What's your average nurse to patient ratio?

[loricatus]

Right now I am averaging 1:7+ (nothing less) and am getting very close to quitting. It truly is becoming unsafe since critical care patients requiring 1:1 are part of the mix.

I just had a CVA who got the order for tPA 5 minutes before the closing window cutoff time (docs/residents/students couldn't decide what they were going to do and how they were going to do it...) Thank God I did a decent assessment, asked questions of the family (since the docs weren't keeping me informed) and knew there was a confirmed time of onset of sxs, allowing me to prepare ahead of time and not be the one that was blamed if we missed the time frame for administration. The patient actually received the initial bolus with 1 minute to spare. Of course, in cutting it that close, the patient did not have any relief in symptoms. While this was occuring, I had 6 other patients that had no nurse. I notified the charge nurse that I was aware that hospital policy required 1:1 for the tPA patient and someone would have to care for my other patients. Her answer was that there was no one to spare and I would have to find a way to be in compliance with hospital policy, while not abandoning my other patients-since I was at fault and should have not prepared ahead of time and just let the time for administration expire.

After she said that to me, I decided I will be leaving this ED as soon as possible. I don't want to get into another situation like this again, so am I asking too much to find a place that has safe pt to nurse ratios and professional management?

What is your patient to nurse ratio? Is it manageable? Do you actually get some help from the aides or do they sit around reading the paper and give you that dirty look if you ask for help? If it is less than 5:1, do you need additional staff? I am willing to move or do traveling because I love emergency nursing, think I do it fairly well; but, hate having to risk patient lives and my license because of poor management, cost cutting of nursing staff while putting millions of dollars into the aesthetics of the buildings...

At the least, thank you for giving me this opportunity to vent.

[bill4745, RN]

Loricatus-I sent you a personal message. We have openings.

[mom2michael, MSN, RN, NP]

One facility I work for - 1 RN and 1 tech 24/7 with an overlap RN that works 11-11 - we see an average of 30 patients a day. We have no set ratio. We do our own triages and then just everyone pitches in and does what needs to be done for each patient as we bring them back.

2nd facility - 1 RN to 4 patients - with 2 float RNs (11-11 and 3-3) that pick up the slack and take trauma or high acuity patients, help with meds, d/c and getting patients admitted. We also have a charge RN that doesn't take patients unless necessary and a triage RN that can help in a pinch. We have no tech though. We have 12 rooms there - see around 100 patients a day.

[Kinky Slinky RN]

1:4 ratio is almost unheard of in my ER. Tonight I had up to 10 patients alone and it was fairly slow... About 4 of the 10 of my patients all at once had ankle fractures. One went straight to OR. Another case was to go to OR shortly after the first one. I had a few admitted patients. One patient had the worst clavicle fracture I have ever seen. It can definitely become unsafe but thankfully I work with a great group of people and we all watch around and help each other out. In this ER, prioritizing is a must.... realizing which patients are truly sick is essential.

On our trauma/surgery portion of the ER, we have hard bed assignments so max patients you will have is between 6-12. However, on our medicine portion of the ER, you may have 2 RNs to 20patients easy.. If we are short staffed, it's possible you can have all of those 20 patients on your own. If it weren't for the fact that all of the RNs pull together and help each other out, our ER wouldn't be as efficient as it is. It can be scary at times, no doubt. We hardly have techs at night and if we do, they are typically transporting patients to the floor. We do have phlebotomy and EKG on the medicine side which makes our job SO much easier.

Although it's crazy and sometimes can be unsafe, it is a practice we deal with daily. My hospital is a huge teaching facility so thankfully we have someone keeping eyes on the patients most of the time, whether it be interns, residents, or attendings.

For our patients that go to the ICUs, we have one nurse to those patients. Typically one nurse to 3 ICU admits.

It's crazy... In fact one of my good friends refers to my ER as an "orangized chaos," and that is exactly what it is... but it works =)

[AndiERRN]

my er has a 1:4 ratio we have a floating charge who is very willing to jump in and help and take over a team when needed. you should have been 1:1 with a tpa pt and if your co-workers and charge weren't willing to jump in and take over your other patients and then help with the tpa you are in the wrong place.

i have found a job that is supportive and amazing but it's taken alot of work and frustration to get here, but i'll never leave.

i work north of atlanta at northside hospital. www.northside.com there are 3 campuses and all are growing. they have a local traveler plan where they pay you for gas millage and pay for you to stay in a local hotel, all within walking distance. we have one rn who actually flies in from maryland! (look on the web site under careers and then benefits and then programs and then local traveler.)

my advice? just keep looking and find something, somewhere else where you are supported and appreciated. experienced emergency nurses are too hard too come by and we need you... don't give up!

andierrn

[Medicine Eagle]

Get ready for a shocker, I worked Christmas Eve in a level I Trauma woth 4 nurses total! That included the Charge Nurse and triage. We thought we were going to loose our mind. Talk about unsafe. Esp. considering that Christmas Eve is not only high MVC time but also attempted and successful suicide time. We were called the gun and knife club. It was baddd. On top of that Administration refused to allow us to go on diversion until 30 min before day shift came in. I had a pt that only needed report called, and after the night we had the day shift nurse refused to call report. The day shift Charge Nurse backed her up and chewed me out and demanded that I call report. I have no idea how many pts I had at the same time that night because there was no time to count them.

Also I have rarely worked in an ER that had a set nurse to pt ratio. I have had as many as 9 or 10 pts going at the same time. Some serious some not. I was working a severe trauma when the charge nurse (I use that term loosely) started yelling at me that my other 2 pts had bed and I needed to call report to the floor. Keep in mind that in the ER, we have pts for a short time comparetively speaking and that any ER nurse can generally pick up a chart and call report on a pt s/he has not given care to. That place was crazy but I loved it. With the exception that the cliques were really bad and the politics sucked. All things considered I would still go back. I had the best Nurse Manager I have ever worked with. Some of you may know her. Helen Sandkhul RN is the best ER Manager hands down. She is the only manager I have ever worked with that would come in to the ER in scrubs ready and willing to help if we needed it usually. Never see that anywhere. Frequently we were so busy that the nurses would raid the saltine cracker supply in desperation. Either that or run out to the vending machine for a candy bar. However, you had to be desperate to do that as in a blood sugar of

Tired Brave Heart

[nursetiffany]

I am currently a travel ER nurse at this one facility that is poorly staffed. We have 15 beds at night with 3 nurses and no tech. The problem is that the Charge nurse runs triage...which leaves the other 2 nurses to take the 15 beds. I feel it is very unsafe and management won't do anything about it. The assignments go as follows. One nurse gets rooms 1-4 the more critical ones and 2 hallway beds. The other nurse gets rooms 5-9..they call it the pit and 3-4 hallway beds. The pit will get slammed with patients all night while the rooms 1-4 barely get hit. And this hospital wonders why they can't keep staff???

[50caliber]

4:1 non acute and 5:1 max non acute.

On the acute side, its either 2:1 or 3:1

[Michellex1013]

always 4:1 in the bed area and 10:1 in the fast track area. Fast track can become a nightmare if the docs are work-up happy. We utilize ED techs (most are great at what they do), and sometimes we have a float RN. We are not a trauma hospital.

[RN4911]

I work nights in our ER---we have 2 RN's and 2 medics----they are the 911 medics and are often paged out for runs/calls; that leaves 2 RN's for a 14 bed facility. We are currently a level 3 trauma center but we are the only hospital within our vast county and we cover a good portion of the UP----the closest level 2 is 1 hr away-------this means we are constantly getting criticals. Our policy also states that a critical warrants 1:1 care but GOOD LUCK!!!! If one RN is with the critical, then the other may be responsible for up to 13 patients(not counting those that end up in the hallway on beds when we run out of rooms). Have been there and done it too many times! Scares the hell out of me. Have brought it up to management and they say "Nights just keep doing what you are doing". NOW they are expanding our services and we have NOT received additional help on our shift!! Drives me bananas!!

[MikeyBSN]

We have a 1:6 ratio and, with the exception of trauma and minor care, our ED is not divided into sections. Personally, I think it is too much but it is better than the 8+ we had at one time. I think 4 is probably the gold standard in the ED with 5 being acceptable. Just the other day I had a very sick patient in my section and, even after doing this for some time and feeling very confident in my skills, I felt extremely overwhelmed. I didn't do as much as I could have for this patient and despite what I did get done, the ICU nurse preceded to make me feel like I was either lazy or incompetent because I didn't have all my ducks in a row. It's hard when you have more than one or two patients to deal with, ICU people, but that's another story. The reason ED should have a fairly low ratio is the relative instability of ALL ED patients (as we don't have as much data on their presenting conditions as they do on the floors). We start with no labs, no x-rays, no CT's, no clinical data aside from our own assessment. Plus, we need to do all of the initial IV's, labs etc. Sure, we do prioritize, but I can't spend all of my time with my sick patient when I don't know what is wrong with the person who just came in to my section other than a short triage note, from a nurse who might have seen this patient for one to two minutes.