[AntFlip7395]

Originally Posted by LuckyoneRN

To those of you who report strict 1:2 RN/pt ratios, how does your unit handle the situation where there are no step down/general beds available, so ICU pt's are "stuck" in ICU, although being billed at the appropriate (i.e. stepdown) rate? This has happened with some degree of regularity recently, so the OOU pt's that are written out with or without tele/pulse ox are "stuck" in ICU until beds open up elsewhere. We have actually discharged patients directly from the ICU home (although rarely) because of this. I am curious to know how other units handle this, perhaps there may be something to pass on!

Very good question, my unit deals with the same problem on a regular basis and in fact, the whole hospital has had such a high census lately we've been taking "only bed available patients" because there was no place else to put them. This included stable tele and isolation patients who definitely didn't meet ICU criteria. So yeah, that 2:1 ratio has been out the window lately. I can't wait until the census goes down a bit, because quite frankly, these patients are a drain on nursing resources.

[cardiacRN2006]

Our strict ratios are based on ICU patients. If we have tele pts, then they go to 1:4. It's all in the 'status' that the Dr writes. But for Tele pts, we only do Q4 assessements and VS, so they are pretty easy compared to my Q1 VS I/O and Q2 assessments.

But, we dont' have room for that many tele patients. So usually I will get 3 stable, easy tele pts if we have them...

[midazoalm1953]

Normally 1:2. With a critical unstable 1:1. But there have been nights due to staffing where the ratio 1:3. No one is happy with that but no one does anything about it! (I mean Nursing Adm when I say no one does anything).
Then there is the ISSUE of our Stepdown unit. This stupid unit was created as our CCU census was basically null. So our manager CREATED the stepdown unit to maintain staffing. Unfortunately stepdown has become synonomous with DUMPING. We get all the high risk surgical patients, aka elderly trainwrecks that no surgeon with a conscious would operate on normally. High dementia #'s, multiple co-morbidities, drug abusers. Here ratio is 1:3. Their 24hr stay often turns into 3 days.We also get "tele holds" from the ER when there are no beds. You should see their faces when we tell them there are no BATHROOMS in ICU/SSD. They would have been better off staying in the ER.

[grubby98]

at my facility they like to pull icu nurses all over the hospital to cover for call ins and leave us short 90% of the time, the other night i had a fresh open heart been out of the OR less than an hour and 2 other pts. another nurse had a patient on CRRT and Balloon Pump and had to take another patient while they floated 2 of our nurses out becuse another floor didnt staff enough for the weekend. if things dont change im outa their in a few weeks do to not wanting to risk my license anymore.....

[midazoalm1953]

Floating USED to be a real issue with us too. They did the same to us, icu nurses, float us to cover call-ins and leave us short....but when people started leaving and in their exit interviews, all were complaining about floating, and no one ever floated into ICU to help us. The DON actually listened and we no longer can be made to float, but we can VOLUNTEER to float if we want,LOL....needless to say floating has stopped from the ICU.Try and organize a meeting with the DON ans see if you can accomplish anything...goodluck.

[jbp0529]

Originally Posted by LuckyoneRN

To those of you who report strict 1:2 RN/pt ratios, how does your unit handle the situation where there are no step down/general beds available, so ICU pt's are "stuck" in ICU, although being billed at the appropriate (i.e. stepdown) rate? This has happened with some degree of regularity recently, so the OOU pt's that are written out with or without tele/pulse ox are "stuck" in ICU until beds open up elsewhere. We have actually discharged patients directly from the ICU home (although rarely) because of this. I am curious to know how other units handle this, perhaps there may be something to pass on!

In one of the places I worked, we had a method of "billing" the non ICU patients differently than the true ICU pt's. The ICU vs non ICU charge was entered every day in our computer system by our secretary. Of course if they were being billed as a non ICU player, then we treated them as such (vitals q4hrs, I/O once at the end of the shift, if transfer orders were for a med surg unit and no tele then the bedside monitor was turned off until we needed to do vitals, etc).

[tree22_RN]

all our ICU's are typically 1 RN to 2 patients, however those that are unstable are 1:1.
our open heart patients are 1:1 until extubated or hemodynamically stable which can be up to 6 hours post op.
if patients have transfers to step down or general floors with no available bed, we go with their standards or assessments which are every 4 hours for step down and every 8 for genereal floor. so....if we have those types of patients we may have a RN to 3 patient ratio.

[NurseCutie]

On the assignment I'm currently on the norm is 2:1, but it seems as if we're getting "tripled" more often. I was told the Director of the unit doesn't care and has even told the House Supervisor the ICU nurses can be tripled...no big deal to her. I think its completly unsafe and many people will get fed up and leave. I'm sure not staying for another 13 week contract.

[interleukin]

"I'm sure not staying for another 13 week contract."

Good for you, get out of there before your career is bashed by the age-old management excuse, "Well, no one told us what was really happening."

CYA 'cause when the third pt extubates himself and dies they'll be all over you and your lack of "judgment."

[midazoalm1953]

Originally Posted by interleukin

"I'm sure not staying for another 13 week contract."

Good for you, get out of there before your career is bashed by the age-old management excuse, "Well, no one told us what was really happening."

CYA 'cause when the third pt extubates himself and dies they'll be all over you and your lack of "judgment."

Good for you....and document in your nurse notes the same. When I have been stretched, i.e. 3 ICU neuro pt's believe me my notes document- no AM care due to high pt load and acuity, or labs not drawn for same. Let the day shift do it as they have a tech and full staff.
I will say my favorite assignment is 2 vented pt's with sedation...no call bell, or obnoxious calls for fluffing of pillows like you get in stepdown!