Any ICUs or critical care settings where the standard ratio is 1:1?

Specialties MICU

Published

I ask because in my ICU (and in the other ICUs in my hospital) 90-95% of the time each nurse gets a two patient assignment- usually two busy, vented patients with families who have a million different questions and demands.:uhoh3: Not to mention all the specialists and other disciplines who round on the patient and want a piece of your time. I'm a new graduate (I've been off orientation for 2 months now) and I still struggle to meet all the needs of 2 patients. I find, however, that I actually get things done on time (or ahead of time) and get to know my patient a heck of a lot better if it's a 1:1- even if the patient is really sick. I don't mind close monitoring of patients and working to maintain airway/resp/hemodynamic stability; I actually really like that part of my job. Next to time management, it's the longer-term care stuff (eg- nutrition, skin/wound care) that trips me up. Maintaining the hemodynamic stability of two patients AND re-dressing their 6 different wounds (each with a different order) AND appeasing family members AND giving their meds on time (or even during my shift) AND providing mouth care AND turning heavy patients q2hours AND documenting everything accurately/on time seems near impossible more often than not. I mean, I get all the really important short term things done when it comes to ABCs, fluids, correcting electrolytes, giving meds, etc- it's wound/skin care and documentation that presents a problem. I just hope I will improve with time and experience. I still feel like I can provide (and have provided) much better care to patients in 1:1 situations, though. I think any nurse would feel the same way.

Specializes in Critical Care, Palliative Care/Hospice.

The unit I started in (high acuity medical ICU) was 1:1 for SLED/CRRT, balloon pump, fresh sepsis. It wasn't long before CRRT was just another of your two patients, two fresh sepsis admits in one night, balloon pump and a SLED next door to each other, or 2 vents and a third patient. By the time I left, we were doing therapeutic hypothermia, which was generally 1:1 during the day but at night you got second patient and Roto-prone therapy for ARDS which was supposed to be 1:1 but if short staffed, I had a second patient with that one as well. That's the way healthcare goes-more work, less help.

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The unit I started in (high acuity medical ICU) was 1:1 for SLED/CRRT, balloon pump, fresh sepsis. It wasn't long before CRRT was just another of your two patients, two fresh sepsis admits in one night, balloon pump and a SLED next door to each other, or 2 vents and a third patient. By the time I left, we were doing therapeutic hypothermia, which was generally 1:1 during the day but at night you got second patient and Roto-prone therapy for ARDS which was supposed to be 1:1 but if short staffed, I had a second patient with that one as well. That's the way healthcare goes-more work, less help.

So what the heck are we all collectively going to do about it? We need to do something- we can't just sit idly by and let our nurse-patient ratios increase. Prone patients and CRRTs NEED to be 1:1- they are 1:1 for a reason! We can't just accept that "it's the way things are going" because eventually you, me, or any one of us will be entwined in an unsafe situation that will result in an adverse event- like a CRRT circuit clotting and the patient losing a whole lot of blood because the nurse was busy with their crashing septic patient next door. And who will everyone else blame for that occurrence? Yeah, that's right- the NURSE. Because everything always comes back to US.

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Specializes in Critical Care, Palliative Care/Hospice.

I agree. I quit that job for that very reason. I went to my manager and told her I didn't feel safe with those ratios, I didn't think it was good that more than half my shift was new grads or less than 1 year experience that can't help me with my SLED/prone pts for the most part. Its not safe. She didn't have an answer and I quit. I loved my unit and I gave it up because it just wasn't a good situation. A lot of experienced nurses did-and now that unit is even less safe. So I protected myself but it didn't change a thing in the institution. They went right on doing what they had been doing, and sadly, many of those that are left don't have the experience to know they're being put in a bad situation. I don't know exactly what the answer is. I'm not sure its mandatory staffing-I haven't experienced that but I've heard it gets down to the ridiculous like lunch and bathroom breaks require you to be covered by a nurse with no other patients. Maybe some of the California nurses can give us insight into whether this mandatory staffing is working the way they want it to. But you know the big hospitals are going to fight that legislation. And working in a state where you can pretty much be fired for anything, strikes and picketing don't happen here. But things don't tend to stay at the status quo in healthcare, they either get better or worse. I hate the concept of standing up for my own license at the expense of my friends and patients.

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Specializes in ICU.

As far as in California, the main thing I've really noticed is that ratios are strictly enforced. I've been there in a MSICU here for 1.5 years and have never seen anyone in a more than 1:2 ratio. Our 1:1's are CRRT, rotoprone, induced hypothermia s/p cardiac arrest, oscillating vents, IABPs, and if a patient was insanely busy and crashing the shift before they'll try hard to make them a 1:1. I've seen 2:1 ratios on patients for example that are on CRRT, an oscillator, and a rotoprone bed. One nurse does the CRRT and helps out where she can, and the other nurse is the main nurse.

On our unit, we have a separate charge nurse that never takes patients (unless it's an admit 1-2 hours before the end of the shift, and only then every great once in a while).

Our hospital also has a Rapid Response Team Nurse, who goes out to other floors to act as a rapid response to floor nurses having bad issues with their patients. If it's a slow night in the hospital, and our RRT nurse is free, she'll help out in our rooms when we're busy.

I feel comfortable with the 1:2 ratio, but our unit also has amazing teamwork, and great resources in our lead nurse and RRT nurse.

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