The AAEM issued an Emergency Nurse-to-Patient ED Staffing Ratios Position Statement in February 2001. Part of the Statement says, “AAEM asserts that, as a guideline for comprehensive, moderate acuity emergency departments, the minimum emergency nurse-to-patient staffing ratio should be 1:3 or based on the rate of patient influx such that the rate of 1.25 patients per nurse per hour is not exceeded. In addition, dedicated triage and charge nurses are necessary in higher volume departments.” The entire Position Statement is available at the following Web site: www.aaem.org/positionstatements/nursetopatient.html. The AAEM also asserts that the emergency physician staffing ratio should be based on the rate of patient influx so that the rate of 2.5 patients per physician per hour is not exceeded. Rate of influx means, on average, how many patients arrive in the emergency department in any given hour. Having physicians advocate for reasonable emergency nurse staffing is one way to advocate for our patients. Already one medical director has indicated that the AAEM position benefited his staffing proposal. 1—Tom Scaletta, MD, FAAEM, Chairperson, Department of Emergency Medicine, West Suburban Health Care, Oak Park, Ill; E-mail: [email protected] Reference 1. Scaletta T. Counting on nurses [on-line]. Common Sense (AAEM newsletter) 2000;7(6):15-6. Available from: URL: www.aaem.org/rulesofroad/nurses.html I appreciate the support of emergency physicians for emergency nurses, especially when it comes to our efforts to promote appropriate nurse-to-patient staffing plans. Two membership organizations represent emergency physicians. The American College of Emergency Physicians (ACEP), formed in 1968, represents more than 21,000 emergency physicians. It has supported ENA's endeavors to benchmark ED nurse staffing and has not published any nurse staffing recommendations. The AAEM, founded in 1993 and representing about 2700 emergency physicians, adopted an emergency nurse staffing position statement in February 2001. I believe that the AAEM nurse staffing position statement has some shortcomings, including the following:1.The AAEM 1:3 ratio does not address “holding” patients. Admitted patients held in the emergency department should be provided the same level of care that would be provided on the inpatient unit, which could mean 1:1 or even 2:1 registered nurse (RN)-to-patient ratios.2.The RN-to-patient ratio should address multiple variables including acuity, patient census, demographics, departmental needs, and clinical staff needs.3.All direct caregivers—RNs, licensed vocational nurses/licensed practical nurses, and unlicensed assistive personnel—are a factor and must be considered.4.I believe that the decision to exclude charge nurses and triage nurses from the ratio should be based on census. I encourage ED nurses to continue to work with our membership organization, ENA, toward an ENA-developed formula that would consider these aspects of staffing. —Diana S. Contino, RN, MBA, CEN, CCRN, President, Emergency Management Systems, Inc, Laguna Niguel, Calif; E-mail: [email protected]; www.ConsultingEMS.com JCAHO has identified pain relief as a patient's right and required facilities to implement specific procedures for pain assessment and management by 2001. These procedures include assessing measures of pain intensity and quality (pain characteristics, frequency, location, and duration), documenting in a manner that facilitates regular assessment, and providing staff education on pain assessment and management. 1 Our hospital actually began work on these issues several years ago with a hospital-wide Pain Committee and a mandatory pain in-service session with a video series. This year we developed a hospital-wide pain policy, a copy of which all ED RNs read and sign. Our triage sheet has a printed 1 to 10 pain scale for adults and the Wong faces scale and CRIES scale for pediatric patients. I regularly perform chart audits for pain assessments at triage, before medication is administered, after medication is administered, and at discharge, and provide feedback. Not surprisingly, I have found that the longer the expected assessment is part of the protocol, the better the compliance. We have excellent compliance with pain assessment at triage (our oldest component); our poorest compliance is with pain assessment at discharge (our newest component). To improve compliance, the next time we revise our charts, I hope to add specific areas for medication and discharge pain assessments. My experience is that documentation is more complete when specific lines or boxes are provided to record the information as opposed to when staff are expected to remember to include the information in their general nursing narrative. As a side note, the research literature reveals that some common misconceptions about pain still exist, particularly for elderly persons and members of minority groups. 2,3 It is a myth that elderly persons have decreased pain sensation 4 and that cognitively impaired elderly persons do not feel pain. 5 It has also been found that the pain of persons who belong to minority groups is (largely unintentionally) undertreated. 6 I believe it is important to report these findings when educating staff about pain management.—Cindy Bruns, RN, MSN, CEN, Emergency Care QA Management Coordinator, Tallahassee Memorial Hospital, Tallahassee, Fla; E-mail: [email protected]