Wow, Jenny, your unit sounds better staffed than mine! Our charge nurse always takes a full assignment and we have a secretary from 7a-7p only. Our unit is divided into two halves, 10 beds on each side, but we only have 16 beds open. We usually try to have 8 patients on each side. On weekdays we have a secretary for each side if census is high enough (or if there isn't a shortage in the hospital; then we only have one).
Our biggest problem lately is that administration says we have to take as many patients as we can staff for the next shift. So if we have 9 nurses scheduled for day shift (and no hearts on the schedule that we know about), the nursing supervisor has the authority to admit up to 18 patients on night shift (after the hearts from that day are extubated they go to 1:2 ratio, freeing up a bed or two or more depending on how many hearts we had that day). If a unit is "over" in house, they will pull a nurse to us, give them the "easiest" assignment and then open up a nurse to "task" for admitability (help everyone else, including three floors in the hospital, until they get one or two admits). The problem with this is that they are pulling nurses will little to no ICU experience and in essence, we have to watch their patients, too. The last time that happened when I was working, the pull nurse would sit at the desk and wouldn't even answer the phone and had a patient on dopamine that was being titrated for BP. I happened to pass the room and noticed his pressure was in the 70s. I told her and she came and looked at the monitor and said, no, look it's 92. Except she was looking at the SpO2, not the BP. She had not even been oriented to our monitors and didn't know what she was looking for. I ended up having to keep an eye on that patient in addition to my 2 sedated vent patients and help her titrate the dopamine. Then the "task" nurse admitted two patients, one that was a post code and the other that had been going downhill and they started coding about five minutes after she rolled into the unit. To top it off, another heart had been added on to the surgery schedule that no one was aware of, so when we changed shifts that day, we had 18 patients and needed 10 nurses, but we only had 8 scheduled. We couldn't even start report till after 7 because they couldn't figure out how to do the assignments two nurses short. At the time our census was supposed to be a max of 14.