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

VAC · May 3, 2002

Maybe not a 1:1, but absolutely NOT with an admission. Would have to be paired up with an extremely easy patient. We do have 1:1 patients at times in my STICU

mattsmom81 · May 3, 2002

Jenny, I sure miss my union in Minnesota! Texas has been good to us in many ways but I am definitely a union nurse! I have been told many times to 'lose the yankee attitude' down here. (It doesn't stop me though...LOL!)

Management has kept workers in the south fearful for generations...even mentioning the 'u' word brings on hints of 'attitude problems' in one's evaluations....

We've tried to unionize in the Fort Worth area several times and we have failed to unite enough nurses to get it off the ground, and then those of us who dared to speak up have paid for the effort. Nurses down here as a group will not stick together, and turn on each other when it suits them. (not unusual, I know.)

Our Texas Nurses Association is very anti-union so there is zero support there.

Jenny P · May 4, 2002

Mattsmom, I did meet some anti-union and also some not-quite-so-anti-union Texans at last years' ANA convention. People in Texas are very different from Minnesotans in some ways; but also very much alike in other ways. I wish we could always remember we are the patients' advocates; in my mind, that alone would make this pt. a 1:1 in ALL settings, both unionized and non-union. And "the suits" would pay and treat us better!

I can dream, can't I? LOL!!!! :)

ArenRN, BSN, RN · May 4, 2002

If census allowed that pt would have been a 1:1. If not, paired with a stable patient. The PACU nurse would have been in the unit recovering the pt and I would take over again after recovery period.

PhantomRN · May 4, 2002

(Post# 23)

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 >

It would not be 1:1 at my place either. All the labs would be drawn by lab including the Q2 hr blood sugars, we dont do them unless we need to pull off a line. All the resp stuff, abg's vent stuff and peak resp readings would be done by resp therapy. They also would speak to the md themselves on what they had done, it does not go thru me.

The CVP and CO2, well at least at my place......we run a strip and tape in the chart....as far as documenting it well....open the computer and click the button to transfere the info.

That is just tasky stuff the real meat is looking at the pt and figuring out when and if theya are in trouble.

NurseDaniMarie · May 6, 2002

In the general ICU where I worked, the staffing would never allow any 1 on 1. Now I work in the transplant ICU (heart & lung) and is also CVICU overflow. 1st 2 days Transplant pts and CABG pts are mandatory 1:1. In fact, transplant pts that just come from surgery are 2:1 for the first 24 hours.

RNforLongTime · May 7, 2002

Since I work in a small hospital ICU any pt that is as bad as this pt sounds would probably shipped out to Cleveland--either the CCF or UH. But then again we have had pt's that were very ill that we've taken care of but never a 1:1 situation. We would usually give that nurse a lesser acuity pt. I am a new nurse in ICU and I doubt that I would be assigned to care for that patient. If I were still in orientation, yes I'd be that pt's nurse but I'd have my preceptor's help.

jessie · Jun 4, 2002

sounds like a lot for a new nurse. Accident waiting to happen. The real problem occurs when you accept that assignment and do not say anything about it. You need to voice your complaints.

good luck

Jessie

aj1973 · Jun 4, 2002

this discussion is really concerning me - i thought the whole point of having a patient go to icu is that they have to be nursed 1:1, what else is an icu for. here we have high dependancy units for patients who no longer require 1:1, but they are 2:1 at the worst. ventilated patients are always 1:1, there must always be a nurse at the end of their bed no matter what. the patient you are talking about would be 1:1, preferably with a more experienced icu nurse looking after them, no question!!!

mattsmom81 · Jun 4, 2002

The general rule here in the states is 2:1 patient nurse ratio and often they push us for 3:1, which we fight unless the patients are fairly stable, or one is ready to move to a stepdown unit.

Rarely do I get a 1:1 unless it's hemodynamically unstable (ie fresh CABG). Once the CABG is relatively stable (first 4-8 hours) I get an admission or pick up a second patient .

I like the ratios in your transplant/CABG unit, Nurse DaniMarie!

I've never done transplant but I bet it's interesting and challenging work!