New tool will change the way you staff your ED

A new tool could change the way EDs nationwide are staffed. In 2001, ENA formed a task force to develop an easy to use, evidence-based tool to determine realistic nurse staffing in EDs, reports Joanne Ingalls McKay, RN, MSN, CEN, principal and senior health care consultant at Charlotte, NC-based FreemanWhite, a consulting firm based in Charlotte, NC, and a member of the Des Plaines, IL-based Emergency Nurses Association’s Staffing Best Practice Workgroup.

The ENA Staffing Best Practices Tool and Guidelines enable ED managers to determine the necessary number of direct care full-time equivalents (FTEs) required to provide care to patients seeking emergency care, says McKay. "The necessary number of triage nurse FTEs also are calculated by the tool," she says.

Here are key benefits of the tool:

• It is easy to use. The tool is developed in an Excel spreadsheet format and is very user-friendly, says McKay. "ED nurse leaders simply type in the necessary data, and the corresponding number of direct-care FTEs automatically are calculated," she explains.

• You can demonstrate a need to change the way you staff your ED. This may mean a change of staff mix or a need to increase or decrease FTEs based upon patient volume, patient acuity, and ED length of stay, says McKay. "It is universally understood that, as patient volume increases, non-nurse caregiver FTE needs increase," says McKay.

• Patient volume, patient acuity, and length of stay are addressed. State-mandated staffing ratios fail to address patient acuity appropriately, says McKay. Patient acuity is broken down into three categories of general, critical care, and trauma, she explains. Critical and trauma patients require two to three nurses during the first 30-60 minutes, but the California ratios only call for one nurse for each trauma patient and one nurse for every two critical care patients, she notes. "Neither is sufficient for the immediate clinical needs of a critical or trauma patient," says McKay.

On the other hand, nonurgent patients do not require a 1:4 nurse/patient ratio, but that is what is called for in the California plan, notes McKay. "The ENA tool is far more sensitive to the actual needs of patients," she says. (For more on staffing, see "Nursing shortage will continue: Make sure your ED stays ahead of the game," ED Nursing, November 2002, p. 1.)


For more information on the staffing tool, contact: Joanne Ingalls McKay, RN, MSN, CEN, Principal and Senior Healthcare Consultant, FreemanWhite, 8001 Arrowridge Blvd., Charlotte, NC 28273. Telephone: (704) 523-2230. E-mail:

ENA Guidelines for Emergency Department Nurse Staffing includes a book and CD. The cost is $100 for members and $500 for nonmembers. To order, contact Emergency Nurses Association, 915 Lee St., Des Plaines, IL 60016-6569. Telephone: (800) 243-8362 or (847) 460-4099. E-mail: