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.

Up Vote Up Vote ×
Specializes in ICU.

Australian ICUs are 1:1 for ventilated patients, and 99% of patients are 1:1 anyway.

Come on over!

Up Vote Up Vote ×
Specializes in floor to ICU.

The only time our ratios allow for a 1:1 is for fresh open hearts. Meaning this is standard. All fresh open hearts get 1:1. Sometimes, they (mgmt) allows for a 1:1 on POD #2 if the patient is really unstable.

Otherwise, our staffing is 2:1. Most times if you have a patient that ends up being a 1:1, you spend most of your time with that patient and the other patient suffers. Meaning that you end up having the other nurses or charge nurse check on their status, help you give meds, etc. I consider myself lucky if there is a nurse on call and they can bring them in to take over the second patient. It is really hard to juggle- especially since you KNOW that second patient needs more attention than you can physically give. It makes me nervous because it is dangerous. Fortunately, if the day shift nurse (or vise versa) has been unable to leave the patients bedside because they have become so unstable, they will try and staff better the next shift and let them have the 1:1.

Up Vote Up Vote ×

Our cardiac ICU is 1:1 on nearly everyone. Post open hearts mostly though. Plenty of bypasses as well. Most of the time when we saw open a chest, you get a 1:1. We also do 1:1 on brain death patients or behavioral issue patients in the ICU.

Up Vote Up Vote ×

After my mom cardiac arrested (PEA), the standard protocal called for 1:1 during induced hypothermia.

The 1:1 ratio was appropriate given the need to use paralytics, titrating multiple drips, manage an A-line. Our nurse was a nurse with 5-7 years of experiance, and was running to get everything done.

Actually, we had almost 1:2 ratio with the nurse manager in the room a good portion of the day.

Up Vote Up Vote ×
Specializes in Cardiac Surgical ICU.

We have 1:1 if the pt is on CVVH or is really unstable. 1:2 if the patient comes back from open heart with an open chest and LVAD.

Up Vote Up Vote ×

Our ratio is 1:2 unless we have them in induced hypothermia, severe brain injury with drains, icp monitor, a-line, etc.... what makes is worse for our unit now is out trauma docs has seen it necessary to have our level 1 traumas brought straight to us after gettin off the chopper and going to ct, completely bypassing the er. Yah us

Up Vote Up Vote ×
Specializes in Advanced Practice, surgery.

most ICU in the UK nurse level 3 patients as 1:1

Up Vote Up Vote ×
Specializes in ICU.

It's 2:1 and sometimes 3:1 where I work. We're a "country hospital" (in a suburban setting) so not all of our patients are "critical". However, I've had a couple of situations where I've had 2 CRITICAL patients and a 3rd not-so-critical all at once and very little help from my co-workers. I should've refused, but I was new. As you gain more experience (& confidence) you will hopefully be able to stand up for yourself and for patient safety!

Up Vote Up Vote ×
Specializes in MICU for 4 years, now PICU for 3 years!.

I'm in a Peds ICU and we routinely are 1:1 for any intubated kiddo... The long term, more stable kiddos are 2:1... I have heard, but haven't seen yet that occasionally they have kids that are sick enough to need 2 nurses...

Up Vote Up Vote ×
Specializes in ICU.

Unfortunately not where I work. It is becoming almost standard to have 3 patients assignment, and I think it is down right unsafe ! I used to love my job, but know the 12 hour shift turns into 14 just trying to catch up with my documentation, and not forget something. Some days by the end of the day we end up having 4 patients, because the empty beds are made to be filled by fresh emergencies. So we transfer patients out just so they can be MET calls same day or a day later! :-(:confused:

Up Vote Up Vote ×
I'm in a Peds ICU and we routinely are 1:1 for any intubated kiddo... The long term, more stable kiddos are 2:1... I have heard, but haven't seen yet that occasionally they have kids that are sick enough to need 2 nurses...

The only situation in which we officially have 2 nurses taking care of one patient is when a preceptor and their orientee take care of a sick patient who is 1:1. I did this a few times during my orientation- such as one night where my preceptor and I had a septic patient who was on propofol, fentanyl, levo, vaso, multiple antibiotics, insulin drip- well, it seemed like you name it, the patient was on it. It got so busy that I basically acted as the documentor while my preceptor provided the majority of the patient care (because things had to happen that fast). Other than that, if there's a really sick 1:1 on the unit, a float nurse might help out the nurse who is assigned to that patient; the float isn't "dedicated" to that patient, however.

Up Vote Up Vote ×
+ Add a Comment