[Vikingnurse]

I need some more information in your nurse to pt ratio. We are ALWAYS 1:1 day, evening and night. But then again we deal with everything medicin, personal care, ventilator "things" (suction, ABG's etc.) Both day and evening shift we have what we call serviceassistents. They do the cleaning, help with mobilisation and some other helpful things. In the daytime we have 2 ekstra nurses that also help with whatever.

If I understand it correctly you have respiratiory therapist and perhaps other similar proffessions around the patient.
What I would like to hear is how many healthcare proffessionals are around the patient.

[Sister S]

Yep - so if the patient is ventilated they have 1:1 nurse. It's a 5 bed ICU ward (we don't separate surgical/medical etc, and there's a nursing float for the ward to fetch and help with stuff and answer met calls. Other than the Intensivist, physios visit once a day and the dietician visits once a day, but that's it. It seems to work. Other ICU patients can be 2:1 if they're not invasively ventilated.

[parko]

Originally Posted by cardiacRN2006

Why only 1:1 for ventilated patients? I find them to be the easiest...

It's a safety issue, not a matter of them being "easy" (which sometimes they most certainly are!!)

Ward policy states that our Ventilated patient's are never to be left unattended. We don't have assistants or anything (apart from the PSA, who we grab if we need a turn or to run bloods to pathology), you as that pt's nurse do all care for the whole day, there is noone (besides the nurse next door to you) who can step in if you are called away/need to grab supplies etc etc. If that happens (including covering for breaks) then you need to let them know and they step out of the room in a spot where they can see both patients and all monitoring systems. This is why when going for breaks, all your IMEDs need to be up to date, nothing should beep or alarm (you know, unless they're sick or something ). The covering nurse should be able to sit at their desk and observe.

Originally Posted by jedimasterr

When the hospital is full and we can't transfer patients, we are expected to follow the protocols of the unit the patient should be on

For the most part though, we are expected to float to any unit except the ER and as you would expect just about no one likes that.

Yep, if the patient is wardable they go to 4th hourly obs.

You don't get flicked to ED? That's the first place we seem to end up!

Parko :-)

[RNFELICITY]

I am currently in an 18 bed ICU which gets a litle bit of everything. Routine staffing is one nurse to 2 patients and we go to 3 patients when push comes to shove or we can't get another nurse. We also will triple up if we have a non-Icu overflow pt.

CRRT pt's are always a 1:1 here.


I ahve worked in other ICU's where 1:3 was routine no matter what they were...EEK!!!

[midazoalm1953]

WOW....reading all these stories...it is reallly getting out of hand in the ICU....my latest story....I was scheduled for my "week" in stepdown, came in last Sunday eve, ( my 5th nite that week in the stepdown hellhole) to find I was alone with 2 ICU overflow pt's! I immediately called the supervisor and asked if there was any help available and of course was told NO! So when I told her how my nursing notes would reflect that that no pt was going to be turned, am care would be forgone and no labs would be done because of the unsafe staffing......lo and behold a magical med-surg nurse was found and sent to help me. Amazing how if you state you are going to document unsafe staffing it is addressed.
Of course at 2am I was asked to do a recovery as I had "help" in the unit.....the RN was actually very helpful and was interested in all the things we do in ICU/Stepdown.....

[RNFELICITY]

Originally Posted by midazoalm1953

WOW....reading all these stories...it is reallly getting out of hand in the ICU....my latest story....I was scheduled for my "week" in stepdown, came in last Sunday eve, ( my 5th nite that week in the stepdown hellhole) to find I was alone with 2 ICU overflow pt's! I immediately called the supervisor and asked if there was any help available and of course was told NO! So when I told her how my nursing notes would reflect that that no pt was going to be turned, am care would be forgone and no labs would be done because of the unsafe staffing......lo and behold a magical med-surg nurse was found and sent to help me. Amazing how if you state you are going to document unsafe staffing it is addressed.
Of course at 2am I was asked to do a recovery as I had "help" in the unit.....the RN was actually very helpful and was interested in all the things we do in ICU/Stepdown.....

it is just apalling sometimes.

[cardiacRN2006]

Originally Posted by parko

It's a safety issue, not a matter of them being "easy" (which sometimes they most certainly are!!)

Ward policy states that our Ventilated patient's are never to be left unattended.

That's just so bizarre. I guess I don't understand the safety aspect of it. My vented pts are sedated and restrained. I find that sometimes non-vented pts warrent much more of my attention. But we rarely have unintubated pts in our ICU.

I would love to work where vented pts are 1:1! I'd even do overtime, lol.




ETA: I think I just remembered something...You guys don't have RTs down there right? So you are doing all the vent stuff. That makes way more sense now.

My apoligies...

[Vikingnurse]

Originally Posted by cardiacRN2006

That's just so bizarre. I guess I don't understand the safety aspect of it. My vented pts are sedated and restrained. I find that sometimes non-vented pts warrent much more of my attention. But we rarely have unintubated pts in our ICU.

I would love to work where vented pts are 1:1! I'd even do overtime, lol.

How sedated are your patients and how often do you use restraints?

We don't use restraints at all and we use little or no sedation (with a few exeptions).
If we have a patient in risk of selfextubation or could do harm to him or herself in any other way, we use nurse- or medstudents who want to earn some ekstra money. They make sure that central lines, arteriallines and all the other things stay in place and of course the patient stays in bed. And they are are an extra hand when needed. Workes perfectly.

[midazoalm1953]

Hmmm....no to little sedation and rare restraints! Well most of our patients are sedated, usually diprivan 75-85%, and restriants @ 90%....unless a family member is at bedside, then we release restraints....but no sedation? My experience it it is very difficult to ventilate a pt w/o sedation...too much high pressure and asynchrony with the vent......

[cardiacRN2006]

Originally Posted by Vikingnurse

How sedated are your patients and how often do you use restraints?

We don't use restraints at all and we use little or no sedation (with a few exeptions).
If we have a patient in risk of selfextubation or could do harm to him or herself in any other way, we use nurse- or medstudents who want to earn some ekstra money. They make sure that central lines, arteriallines and all the other things stay in place and of course the patient stays in bed. And they are are an extra hand when needed. Workes perfectly.

Well, my last pt had 250mcg of Fentanyl and 20mg of Versed per hour. That seemed to do her alright. No restraints for that one.

For the pts who aren't so sedated they are restrained and on something likne 50-100 mcg of Fent and 2-10 of Versed.


And sometimes we interchange Propofol with one of those, and sometimes, pts get all three. But they always get 2 of the 3 when they are vented.