unsafe nurse to patient ratios

Guest219794 · May 7, 2015

Please let me know your 3rd party opinions on if this is acceptable?

No

Does it happen elsewhere?

Yes. Not where I work, but lots of stories out there.

Do you feel it is a safe practice and okay?

No. And no.

What would you do in these situations as far as mangers and work environment?

It would depend on whether the manager was interested in safe practices. Mine is not, so talking to him is a waste of time. There are some scary things where I work, but, in balance, I like the place so I stay. Nothing I can do to change it.

AnnieOaklyRN, BSN, RN, EMT-P · May 11, 2015

No it isn't, which is why I quit my ER nursing job! We had up to 7:1 ratios and it was unsafe, and I felt the liability was just not worth it. Some members of management just don't get it! Our ER had ridiculous turnover for this reason, and again, because it was so poorly managed!

Annie

emtb2rn, BSN, RN, EMT-B · May 12, 2015

Your manager says 4/5-1 because thats how your daily volumes dictate staffing. Reality is a whole 'nother animal.

ddaviddudley · May 12, 2015

Quality of care is at risk of becoming compromised once you exceed 3 patients. At 7-8 patients, your stretched so thin to where I couldn't see how you could get anything done in a timely manner.

The max I would take on is 5. Anything more than that and I'm putting in my resignation, real quick.

aaox0 · Jul 8, 2015

Hi everyone,
Just wanted to get some third party opinions on my current situation.
I work in a fairly busy ED we see approximately 220 patients a day. When I was hired I was told the patient-nurse ratio was 4-1 sometimes 5-1. (A lot of the staff are new nurses or new to ED nursing)
Lately in one area of the ED where we can fit stretchers our ratio can become as high as 8-1.
A lot of these "stretcher patients" are BH and are there for psych eval in am. We also get a lot of ETOH detox patients on these stretchers who are also waiting for psych in am.
Last night in this area 1 nurse had 7 patients and the other nurse had 8 patients without a resource or charge nurse to help out. One of the patients in the 8 pt assignment was in severe hypertensive crisis (220/140) and needed extra attention.
When this was brought to the head management team of ED that nurse was told that this is a "good opportunity to use her nursing skills to manage the hypertensive patient." Also to "please let me how you were able to manage this situation".
Please let me know your 3rd party opinions on if this is acceptable? Does it happen elsewhere? Do you feel it is a safe practice and okay?
What would you do in these situations as far as mangers and work environment?
Thank you!

As a new grad, my preceptorship required a group study of something we thought could be improved or investigated further in our ED, and we picked 4:1 vs 3:1 nurse to pt ratio. The national approved ratio is 4:1, which is the norm in my ED, but we fight for 3:1 regardless, because of how difficult it truly is to manage 4 technically "unstable and unpredictable" patients because they are in the ER. When we initially presented this project for approval we were told that the average was 4:1 but in some places it is 8-10, and pretty much to (politely) stop ******** about it lol.

I've been assigned 5 acute care patients max, and at times I would refuse the 5th, even as a new grad, because I was uncomfortable with the responsibility. It is way more dangerous for the patient (and my nursing license) for us to be stretched that thin, and you actually have the right to turn down an assignment that you don't feel comfortable with. I have been told by preceptors and coworkers to only take on what you can manage because it is easier to find a new job than a new license. Your manager at least owes you guys the respect and support to investigate the problem further. Crazy stuff with management goes on in all EDs from what I've gathered, but this doesn't mean that employees don't deserve protection from dangerous situations like the above^

At the end of the day always speak up if you feel unsafe, because we worked way too hard for our licenses to not protect them, and patients are in danger of having something critical missed.

I have a question in return, does the ratio vary in different areas of the ED? For example, in triage technically one nurse could have 20 something people they signed up to see, acute care ranges from 3-4, and express care is 4. Anyone else's EDs similar?

Lemmy8 · Jul 8, 2015

You are lucky to have a nurse to pt ratio of 4:1, I work in NYC and it's horrible, I had 10-12 or yesterday all day. They don't even consider the acuity of the patients they just slam you back to back with chest pains, abdominal pains and psych, it really sucks in New York City. Thinking of moving, it's very unsafe here, one time I had 14 pt's and 11 of them were admissions.

rearviewmirror, BSN, RN · Jul 8, 2015

that is NOT safe.

Jm0136 · Jul 9, 2015

Wow when I did ER our max was five at the MOST. If we had unstables the charge would

Help out.

BonhamsGhost · Jul 12, 2015

THIS is my burning question/concern presently. I am fighting tooth and nail for 3:1, but with our new facility and more rooms we are forced (by our RN peers, if you can believe it) to take 4:1. I cannot get my fellow RN's to Stand for 3:1 ratio, and I think a lot of it has to do with what I might cal "hero complex." Imagine, our own peers/RN's not standing for safe practice, and then thinking that management will?? I am at my wits end. And I'll tell you right now I am a diligent, hardworking RN. Along with this frustration is the fact that the majority of the time we are short staffed, and we still have an LPN on staff on some of those days, no offense to the LPN's. I'm in Michigan, and someone told me a few days ago that there is legislation in the works pertaining to safe RN to patient ratios...hope to see it soon. One more thought...and to think, some folks actually bought the lie the Unions are the problem...sigh