Just curious; Would this pt be one-on-one in your ICU? - page 2

Septic, vented, Swann-Ganz, Q1hr peak airway pressures, Q2hr blood sugars, Q6hr CBC/lytes/lactc acid/ABG's plus PRN labs making it more like q2-4hr labs, gastric tonometry with Q1hr PgCO2 readings... Read More

  1. by   CC NRSE
    no such thing as 1:1 where i am. only time that happens is when you have transfered one patient out and are waiting for the next (train wreck or fresh open heart) patient to arrive. we try to pair patients like this with a lower acuity patient,..but that's not always an option. i also agree maybe a more experienced nurse should have taken this patient,... but in this day of the "nursing shortage" even that is not always an option.
  2. by   ERNurse752
    There's definitely a common theme here.
    That's the way it is where I work, more so in the CICU as opposed to the M/SICU though.
  3. by   prn nurse
    No one-to-one in my hospital...one-to-one is definietly a thing of the past. Ditto what other posters said...one gets ignored. Fresh open hearts are one-to-one for 4 hours also, and IABP are never one-to-one as years ago. In 1985, I had one patient , with IABP, and a pump tech. those days are loonngg gone !! And yes, there are more infections, and complications...but, Hey !!! The corporation netted $75 million dollars in 2001 after all expenses were paid. So, who cares if a few died of septic wounds, septic septums, renal failure.....and a few toes turned black and feet amputated, a few never got weaned??????????
  4. by   Stormy
    Definitely 1:1 here! The only time we double a vent is when they are loooong term/stable. Then they might be doubled with a stable uncomplicated pt. But only maybe.
  5. by   sharann
    I think I'll stay in PACU where I am safe. The fact that 3:1 was even mentioned here makes me shudder. I have had 2 sometimes 3 fresh(right out of OR)pts, but I can tell you that this is managable for only a brief period of time. This sounds really scary to me. I was gonna suggest Grouchy's pt should be 2:1 (LOL right!)
  6. by   shamadoosky
    Nope, not a 1:1. Even when one of your pts code, or you get a floor code for your 2nd pt., it's pretty rare to be able to make anything and then keep it that way for more than a shift. Staffing is always too pathetic. But that pt. you had definitely should be paired with a stable pt. who was not as busy.
    We have two vent pts all the time, since most of our pts are on vents. One time I had two patients on vents, and one of them had a separate vent for each lung, and 4 chest tubes.
    We also have 'Concentrated Care' patients within our ICU and take turns doing those 3-patient assignments. YUCK! Hate it!
    I'm movin' to Canada too!!!! The ratio sounds much better there.
  7. by   JMP
    Yikes........ these posts scare me. I can not even imagine the scenes you guys are painting. No wonder the States has such a shortage of critical care nurses.

    I have been thinking long and hard about moving to the states, for more of an adventure and learning experience than anything. However, these posts are certainly a WAKE up call for me.

    One question, are you using paper charting or electronic? Does it even factor in as a time saver? We are still using paper and it does take a fair amount of time.

    Do you have rounds every day? These take a fair amount of time, we have to stand in on rounds, give a head to toe assessment of our pts and any areas of concerns- issues?

    Just wondering??

    J.
  8. by   mattsmom81
    I am so impressed with Canada...the national healthcare plan, the union, the BSN mandate and how you guys handled it. And your salaries stay pretty good through it all too!

    Hopefully the US will follow our northern neighbor's good examples!
  9. by   l-andre
    Just so you don't think Canada is heaven!!

    I work in Montreal (Quebec) and this patient might very well not have been one on one. And yes, we make rounds everyday, and no we don't have electronic charting! Althought, I think this patient might have been taken care of by a more experienced nurse if not one on one (...we try!).

    I work nightshifts and more than half of my staff have less then 2 years experience, so we do our best to "pair" then with more experienced nurses in the same unit. We do our best... but those things happen. And one on one really depends on the staffing...


  10. by   -jt
    <<Just curious; Would this pt be one-on-one in your ICU? (Post# 1)

    Septic, vented, Swann-Ganz, Q1hr peak airway pressures, Q2hr blood sugars, Q6hr CBC/lytes/lactc acid/ABG's plus PRN labs making it more like q2-4hr labs, gastric tonometry with Q1hr PgCO2 readings and Q6 PgPi/Ph readings,Q4hr CVP readings, to OR and back for debridement of necrotic pancreas, on Versed drip, etc, etc..Nurse with < 6 months ICU experience. Also got an admission. Is this alot, or is it just me?Just curious...>>

    No vasopressors? No crashing V/S? Not unstable? Then no he probably would not be a 1:1 in my ICU but he would be given to an experienced RN - which we all are anyway. He sure wouldnt be given to a new grad on her own but could be assigned to a preceptor with a new grad. If that was the case, he would be a 1:1 so the preceptor could have the time to teach the new grad about what they were doing & not just show how to do tasks. Otherwise it would be assigned to an experienced RN with another fairly stable, easy pt. Not with an admission.

    Our minimum staffing ratio is 1:2 - we have 1:1 for very unstable pts. Even if this pt was stable, if it was too much to take this pt with another and the RN objected to the assignment but it wasnt fixed to allow her to have just that 1 pt, she could submit our unions protest form to our hospital. Usually that will get the supervisors to miraculously find staff so this pt could be a 1:1 if necessary. If they dont, then at least the form would make the hospital responsible for anything that goes wrong with that assignment instead of leaving the RN holding the bag - but the pt sounds like a typical ICU pt and we get those with another less busy pt.
    Last edit by -jt on May 2, '02
  11. by   fedupnurse
    I'd feel lucky in my unit if that patient wasn't a 1:3! My hospital is like a giant float pool. We are a 24 bed unit. Our acuity demands a 1:2 maximum ratio. Most of the staff on nights have <3 yrs. experience with 5 here less than 1 year! We should have 12 nurses providing patient care and we routinely have 8. Our managers sit in their offices while we try to take care of our 3 and keep an eye on the new staff so they don't inadvertantly kill anyone. There are times when I feel like flicking a bic to my nursing license! So no, you are not alone. It sounds like your hospital is similar to mine.
    Good luck.
  12. by   grouchy
    Thanks for all the responses. It was fascinating-and scary- to see the differences in staffing between different ICU's, and especially between the U.S. and Canada.

    My gut feeling is that I could have handled having this pt along with one of the at least 2 relatively stable long-term pts that we had. I couldn't understand why the charge nurse (who did not have an assignment and who did not help me ) was so insistent on giving me a post-op admit. Especially because our ICU pts do not go through the PACU, we are their PACU, including Q15min VS and Neuros. My admit came to me intubated and was extubated an hour later.

    Thank God I did get alot of help from the other staff, including a wonderful agency nurse! (I'm mentioning this because I know people often dis agency nurses). And I'm not a new grad, just new to the ICU. Because I'm new to this environment I wasn't sure how much to trust my intuition about this assignment. Now I think my intuition was right!

    JMP, I think I want to move to Vancouver!
  13. by   mattsmom81
    Grouchy, it burned me to hear your charge nurse didn't have an assignment and did not help you. I would never do that to another nurse personally. As charge I would frequently offer to take the third patient...I often chose the most stable so I could be a floating resource to the team, do bed control, help with orders, be a gofer, etc.. Only in a highly unusual situation would I be free...like if I had an entire staff of agency, then I might be assigned to be free floating. I worked with a good group...I miss 'em...although I don't miss the politics and administration! LOL!

    Sounds like your charge nurse is a bit of a 'challenge' for the rest of you....sorry you have to put up with that.

    Funny you mentioned the helpful agency staff...as I found myself often supporting new staff members too when I did an agency shift...some staff abandon them for some reason. Unacceptable.

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