staffing - page 2

by matthewrn03 | 2,268 Views | 18 Comments

So i keep reading horror stories about crazy CVICU and CCU ratios. i work in california where the ratio is ALWAYS 1:2 or 1:1. are you really expected to take 3 patients in other states? also how long are your fresh hearts 1:1... Read More


  1. 0
    I forget the exact circumstances, but I was mandated once (short staffed) in my CVICU to stay over into day shift from nights, handed 4 patients with the rationale that I would transfer one out and be _only_ left with three.
  2. 0
    When I worked in the CCU, there were times that we would have 3 patients if the other 2 were stable. I have refused a 3rd patient before and was very glad that I did because one of patients, that I was supposed to be transferring out (and was getting flack for not transferring out), actually went bad (had to take for stat CT Brain- neurochecks q15mins, replace Foley stat, send cultures, start IV Decadron stat) and ending up being almost 1:1. My other patient that I had received earlier from the ER was on a drip and unstable and they were trying to give me another ER patient. Luckily they pulled another nurse to our unit because the second ER patient was also unstable and I was not going to risk my license. Our IABPs and CVVHD were always 1:1. How can a supervisor/manager think that you can do more than one patient when you have an IABP or CVVHD? Have they never taken care of these types of patients before? That's sooo unsafe for the patients!!!
  3. 0
    I'm afraid we are going to be getting into this more and more. The solution for controling health care costs (medicare/medicaid) seems to be "reducing reimbursement!!! When hospitals have to have the drugs, equipment, lab supplies, as well as marketing and recruitment issues, Nursing services are the only significant expence they can cut and still keep thier accreditation. Triple assignments in critical care and reducing the level of experience of the staff will be a choice most hospitals are going to have to make in the next few years.. Most hospitals are down to the nitty-gritty as it is. Depending on the market- the choice may be triple the patients in CCU or lock the doors. I'm glad I'm <5years from retirement. I hope I make it. I've only been tripled a few times and still have nightmares.
  4. 0
    I work in a mixed ICU (medical, surgical and hearts). Our hearts are usually 1:1 for at least 24 hours (more if needed). I have been tripled more times than I can keep track of. We have had a nurse with an IABP that was made to take on a second patient on the opposite end of the unit. They try to make nurses who have never been formally trained how to operate an IABP take those patients because we all completed an online tutorial, so therefore we should all be competent enough to handle those patients...One of the nurses was told by the nursing supervisor that she was going to have to take another patient (one of her patients was maxed out on every vasopressor and on the verge of coding) because he said that her patient was already on everything so there was nothing else for her do do--this supervisor obviously has no ICU experience. We have an absolutely no agency policy and are short staffed, so it is not unheard of to have 3 nurses tripled on a shift. It is because of all this crap that I am in grad school to be an NP so I can get away from these unsafe practices--I will not risk my license forever so the hospital can make a buck.
  5. 0
    I work in a high-risk CVICU (we do VAD, Transplant, IABP, CVVH, ECHMO etc. etc.). Machines with the exception of long-term VADs are always 1:1, though recently they've been starting to pair more fresh VADs (2-3 days out of surgery) with another patient which is just plain unsafe. I don't know how you can pair CVVH, IABP. Those are some of the sickest patients on the unit, there's a reason why they're on a specialty machine!

    Our sickest are 1:1 but that doesn't always happen, very rare though to go beyond 1:2. Some of these 1:2 pairings though are just insane as well Generally if out fresh hearts are "stable" 4 hours out of surgery they're paired, sometimes with other fresh hearts 4 hrs out of surgery, and my definition of stable is a lot different than management's. That of course doesn't always happen either, i've been paired fresh heart 2.5hrs out of surgery before.

    Hospitals only care about money, they're becoming like what they were in the early 1900s, except instead of ppl dying of infection, they're getting unsafe care that could lead to increased mortality with under-staffing when we have countless new grads looking for jobs.

    I can't wait until I leave the ICU one day, it's broken me...
  6. 0
    Our staffing is anywhere from 2:1 to 1:3 depending on acuity. If you have three patients, none are intubated. We don't get open hearts... we have a separate unit for those. 2:1 or 1:1 is almost always induced hypothermia patients post cardiac arrest. Our balloon pumps are usually 1:2 or 1:3 depending on acuity. We get balloon pumps that are pretty stable sometimes. The main thing that we complain about is needing a float nurse or a PCA or LPN or someone to help with turning and baths. It gets annoying when you are ready to turn for an hour but can't find anyone to help. I think acuity on cardiac ICU's varies a lot more than other ICUs. We keep some types of patients through d/c.
  7. 0
    look frankly, i am appalled that some of you have to pair IABP's. sure, MOST of the time, the machine handles the timing but i have noticed these patients are "squirrely" (even intubated and sedated) and having personally seen a patient lose a leg with an IABP(not my patient thank god), i can not even imagine a scenario where i would accept a 2nd patient. as healthcare costs continue to rise, there is going to be a time where we all need to band together and say "enough" to management. find another way to cut costs; my suggesstion is cut back on HR and other admin's, lol.
  8. 0
    Quote from matthewrn03
    i can not even imagine a scenario where i would accept a 2nd patient. as healthcare costs continue to rise, there is going to be a time where we all need to band together and say "enough" to management.
    Unfortunately, in several states that would be a ticket to the front door and immediate unemployment. There are plenty of new grads out there that don't know any better and are gladly willing to take our jobs.
  9. 0
    As "charge nurse" for an extra dollar an hour we still carried a 2 pt load in the ICU/CCU. Our house supervisor had 1 year of a regular pediatrics floor background (not nicu or picu) then went into various supervisory positions. My gut told me she did not understand a thing I gave to her in report. But I would give her the benefit of the doubt. Sure enough I quickly found out she did not understand even the drips we were running or anything about the diagnosis's we cared for. As charge I took the 3 pts one night because one was to transfer, (walkie talkie) we had several very unstable pts that night. She -the pt, was helped up to transfer and coded. Part of the charge duty was to make sure pts properly assigned for staff skill level, help in learning opportunities. As well as giving verbal report no less than five times during the course of my 8 hour shift. House physician included.
    P.S. We all learned quickly how to use the house supervisor to our advantage.


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