Staffing HELP

ecnav · Apr 5, 2008

hey folks,
new to the forum. i am looking for some help. we just moved in to a brand new ed. 3 times the size, with an increase in beds. the place is amazing but for some reason now that we got the patients out of the hallways and in to rooms it seems as if we are running ragged.
i am hoping some of you guys can direct me toward any links or personal ideas/thoughts/approaches regarding staffing. we are presently 5:1 (ideally), we do zone nursing with two nurses, so meal break means 10:1 or more. despite the new, larger digs we are at wits end. emotions are high and proving need for more licenses is at least a year down the road, between getting numbers, submitting reqs. for extra nurses, then training etc.
so again any source for staffing ratios/ideas would be greatly appreciated

maybe...

institute a transfer liaison - someone who can coordinate and execute discharge, unit admits and interfacility transfers. sharp intern/externs are good at this but, it really ought to be a regular staff assignment.

expand utilization of nurses aides to accomplish tasks like phlebotomy, iv setup (everything up to stick & connect), trauma labs, and anything else that's permissible. and hire a few more aides that have emt experience.

stagger shift change and overlap so that the whole department isn't turning over at once.

ed float pool - in hospital staff that's trained and willing to walk to ed if needed to cover. provide some incentive and good luck.

the trend is to expand the scope of para and non professionals. did they issue you a pedometer so you can gauge how many more miles your walking in that big spacious er? bon voyage...

Larry77, RN · Apr 5, 2008

5:1 sounds dangerous in the ED. What do you do if you have a critical patient or a trauma that requires 1:1 nursing? We are staffed for 3:1 until the wee hrs of the night but usually have a float or two to take over your section if you get a trauma/code etc. We also recently moved into a new department and it did take some time to adjust especially in finding a place for everthing.

I work at other hospitals as well as agency and have never seen 1:5 nursing staffing unless there is multiple traumas or some kind of crisis.

KatieBell · Apr 6, 2008

5:1 is a pretty high ratio in the ED, though I just finished a contract at a place where I was regularly 6: 1...low acuity though.

I was part of a move into a bigger ED last year. It was maddening, and we had ratios of 4:1. Part of the problem is that we spent a great deal of time looking for stuff that we used to know where to find easily. I remember wandering through all the areas once just looking for the nasal cannulas.

One thing to remember is that many many people do not deal well with change, even positive change. Many times unfortunately these people are totally unaware of this and simply get snappy and upset. Thus, the move is probably causing some stress just by being what it is.

Our move was also gradual. We opened the new area and closed the old area for renovation, giving us time to hire more nurses to cover the new beds...

Personally I think you need to bring the ratio down to 4:1. Also look carefully at assignments, so that they are somewhat balanced. Most ED's tend to have one area they like to do Chest pains in and then one nurse may end up with 4 chest pains which means someone is not getting the best care they could have.

Be sure the aides are doing what they are supposed to be doing, so the nurses can concentrate on doing their job.

Instead of looking at your needs and such to justify more licensed personnell, you may want to simply get ratios from around the country to ustify the new hires, because 5:1 is not really the norm anymore.