whats your nurse pt ratio for ED?

Specialties Emergency

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Im in Houston, ours is 1:3 currently. My nurse mgr wanted me (just me!) to take 4 tonite for 12 hr shift. Im a new nurse (1 1/2 years) and I told her I was uncomfortable with this because Ive tried to do it and gave poor nursing care. She told me I had to do it if she told me to. Is this true? How many pts do most E.D. RNs take? We mix all acuities (stable, urgent, emergent, whoever's next) Thanks for info!

Our Administrator just won't hear of it.. don't know why, really.

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Specializes in Emergency Room/corrections.

oh dear, Spanisheyes, that does make it difficult for you to stay on top of things.

We go on divert frequently, simply because we are holding patients for every dept in the house and our monitored beds are generally full. we do the ED divert, (2 hours and then reassess) and it helps us keep our heads above water.

However, our sister hospital down the road cannot go on divert either, they hate us when we do.:)

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Yea, we hate it when all our hospitals go on divert, too! LOL We do have a 20 ICU beds, I think.. 8 ICU, 8 CCU, and 4 MICU and we also have a unit that takes some ICU overflow pts if they have the staff, so it makes our holds a little shorter, but as far as regular beds, our doc are pretty flexible if a certain floor doesn't have a bed. All our our floors except L&D have at least one medical telemetry bed, and we have 3 floors with cardiac telemetry beds, so really our only problem is if our ICU is full. Our boss it pretty good about staffing as well. We have 2 on calls just in case, so overall, it isn't generally too horrible. Take it as it comes.. the ER way! LOL

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This 3:1 and 4:1 ratio sounds like a dream to me. We have a 31 bed ER and work it with a teamleader, 4 nurses, 2 triage nurses, 1 tech, 1 lab person and 3 docs. 3 of the nurses work the main ER which consists of 4 trauma rooms, 6 monitor beds, a suture room and 12 acute care rooms. One nurse works the fast track, which is 8 beds. This averages out to a 8:1 ratio most of the time. It is extremely stressful not to mention dangerous. The nurses have complained to administration, the docs are going to bat for us, but so far nothing can sway the bottom line.....green. And they wonder wait times are high and customer satisfaction is low. We are also one of the busiest ER's in the state, usually seeing over 100 patients in a 12 hour shift.

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our ratio..is 4:1 reg rooms which tend to be filled by MS holds, tele holds most of the time , 5 trauma rooms which are split by two RNs so runs 2.5 each. Our ER is run by half regular staff, half travelers. I think the original poster for this thread stated that she questioned having 4 rooms...

Today i had three rooms which consisted of a 42 yr old post code, down time 20 min. who had all the drips ( she was held in ER for 10 hours...fun), acute cva and a r/o MI. I also have 1.5 yrs experience, scary part is im a vetran compared to most of our staff...needless to say our ER did not meet the new staffing laws for california, our Charge/micn had 6 full rooms starting this morn.

:eek: 8 to 1 for last poster...yikes...

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the post i posted earlier (4:1) does not stand true for our fast track - only our Core ED patients - sometimes our fast track nurses can have 10 or 12 patients....

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I work at a 20 bed ER. 14 in ER including 2 Trauma Rooms and 6 in Exp Care. We see about 30,000 pts yearly. Our usual ratio is 1:3 or 4. Of course boarding pts through everything to the wind!!

Why IS that??!!??

Why do we feel empowered to through aside a doc who is just getting in the way of patient care and crumble when an ICU nurse says..."we can't take that patient...we don't have another nurse"???

How can we handle a full arrest in the middle of a full ER and 10-15 boarding patients, with a screaming drunk and a psych patient strapped to the cart and we cannot handle a unit who "hides" discharged beds from the admitting nurses??

Our usual has become holding 10 patients all day. Usually monitored patients with a few ICU and M/S patients thrown in for good measure.

There has to be a way out!

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My ED has 15 rooms and one trauma/code room. We have it split into blocks. The front has 6 rooms, the middle 4 and the back 4-5 depending on if our fast track is open or not. If you have the front block and it is full you never see the light of day. All of our rooms now have cardiac monitors so we can be full of tele admits. On day shift they are usually full staffed with a float RN. On nights we are lucky to have 2 staff much less full staffed. Then at 3 am we usually lose another RN. Our sister hospital is a little more fair. The most pt's they usually have to one person is 5. On nights they always have 1-2 more RN's then we do since they are considered our "trauma" center. When I went in Saturday night at work we had snow, freezing rain, sleet through the day on Saturday and our sister hospital had gotten slammed that day. They had 2 trauma pt's and two pt's who were injury calls. Some days' I want to work trauma and there are days where I am glad I am not there.

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A lot of your EDs seem to have room assignments rather than patient assignments.

We do patient assignments at ours. I am one of the charge nurses and I try to make sure no one is killed (or killing!!) by all the criticals or traumas...so we mix it up a bit.

Some people wanted to try the room assignment thing but I was worried that it would be worse than now.

How do you all feel about it?

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Originally posted by RNin92

A lot of your EDs seem to have room assignments rather than patient assignments.

We do patient assignments at ours. I am one of the charge nurses and I try to make sure no one is killed (or killing!!) by all the criticals or traumas...so we mix it up a bit.

Some people wanted to try the room assignment thing but I was worried that it would be worse than now.

How do you all feel about it?

I like the idea. I know with us having room assignments we try not to place a bunch of critical pt's in one block of rooms. At our hospital we have the three blocks. The front block has two major medical rooms and the back block has two major medical rooms. The middle block usually has the code/trauma room but it is very rarely used unless we have a code come in. We don't see hardly any trauma at our facility unless they are a walk in and if they do come in alot of times our ER doc will have them sent to the sister hospital since it is our trauma center. It upsets me at times when they do this because we are all nurses and doctors and can do all of the same things but in order to keep up our level 3 they have to go to the sister hospital. Most of the time if we are full in the ER our charge nurse makes sure that none of us are drowning and helps out.

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I had another one of those extremely unsafe days in the ER.

Trauma 1: acute MI, bp too high for Retavase, needs NTG and heparin and prep for the cath lab

Trauma 3: Severely dehydrated elderly man, BP 60 by doppler, needs fluids and careful monitoring (don't want to put him in CHF)

Room 10: Women brought in with decreased LOC is now seizing, need IV access and Ativan.

Room 9: LOL from the nsg home, family wants me to function as the nsg home aide ie..."she needs help to the potty, can we have some footies?, I think her gown is a little wet" "No s#it sherlock, she just pee'd on my leg!

Room 7: A drug seeker who has decided to fake a kidney stone, very loudly and obnoxiously might I add

These were all my rooms, and the only other nurse up front was just as busy. Will this madness never end????

:( :angryfire

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In our ER it can be as much as 1:7. However there have been times I had 8. :confused:

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