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Is it legal for our ED staff to be cut to one RN? I have concerns about this.

Wednesday March 13, 2013
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Dear Nancy,

We are in the middle of staff cuts. Two RNs, a ward clerk and a physician staff our ED. Is it legal for them to cut our staff to one RN? I am concerned that when I am hanging or administering high-risk medication, I will not have that second RN for verification. Also, I’m concerned that patients will not be seen in a timely manner.


Nancy Brent replies:

Dear Eliana,

The cut you describe for your ED does not sound very safe and may, in the long run, prove to be shortsighted. When looking at staffing in the ED, one has to look at many factors, including the types of patients seen (e.g., trauma, cardiac), the volume of patients seen and the skills and expertise of all the staff in the ED.

Staffing is regulated by state laws for hospitals and their EDs, and by accreditation standards. An important resource concerning staffing is the Emergency Nurses Association (www.ena.org), the professional association for ED nurses. The association has many position statements and publications available on their website for download and purchase. Some that might be helpful include the position statements: “Staffing and Productivity (2011)” and “Non-RN Caregivers In Emergency Care (2003).” Publications of interest include “Emergency Nursing Scope and Statement of Practice (2011)” and “A Practical Guide To Nurse Management in the ED: Skills for Nurse Managers (2005).”

Raise your understandable concerns with the risk management department, the nurse manager of the ED and your CNO. It is in everyone's best interest, not just yours, to have adequate staffing in the ED, so the safety of patients who seek help there is not compromised. Bring to the meeting any legal requirements and professional statements you can to support your case. Speaking with other ED nurse colleagues, about the staffing in their EDs, would be helpful as well.


Nancy J. Brent, RN, MS, JD, is an attorney in private practice in Wilmette, Ill. This information is for educational purposes only and is not intended as legal or any other advice. The reader is encouraged to seek the advice of an attorney or other professional when an opinion is needed.