[nursewratchet]

Does anyone have a written guideline for 2:1 (2 nurses to 1 patient) critieria? We occasionally have to go 2:1, but there's nothing in writing when a patient becomes 2:1, so constant battle between some supervisors and staff. If you have anything, would you please email it to me or post a link? Thank you!

mkchaka@yahoo.com

[dorimar]

holy crap! we have constant battle just to get 1:1 & the patient could be coding all shift. Good luck with THAT!
Doris

[Zee_RN]

Heck, 2 nurses to 1 patient?! I've never seen it, let alone have a policy for it.

The only thing that came close was a patient who was on CVVH and the nurse assigned to him had just learned the system. So we had 2 nurses in that room for one shift: the new nurse manning the machine, the second nurse taking care of the patient. That was a one-shot deal, though.

[pickledpepperRN]

Recently we had CRRT, IABP, bleeding with transfusions, sepsis, DTs, confusion and agitation, chest tubes, drips, and more. We asked and the cardiologist unit director wrote an order.
Thank goodness because it was a weekend and our supportive sensible manager was out of town. That order prevented time wasted arguing with a supervisor with no ICU experience who seems to think the extra nurses pay comes from her check.

[darienblythe79]

We often have 2:1, occasionally 3:1 or 4:1. Those are usually reserved for really sick VADs with bleeding etc. We have chosen not to have written guidelines because that would hobble us in certain situations. Such as a pt that comes out of surgery sort of okay, then goes down hill. Without written guidelines, we can upgrade the pt so to speak. Thankfully, our supers know that when we say the pt is sick they know we aren't pulling their proverbial chain. It doesn't always work out if there isn't the staff, but we will even triple other pts in the unit if it gets that bad. The unwritten guidelines we have set is,(these ratios are for righ out of surgery)VADs 2:1, heart or lung tx 1:1, IABP 1:1 (always), CRRT 1:1 (always). As I said earlier though, if the pt goes down we will certainly change the ratio to best suit the needs of the pt.

[TraumaQueen]

Our balloon pumps are rarely if ever 1:1, our prisma is rarely if ever 1:1......heart transplants are always 1:1 to start with, VADs are 1:1 and the charge nurse helps, and if you're lucky other people have time to help too.....

I have had instances where one of my patients were so sick that I gave up my other patient to a nurse who was less busy, even if it meant them being tripled.

We are frequently tripled.... so much so that we keep a list of who was tripled last so it's spread out fairly.

We do our best with what we have to work with.... but it sure is tough sometimes.

I love my job, I love my job, I love my job.

[Zee_RN]

Our balloon pumps aren't 1:1 either. Only our CVVH (Prisma, CRRT, whatever your place calls it) are 1:1. Our sister unit, the CVU, has 1:1 for open hearts.

But we're fortunate that we rarely triple up. My unit is really pretty good at keeping the ratio 2:1.

[papawjohn]

Hey Y'all

Here's the thing we need to think about with this question: In reality, if you had a Pt with AIBP and CVVHD and multiple drips and meds and rhythm problems---aren't you always needing one of the other nurses on your team to help out with this, help out with that, do this, do that? Cause you can't leave the bedside? Well, that's how it's been with me when (I was younger and) I had those Pts. Couldn't possibly do it even 1:1.

And did you do your chart 24hr checks? Did you check off the MAR carefully item by item?

Can we all go throw up now?

Of course a decent staffing ratio for some of those Pts would be 2:1!!!

Unless the hospital administration had put it's money where it's mouth is about Intensive Care by building a team and staff that works smoothly together and covers for each other and has a charge nurse that is always 'light' or completely without Pts and can therefore "cover" the nurse taking care of this Pt. Which means keeping RNs on the job when the only thing they have to do is help TRAIN and Co-ordinate the ICU TEAM. Instead of sending them home as soon as the 'staffing ratio' makes it possible.

Remember---You or I can do the most extraordinary things, truly HEROIC things for 8 or 12 hrs at a time. But it is the people who come and go during the 8 to 5 shift and drive Jaguars that REALLY decide what kind of care the Pt gets. And most of them think that Nurse's salary is a net loss on the financial statement that they see every week.

Clueless administration is the reason for most of the poor nursing care and difficult nursing situations that we encounter.

GRUMPY OL'
Papaw John

[zambezi]

It is in our policy's to have 2:1 nursing for VADs (which we haven't had in over 3 years) and CRRT with calcium citrate (only because it is a new policy for us- now that we have used it a bit we rarely staff 2:1 for it- we will try if we have someone wheo is just learning the machine and protocol).

IABPs and CRRT generally 1:1. Fresh, intubated, hearts are generally 1:1 (but not always).

Other 2:1s that are not in the written policy include: cracked chest in the unit (usually more like a 3:1 initially) with multiple, continuing transfusions or other issues (often we will have lots of helpers that have other stable patients), CRRT and IABP combined...if the patient needs to be 2:1 we try to get others to help...or will assign one other "easy" patient with the one that is running their a$$ off...it kind of depends on the situation. Thankfully there is usually no shortage of those willing to assist in an emergency if their patient is stable!

[amyindallas]

If you don't mind me asking....at what facility in Houston do you worK? I'm considering moving to Houston.

Originally Posted by darienblythe79

We often have 2:1, occasionally 3:1 or 4:1. Those are usually reserved for really sick VADs with bleeding etc. We have chosen not to have written guidelines because that would hobble us in certain situations. Such as a pt that comes out of surgery sort of okay, then goes down hill. Without written guidelines, we can upgrade the pt so to speak. Thankfully, our supers know that when we say the pt is sick they know we aren't pulling their proverbial chain. It doesn't always work out if there isn't the staff, but we will even triple other pts in the unit if it gets that bad. The unwritten guidelines we have set is,(these ratios are for righ out of surgery)VADs 2:1, heart or lung tx 1:1, IABP 1:1 (always), CRRT 1:1 (always). As I said earlier though, if the pt goes down we will certainly change the ratio to best suit the needs of the pt.