,we have a total of four diffrent parts to our er,we have a medicine side which has at aleast 40 actual beds including hall beds,with rooms 1,2,3 being resucitation booths,in the same area we have a corner with 8 recliners and heart monitors we call chest pain area(there we do 3,6,9 troponin draws and ekgs)also in the same area we have the asthma room 8 chairs for nebs,also in the same area we have fast track which has 3 exam rooms and 30 chairs pts sit in and np or pa will call them into a room checkthemout then they go back to chairs for iv,or blood draws,and the nurses station is a joke its like grand central station,you are butt bumping and trying to open the pxysis while you trip over one another,on the other side is surgery side/trauma, we have our own trauma team and they manage the trauma bays which we have 6 and are all setup for level 1 traumas,and we have 30 beds which 3 are in the ortho bay,including a major burn room,and two of the rooms can be used for resucitation,not including 6 chairs in the ortho room,and 30 chairs in a room will call assessment room which are for folks to sick to leave in waiting room not minor enough to go to fast track,not sick enough for a bed, and we have our own psych er and ob/gyn er which have beds of there own not sure how many there? but with all that said our er generally has 85 full time staff nurses, right its 65 very short, usually a assignment you will be on one side or the other med or surg and on a team of a certain color which has nurse maybe two if you are lucky and a doctor all on one color team on med we have 3 teams/colors on surg we have 2/teams/colors,so usually there is one nurse on a team with anywhere from 20-30 pts/if you are lucky 2 nurses split the load and you still have anywhere from 10-15 between the both of you,plus each team has a basket which are for orders but before you do the stat or now orders you go and assess each pt mainly to be sure you know what they look like and if they are breathing, and in what condition,yep it gets pretty hairy at time the ratios are nutty when i was hired they told me 8 to one,shhh right that would be awesome,oh and we only have like one or two techs for the whole er,so we do all our own vital,ekg's iv's blood draws,abg's because we only have 1 rt..yikes....and if we get a level one in kiss him goodbye...we have to call the resp supervisor,oh and we dont have cat scanner in the er we have to go over the hill and thourgh the woods to radiology dept we have a small x-ray dept in our er and we take them over and they are supposed to bring our pts back...which never happens....i had search all over for my pt's b/c nobody brought them back,and then we usually have ambulances laft and right needing a bed so again we shuffle bodies around,sometimes we make ambulances drop off pts at triage if its something stupid or minor which happens alot,we have a huge population of homeless also we are the hosp for the jail and we have a police room where inmates sit and get treated in their shackles,any way its always mass kaos to a somewhat organized degree.i can rig up all kinds of stuff,i ve had to tape iv bags to the wall where there was no hook!...you just can't imagine,but i love i dont want to work anywhere else! believe it or not i'm actually getting to live my dream,i always wanted to work at this hospital! because everybody knows the best come from this hospital. and you always guaranteed a job anywhere with this on your resume,but i'm hoping to excel to my ultimate goal and be on the trauma team.if you have any questions about how i do it all,just post it!

chip193 · Nov 6, 2004

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 work nights, so that may explain the problem!

First a little background. Our day and night staffs at 9 RNs for both shifts. As we're under construction, the department is, well, cut in half with a 200 foot hallway between the two parts (it's never a good thing when they have to use only existing space!). At night we drop to 5 RNs, or 4 RNs and an LPN.

On one side of the department is the "Critical Care Area" During days, it is staffed by 3 RNs (4 if you include the charge). There are two trauma beds, three heart beds, three "real" step down beds, and four "acting-interim-temporary-hallway" step down beds. All are monitored. At night, this area drops to 1 RN (two if you include the charge) and an LPN (who is actually a "float" for the whole department).

On the other side is an intermediate care area. Think of this as where future med-surg patients arrive. There are four monitored beds in the front, an Ortho monitored bed, and a GYN monitored bed. There are also five acting-interim-temporary-hallway beds, which are unmonitored. Days and Evenings staffs this with two RNs. Nights is one. And at night we pick up the Psych area from here.

It's not uncommon when I take this intermediate care assignment that I take report from four nurses on up to 14 patients. Try that one on for size!!

Chip