Staffing/Patient Ratios in your ED

[Collins030505]

I was curious what everyone's nurse to patient ratio is in the ED. Explain a little about your ED as well. I'll try to add a poll for those who just want to answer and not expand on their answer.

I work in a metropolitan downtown ED, level 4 trauma. There are two level 1 trauma EDs nearby and 7 other level 4 trauma EDs within 20 minutes of us. Anyway we have 30 beds and have a 1:3 ratio in the trauma/code beds and a 1:4 in all other beds. So if you're working in rooms 1-6 you get 3 high acuity patients all at the same time. Or essentially you could have three codes going on at the same time. I think the assignments at this ED are unsafe, but this is the only ED I've worked at, so I keep my mouth shut. I'm curious though, what other EDs have to work with.

[sserrn, BSN]

5 pts per nurse

[CodeteamB]

I work in a large inner city ER. Our ratios vary from 1:3 to 1:6 based on acuity. In our fast track area you can have more patients, but obviously less sick/busy.

We have a 2 nurse code team who do not take an assignment, we float unless there is someone in the code room, so our ratio there is either 2:1 during stabilization or 1:1 if we need to hold the patient.

[emtb2rn, BSN, RN, EMT-B]

350 bed community hospital, 50 bed ER. 1:3-4 main ER, 1:5-8 fast track depending on staffing.

[mybrowneyedgirl, BSN, RN]

Level 1 trauma. 1:3 unless you're in the 3 resuscitation bays. Then it's 3 patients to 2 nurses.

[Sassy5d]

1:4 unless we're swamped then it could be 1:5 or 1:6 but thankfully that doesn't happen often.

[muesli]

Metropolitan, level 1 trauma center. 1:4 unless we have poor staffing and then 1:6. Honestly the flow coordinator and pod lead seems to try to even out the acuity and staff patients based on nurse experience level so I don't often feel overwhelmed. Many people on my shift help one another out. Trauma patients are seen in dedicated trauma rooms with trauma nurses before being absorbed by the general ED. You would, however, see less than level two traumas, codes, strokes and STEMIs in the general ED.

[turnforthenurse, MSN, NP]

Ours is 1:4 in the main ER, fast track is usually an LPN and their ratio is 1:5. RNs cover their IV push meds. If we're full in the cardiac/trauma rooms (and that's on a bad night) it's 1:5, which we have been trying to argue because if you truly have 5 critical care patients, that's pretty unsafe. We try our absolute best to either have 2 RNs in those rooms or have 1 RN assigned and have a back-up RN assigned elsewhere. You're never truly alone, though.

[bebbercorn]

Where am I working? We are 1:4 in critical/trauma and our max is 1:10 in main/fast track, usually you can count on 8 but most days I have 10 in the main in a level 1 trauma center. Yikes. I assumed it was like this everywhere.

[Anna Flaxis, BSN, RN]

At my last place of employment, Level 2 regional trauma center, it was 1:1 for your ESI 1s, then 1:3-4 for your ESI 2-3s, then 1:6 for ESI 4-5s, only because that was how many beds were available in the Fast Track area, otherwise, it would have been more.

At my new place of employment, I don't know because I haven't started yet!

[Murse901, MSN, RN]

12-bed ER, small community hospital with no specialty services.

We are supposed to be 1:4, but are actually up to 1:6 at times with a free charge nurse (who also has to triage at times). No techs, no transportation, no housekeeping. Nursing does it all.

[ZooMommyRN, ADN, RN]

Level 1 trauma Peds, 1:3 once in a while we get 4 patients, if you have a really sick one or one that looks like they might turn south the charge might keep you at 2 patients, if we're really busy the sick one might end up in the bay to free you up to take more but that's a rare occurrence.