ICU nurses, Is 3:1 patient to nurse ratio a common occurence or am I just tripping? - page 10

by Scrubs911

32,306 Views | 126 Comments

*I posted this in the new grads section but I also want to hear from the experienced nurses* Hi. I'm a relatively new nurse in a general ICU (we get a variety of patients). Considering the shortage of jobs for new nurses, I'm... Read More


  1. 1
    Quote from Dodongo
    That sounds just like my hospital system. They can take it if they want but they're bottom of the list. And like I've mentioned before, 1:3 in a community hospital is often not much of a stretch. Our progressive care floors get transfers from community hospital ICUs frequently. And the step downs are 1:4. It's all relative.
    CRRT makes sense. We are 1:1 for that. But why IABPs? We manage our own and it doesn't add much more work to the RNs workload. Just keep track of the timing (frequently) and adjust as necessary. And, to be honest, if I showed up to work and had a 1:3 assignment, I'd about have a stroke too. I'd be running around like a mad person.
    PMFB-RN likes this.
  2. 0
    Quote from PMFB-RN
    *** Probably cause in California it is illegal to staff 1:3 in ICU.
    And yet California hospitals can still make a profit despite having mandatory staffing requirements.

    "The average operating margin for California hospitals was 3.4% at the end of last year, according to the Office of Statewide Planning and Development".

    Embattled HCA reaps strong profits from California hospitals - Los Angeles Times
  3. 0
    Quote from Dodongo
    CRRT makes sense. We are 1:1 for that. But why IABPs? We manage our own and it doesn't add much more work to the RNs workload. Just keep track of the timing (frequently) and adjust as necessary. And, to be honest, if I showed up to work and had a 1:3 assignment, I'd about have a stroke too. I'd be running around like a mad person.
    Same here. We run our own is balloon pumps and they are not a cause to make a pt 1:1.
  4. 0
    Run an epi drip at 999?? Just because the ER doc told you to, and you didn't know the concentration?! Yikes. This is why I don't ever want to be a patient in the hospital. Loss of control. I almost wish I didn't know what I do know because being a patient in a hospital down the road will be very anxiety producing every time you meet your nurse and on call MD (if there) for that shift. After an hour or so, you can probably see how things will go. Are they smart? Competent? Caring? Don't leave me laying in a pile of poo for a year?

    I wish I could hand pick my nurses now that I will need 40 years from now lol.

    1:1 is appropriate sometimes. Most times, 2:1 ratios are appropriate. 3:1 is only appropriate in an intermediate ICU/step-down.

    1:1 is not appropriate for all vented patients. Just does not make sense economically. Vented patients do not equal unstable. Some vented patients are very stable, more stable than the guy on 2 L of NC about to be transferred tomorrow that is rapidly decompensating 30 mins after you walked in the door.

    Some vented patients just hang out on their PRVC settings for days, unable to wean. Why on earth would they need to be 1:1?
  5. 0
    I work CVICU and we are tripled on occasion. If we are, one or two of the patients will have orders to be transferred to the cardiac floor and are just waiting on an available bed (i.e. POD #2 or #3 CABG w/ Swan and chest tubes out).
  6. 0
    Honestly, sometimes 2:1 is hard enough, these patients are unpredictable, but 2:1 is appropriate. However, 3:1 is unsafe IMO. Even if you have a pt that is a q4 hour vs, he or she can be a "dinger' or very needy. Sometimes I find myself in that pt's room than in my critical patients. A pt like that can take up your whole time, and next thing you know... your other patients are tanking. And who is going to get blamed if something happens to your other patients? Yep... You... and only you... I understand that there are a lot of staffing shortages and budget cuts going around, but it is unsafe for our patients and is a disaster looming against us and our licenses.

    On top of that, in our hospital, we have no techs or secretaries at night.
  7. 0
    Quote from Dbb82
    Honestly, sometimes 2:1 is hard enough, these patients are unpredictable, but 2:1 is appropriate. However, 3:1 is unsafe IMO. Even if you have a pt that is a q4 hour vs, he or she can be a "dinger' or very needy. Sometimes I find myself in that pt's room than in my critical patients. A pt like that can take up your whole time, and next thing you know... your other patients are tanking. And who is going to get blamed if something happens to your other patients? Yep... You... and only you... I understand that there are a lot of staffing shortages and budget cuts going around, but it is unsafe for our patients and is a disaster looming against us and our licenses.

    On top of that, in our hospital, we have no techs or secretaries at night.
    ^This!!

    I had assignments of 2:1, which eventually found me transferring or discharging one, then getting a pt that is really a 1:1, and becomes a 1:1 on the next shift. My unit staffs 2:1, max.
  8. 0
    Our unit staffs 2:1. 3:1 is only if there is a necessary admit and no nurse to call in to take it. I would never work where 3:1 is the norm.
  9. 0
    Quote from Dbb82
    Honestly, sometimes 2:1 is hard enough, these patients are unpredictable, but 2:1 is appropriate. However, 3:1 is unsafe IMO. Even if you have a pt that is a q4 hour vs, he or she can be a "dinger' or very needy. Sometimes I find myself in that pt's room than in my critical patients. A pt like that can take up your whole time, and next thing you know... your other patients are tanking. And who is going to get blamed if something happens to your other patients? Yep... You... and only you... I understand that there are a lot of staffing shortages and budget cuts going around, but it is unsafe for our patients and is a disaster looming against us and our licenses.

    On top of that, in our hospital, we have no techs or secretaries at night.
    Couldn't have said it better myself!
  10. 0
    Haha... Very good point about the needy "q4 hour vitals" patient. Even if they aren't particularly needy, it never fails that they'll need to get up to the bedside commode or on the bedpan while you are in the middle of some crisis with the critical patient.


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