Specialties Emergency


I am trying to find out if anyone knows of a resource to determine the "average staff hours required per pt visit in the ED". I was unsure if there is a national standard etc... I am in a rural hospital with average daily visits of about 32.

I appreciate any guidance you can give me.


518 Posts

I don't know if there is a national standard but I work in a community hospital ER whose average daily census is usually over 50.

We staff 7-3 with 3 RN's, 1 Tech, 1 Secretary and 1 Doc. 3-11 is the same. 11-7 is 2 RN's and a Secretary that also doubles for a registration clerk. On 7-3 and 3-11 shifts we also have a registration clerk. There is a triage nurse out front 7-3 and 3-11 but on 11-7 there is no triage out front, all the pt's are brought to the back for assessment.

We always have 1 Doc working unless we get slammed and we call another in.

We also call extra staff in if we have too many holds in the ER.(if we have any extra staff willing to do it.)

Hope this helps.

Trauma Columnist

traumaRUs, MSN, APRN

97 Articles; 21,237 Posts

Specializes in Nephrology, Cardiology, ER, ICU.

The ENA (Emergency Nurses Association) has done a lot of bench-marking in this area. They are located in the Chicago area and have web address. I work level one trauma center and we have average of 210 visits/day - we staff with over 40% travellers due to nursing shortage. (Gulp, gulp)

Uptoherern, RN

337 Posts

Specializes in Emergency Room.

I work in an Iasis facility. We average around 35-40 pts per day, but seem to get SICK people. The powers that be have decided that we must get 41 pts per day to be able to have all of our staff. Our staff consists of 2 rn's with a "middle shift" rn either from 12-8 pm or 11-11pm. We then have a secretary 12-8, one dr. (at all times) and a registration clerk. After approx. 5pm, the registration clerk becomes the clerk for the entire hospital. They way they figure it is we have a "Magical number" 1.78. They take the total number of hours worked (registration clerk, and dr. don't count, however we "pay" for 3 hrs for transport per day) . and they divide this number by how many patients we see in 24 hours. This then gives us a "good" number (@ or below 1.78) or a "bad" number (over 1.78). Say we saw 40 patients, and for that day we had secretary (8 hrs) 3 rns (for total of 60 hrs) + 3 hrs of transport. Total hours worked =71. divided by 40 =1.78...

Is this not the most ridiculous system ever??? They are cancelling the middle shift rn and the secretary @ 9:30-10:00 am FOR THE WHOLE SHIFT!!! They tell us that it is "our choice" whether or not to "be available" in case they need us later. They refuse to pay on-call pay or call-back pay. The two nurses who are left get creamed later in the day. We keep asking them, how can you possibly know what "the numbers" are, until the day is over???? And what, if anything, does a census of 15 "in the books" at 9:30 in the morning have to do with the rest of the day. We cannot get it thru managements thick skull that we are an EMERGENCY room. This means that things happen that you can not plan for! AAAARGH. Talk about somebody please hold my purse!!! The really puzzling thing is that Iasis owns 3 hospitals in Phoenix, and the other two are not staffed like this! Matter of fact, I am voting with my feet, and have approx. 3 wks left at this facility, and am transferring to another. Spout, spout, vent, vent. Nothing changes.....I have certainly tried.


475 Posts

Good for you,erdiane. In my last er they kept cutting staff, the suits always had a great excuse for it. I, too, voted with my feet,I am now working in a place that I really enjoy.:)


34 Posts

Our ER averages 250 per day, although a lot of the patients use the place like a PHC. We have 7 RN's, 3 MD's, 1 clerk and 2 receptionists in the day and 1 at night.

neneRN, BSN, RN

642 Posts

Specializes in Emergency, Trauma.

Level II trauma center- see 110,00 pts/year. We staff 7 RNs, 5 LPNs/medics, 2 techs, 2 unit coordinators per shift (minimum staff) Our docs stagger 9 hr shifts, so there are 2-5 docs depending on the time of day.


52 Posts

WOW.....we see about 150-200 a day and during busy times we have 12 RN's!!!!...guess we better not complain huh??...level ll trauma


11 Posts

I'm a manager in a small town hospital where we have about 14,000 visits per year. Staffing is very hard to predict. I use data obtainte thru the database to trend peek times. We see anywhere from 30 to 60 patients per day with the average censes of 38 patients per day.

My ideal staffing is two RN's 24 hours per day, one LVN 12 hours per day (11a-11p) and a tech from 2pm-10pm. Because of the RN shortage, I often have to staff only one RN and utilize a LVN to fill the gaps. There is problems with this. Thankfully most of the LVN's I have are very good.

The magic number sent to me by the CFO for staffing guidelines is 1.9 fte's per visit. I have been creative and have found a way to pick up a few extra points by adding the total number of breathing treatments, ekg, out patients visits and IV sticks for the radiology department to enhance my numbers.

I failed to mention that I am available from 7a-3p as backup. and my hours are included in the fte value of 1.9.

W have 7 beds and one full time doctor. Registration is processed by another department.

I wish to add a unit tech from 7a to 3a. This would really help. However, I have to fight to keep what I have. It would take an average of 50 patients per day (an additional 12) to support this staffing.

I forgot to mention, all inservices, orientation and any other special eduation or events are also include in the number. So if there is a high turnover rate, you will be really hurting to stay within the guidelines. I always tell upper management that when I'm over my guidelines because of orientation, education, that it was money well spent. I refuse to decrease staffing to make up the difference. I still have a job so I guess if you really push its possible to get a little extra.

I'll tell you from a ER department managers point of view, it hell trying to stay in the guidelines. What works best for me is to help the staff at every oppertunity I get. The really appreciate it and will go the extra mile for me when I really need it.

By the way, I am 3 full time positions short of a full staff.

Hope this helps


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