ICU Staffing?

  1. I work in a 6 bed ICU/CCU at a small community hospital. The administrators are VERY money conscious around here to the point that they could care less about pt safety, in my opinion. Earlier this year, I was left ALONE with a pt on a vent that was a full code. :angryfire

    The other RN was put on-call. Last Friday, after 3am, I was left with an RN, who is a new employee (this was her 4th night working here) and has NO med/surg acute care experience. She'd been a nursing home RN her entire career. We had 4 pt's. I of course had the vent pt that was a full code, with an a-line, several gtt's. Thankfully nothing happened but I felt that the entire situation was unsafe and I let the Nursing Supervisor know about it before I took report. She "tried" calling my nurse manager and never got a call back. They (nursing admin) felt that it was fine to leave me with a new employee with no acute care experience!!!!:angryfire

    Tonight, I have one pt. She's a DNR. Nsg Sup pulled the other nurse up to the med-surg floor to float. Should there be a new admit to ICU the other nurse would be pulled back to ICU. So, here I sit ALONE with one pt in an ICU. EVEN THOUGH the staffing policy clearly states that in ICU for one pt there is supposed to be an RN and a nurses aide (ours is off tonight). Apparently the CEO of the hospital would get really upset if they paid TWO nurses to sit in ICU with one pt. So, that's why they pulled the other nurse.

    Personally, I don't think that this situation is safe either. This is why I get irritated with this place. My yr is up at the end of February. Hopefully, I can get back into the other hospital where I initially started my nursing career. To be honest, I don't see myself working here much longer when Nsg Supervisors pull stunts like this and don't see the problem.

    What say you?
    Last edit by RNforLongTime on Dec 14, '06
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  2. 16 Comments

  3. by   augigi
    1:1 care seems fine to me, and I've done it many times in small ICUs. However, 4 patients, including one ventilated patient, is too many for 2 staff - especially with a new nurse who has no acute experience. What if yours coded, and another 2 went south?

    Make sure you document your concerns with dates, times, and details IN WRITING to the nursing manager to cover yourself for the future.
  4. by   RNforLongTime
    Oh believe me, I have done that and it's gotten me nowhere. The more I voice my concerns, they start labelling me as a "complainer". I see myself as an advocate for patient safety. What I don't get is that the other RN's in the unit don't seem to have a problem with the staffing.
  5. by   augigi
    They are either extremely naive or extremely stupid, or haven't seen what happens when mutiple patients crash at the same time.
  6. by   RNforLongTime
    I don't think that this ICU has ever had that problem of more than one pt crashing at the same time. Typically, our pt's would be in a step-down unit at a larger facility. So, in that regard they are,both naive and stupid.

    That night, I prayed really hard that nothing bad would happen and thankfully it didn't.
  7. by   GardenDove
    I also work in an ICU/CCU with 6 beds in a small hospital. Your first scenario with 4 pts and a new to the hospital nurse sounds absolutely unsafe and would never happen where I work. Your second scenario sounds ok as far as the standards where I work. We, however, are just a step away from Med/Surg, and we monitor their tele pts. Yes, we have one nurse there if there is only one pt. At night we don't have a nurse's aide and will borrow someone from Med-Surg for turning, etc. Ours is a combo ICU and Stepdown Unit.

    I work 12 hour nights btw. On days they have a tele-tech/CNA/unit secretary gal. She often gets floated, however, so they often don't have an aide if it's not super busy.

    It can get instense at night if we fill up, but I'll be honest with you here, we can get quite a bit of kick back time as well. The census fluctuates quite a bit. I think in a small hospital you have to be flexible. But, your first scenario sounds totally out of bounds as far as safety.
    Last edit by GardenDove on Dec 2, '06
  8. by   LoraLou
    I would personally never sit by myself with one patient, regardless if they're a DNR or a Full Code, obviously the DNR I would feel a little more comfortable with, but a Full Code and you said that they were vented? I would prefer another nurse, but at least a tech, what happens when you want to go to the bathroom? extremely unsafe! Most BON have 'assignment by objection' papers, if you're not getting any response from the NM or the nursing supervisor I would be filling one of those out everytime a situation like that arose.
    Lora
  9. by   jbp0529
    Staffing at my place is (thankfully) very safe. We can never ever have less than 3 nurses. I suppose this is the result of many confrontations over the years between nurses and managers. Sounds like you were put in a potentially bad situation, nurse-lou. If things arent going to change at your current job, and it sounds like they wont, then maybe you should go back to your original place.
  10. by   nutsyrn
    Hi, I'm new here. I just found this forum today. I also work in a small community hospital ICU/CCU. We have 7 beds. Staffing is usually pretty good when we have 1-3 patients. We are required to have 2 RN's on any unit in the hospital at anytime we have 1 patient. I thought this was a JHACO recommendation. Our patients also would be in a step down unit in a larger hospital. What they did to you is VERY wrong!! I would be out of there in a heartbeat! It's not worth loosing your license over.
  11. by   robred
    I found myself in this situation in the 6 bed small community hsopital in which I worked for 8 years. A change in management led to policies in pt care (such as what you are exposed to now) and I left the place two weeks later and have never looked back. These are extremely serious issues; I did not want to be on the defendant's stand at a nursing malpractice trial after a patient under my care died, in essence, due to lack of immediately available help. Although I took a pay cut and underwent inconvenience (I commuted 40 miles one way to my next job) I was able to look myself in the mirror knowing I did the right thing by leaving.
  12. by   CardioTrans
    Ok, first thing........... 4 pts with you and a new nurse........ unsafe.
    1:1 is fine IF you have someone else with you............. what happens if there is a code on the floor that you have to respond to???
    what about potty break.....lunch.....

    That is not a good situation to put yourself in. What if you had went to the potty......... the pts family came in.........and they couldnt find you??? Do you think that they would have been so polite to the nursing admin??? Or to you???

    Im sure that you like your job, other than the apparent issues, but its not worth risking your hard earned license over.
  13. by   RNforLongTime
    So, TODAY after working a 12 hour shift, 8 of which were with a new RN who oriented with me when I started at this place back in February but left our ICU for OB back in July, my boss tells me she has to speak with me about some issues.
    One of which was my "complaining" about the staffing issues. Basically I was told to put up or shut up. "It's gonna happen, you are going to be left in here by yourself with a vent patient." I told her but it is NOT safe. She replied, "you have your CCRN you should be able to handle it". BUt that is not the point, even our staffing policy says I shouldn't be left alone. She said she knew what the policy said but that it's gonna happen.

    Well, after THAT convo, I have decided that I am going to start to put together my resume and get some apps out. I cannot continue to work there when the manager knows that certain situations are unsafe, yet continues to allow it to happen.

    Unfortunately, I was fired from a job at the beginning of this year and have been "black-balled" so to speak by the other large hospital where I started my nursing career. It's a small town so at each of the two larger hospitals, someone from one place knows someone from the other and vice versa and you know how people talk. I work at the "pet clinic" so says one of my friends. And it's for reasons like this that I can't jeopradize my license.

    For whatever reason, I don't think that the manager realizes that HER License could also be on the line.
    Last edit by RNforLongTime on Jan 1, '07
  14. by   NURSJADED
    its not worth losing your license over. if you accept the unsafe assignment and something goes wrong, its your fault. i would bet that your state's nurse practice act tells you that its your responsibility not to take an assignment you know is unsafe. if you have a contract to finish up there, tell them you'll do it on another unit and refuse to float to icu if there's an unsafe assignment.

    also, on your way out the door..joint commission international center for patient safety - file a complaint..

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