How many nurses should be on duty at a freestanding ER?

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How many nurses are needed to run a freestanding ER? Based upon the licensure agreement in my state, the simple answer is a minimum of two. There must always be a “charge RN” on duty, and there must be a minimum of one other RN to provide patient care. Of course, I did not staff a busy freestanding ER with just two RNs. These are “minimum staffing levels”. During my 8 year tenure as the nursing director for a freestanding ER, I altered the staffing matrix at least 10 times. The facility where I worked had a total of 18 treatment rooms. Once we had established the facility and determined the average daily census, I then modified the staffing matrix to ensure our patients were immediately bedded utilizing a bedside triage model. We had also established that the facilities weekend census was greater than weekday census by at least 30%. Thus, I had a weekday staffing matrix and a weekend/holiday staffing matrix. One additional comment on experience. These RNs required a high level of ER nursing experience, to include providing all respiratory treatments/procedures (simple nebs, nasal washing, CPAP, etc.) as we did not employ respiratory therapists at the facility.

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