[koleaga]

Hi
I'm an Australian adult ICU nurse who is now in in a PICU in the New Orleans.
There is no way ozzie nurses can double up.Firstly,here you don't touch the vents.I can only touch the Fio2.I don't even give nebulizer treatments(i can but tha'ts resp therapists job).When patients are admitted from OT/Er and they require a ventilator the resp tehrapist sets everything up and attaches patient.We are allowed to suction but we don't tie ETT tapes,do trachy care.
Secondly,when you need you drips you scan an order down to phramacy and they draw it all up for you and send it up.
Everything is computerized and there'sfar much more virtual paperwork.
There obviously are pro and cons to both systems but you are expected to do alot more Oz.
Hope that sheds some light,the two systems are completely different

[littleneoRN]

I don't work in the PICU, but I have friends who do. Most of the patients are 1:1, except in urgent staffing situations or stable kids preparing for transfer to the stepdown. Like previous posters said, stable vents can quickly become unstable vents. On average, in a 22 bed unit there might be one doubled assignment.

[koleaga]

Hi

Is this is the USA and may i ask where as iwould love to come there is it is a 1:1 ratio most of the time.

Thanks

[xkimmie518x]

Most of our kids are 1 nurse to 2 kids. Usually vented, stable, but still busy.

We also do these configs too:

2:1 - Not too many of these.
1:1 - Fresh transports (if intubated). Cardiac kids- they stay 1:1 until extubation.
1:2 - Both can be vented and on drips. If the kids got an ETT, they will be on at least a Versed drip. A lot of times you'll have a vented kid with a "floor kid".
1:3 - Usually all floor care kids, just waiting for a bed. I was told when I was hired that you would not have a vented patient in a triple, but I have seen it (granted the vent kid was trach'd and awaiting to be d/c). We've been seeing these more often.

Our RT's do all pulm meds, vent checks, changes, set ups, extubations, sometimes cpt/sxn if the patient needs it when they're in there.

[RNNPICU]

Where I work you are either paired or a sick 1:1. The Respiratory Therapists do a lot - help suction, make vent changes per MD orders, do vent checks, are there for intubation, extubation. They are incredibly helpful

[kessadawn]

In my PICU, nearly all nonintubated patients are a 2-patient assignment, and that includes stable, established trachs who are vent-dependant. Exceptions might be a really sick busy hem-oc kiddo with lots of blood products, labs, antibiotics, etc. Or that RSV baby retracting so hard he's turning inside out, and you just KNOW you'll be tubing him soon. ALL intubated patients are a single patient assignment, and most patients on CRRT are too. The travelers who come to my facility say we are a rarity when it comes to our ratios. Maybe it's because of the way our unit is set up. 24 private rooms, nurses stations in the far corners of the unit, if you're in a room you can't always hear the vent in the next room alarming unless in real doggone quiet. Makes for a good time when these kiddies like to pull out their trachs!!!!

[koleaga]

where do you work?

[kessadawn]

I work in Akron, Ohio.

[sagreeg]

Hi there
I read a few of your comments and staffing ratios. Is there anyone out there who can direct me to something on 1:1 nurse patient ratio. I am looking for a tool to calculate this ratio, or better yet, Need to justify 1:1 in the critical care setting. Studied the NEMS, but this does not tell me that the nurse patient ratio is 1:1.
Please help

[irisRN]

i think it all depends on your staffing. If you have the ideal number of nurses, then your kids who are intubated and on drips would have a 1:1 ratio. When we do 2 patients to a nurse, they can both be extubated, or one intubated/one stable. We never do 3:1 ratios...i think that would be very unsafe in the ICU setting. I personally have never had 2 intubated patients at the same time, but i guess anything is possible if we were short on staffing. typically, the assignment is 1 extubated/1 stable, 2 stables, or 1 sick intubated pt per nurse.

The other thing to consider is that not all PICUs are the same. I have visited other PICUs at big hospitals...and their patients would go to our floor, not the icu. And, vice versa...if one of our chronics come through their ER, they would be prompt to transfer them out of their hospitals and into our icu.

As far as RT goes...they are usually a phone call away, they come and check on our patients a few times per shift. The nurses do all the suctioning, most vent changes, ETT taping, etc. If we need them for any of these things, its pretty easy to get them to the bedside. I actually like that we can do these independently and not have to wait until a RT comes by, and that if we need them, they come pretty quickly. Its a good system, IMO.