ICU nurses, Is 3:1 patient to nurse ratio a common occurence or am I just tripping? - page 11

by Scrubs911 35,306 Views | 129 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. 0
    That is sooooo unsafe!! However, I have experienced the very same thing in several places I have worked at.
  2. 0
    You are definitely not tripping!! However, I really feel like tripling in an ICU is unsafe. I worked at a hospital where it is not uncommon for the whole day shift staff and night shift staff to be tripled for weeks at a time.
  3. 0
    Quote from Stratiotes
    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.
    Isn't this part of both icu and floor nursing though? It never fails that everything deteriorates all at one time. Lol.

    ~ No One Can Make You Feel Inferior Without Your Consent -Eleanor Roosevelt ~
  4. 0
    Where I work, it's always 3:1, unfortunately
  5. 0
    I know I am getting into this conversation way too late. But I have tripled up more times than I can count and the reality is there are a lot of liability issues and certainly less than optimum patient care is common in these scenarios. I also have to agree that retention of staff is always threatened when nurses feel as if their very licenses are threatened. Unfortunately I don't know what the solution is, I just know that critical care medicine is stressful enough without adding poor staffing measures to the mix
  6. 1
    I work in CA so we are always 2:1 and some days I don't get a break and only a few bites for lunch. It is unsafe. I know facilities are not interested in retainment with many areas not having a shortage; however, where is their concern for patient safety?
    maloneys likes this.
  7. 0
    Quote from ariel25
    I work in CA so we are always 2:1 and some days I don't get a break and only a few bites for lunch. It is unsafe. I know facilities are not interested in retainment with many areas not having a shortage; however, where is their concern for patient safety?
    Not getting a lunch break in CA is nobody's fault but your own. Are you union?
  8. 0
    Ugh...we are ALWAYS tripled in the ICU where I work. I graduated in '07, and in the beginning it was only once in a while, then our hospital merged with another local hospital, and we took over all of the ICU admissions, without increasing staff. For a while, management was refusing to allow agency or travel nurses in to help, and it was a few years of non-stop triple assignments.

    Our unit is a 2-floor, 36-bed ICU - I was charge on the first floor this past weekend, working 7p-7a, and it was awful. There were 14 beds filled, we had gotten two admissions, had a class 5 pt coding every couple of hours, three nurses left at 11p and only one came in. There were only 5RNs on my floor of the unit, 1 ended up with 4 pts because she picked up the pt that was originally paired with the class 5. She had three vents, one on dopa and vaso, one having issues with O2 sats, and one chronic, very needy vent, as well as a perfed bowel. The class 5 was vented, on Heparin, Lido, Amio, Levo at 80, and Neo at 120...so definitely a legitimate class 5. One RN had two GIBs and admitted a resp distress pt. One had one vent, admitted another vent, and picked up a pre-op CABG pt at 11, and I started off with a vent, titrating a lady on Levo, and picked up a new admit pancreatitis who had morphine 2mg q4 as her only pain meds, and nothing for nausea at all. Levo lady was also supposed to have a TEE in the morning to R/O endocarditis, and possible OR trip for toe amputation...oh, and did I mention I was charge? We also very rarely have techs to go around, either because of being stuck in 1:1s, or just because we don't have enough of them. It's a lucky night if we have 1 for each floor. We do our own BGs, empty garbages, linen, do all the baths (on night shift), and are expected to T&P these 300lb pts every two hours by ourselves.

    I HATE charge, if for no other reason than it blows having to tell someone who already has two sick pts that they have to admit a third and there's nothing I can do about it. Our supervisors, depending on who's on, are less than supportive, and I have been told in the past on a night when I was charge and everyone was already tripled, that the supervisor " would keep it in mind, but couldn't promise that we wouldn't get beeped with another admission." We are now expected to bend over and take a 4th if one popped up on the bed board, regardless of the safety issues involved.

    Our nurse managers are coming and going like the unit is a revolving door, but nothing changes. We did get agency and some travel nurses in for a little while, but as soon as JACHO came and went so did the extra help.

    Sigh...I've been on the unit for 5 1/2 years now, and it's getting really hard to justify not leaving. We've had really great nurses leave because of the ridiculous staffing. Ok, I feel better now for venting...sorry for the long rant.
  9. 0
    Wowzers ..... In a LPN to ADN bridge program with the goal to be an ICU nurse ... I hope this is not the norm everywhere :/
  10. 2
    Quote from broknsole
    Ugh...we are ALWAYS tripled in the ICU where I work. I graduated in '07, and in the beginning it was only once in a while, then our hospital merged with another local hospital, and we took over all of the ICU admissions, without increasing staff. For a while, management was refusing to allow agency or travel nurses in to help, and it was a few years of non-stop triple assignments.

    Our unit is a 2-floor, 36-bed ICU - I was charge on the first floor this past weekend, working 7p-7a, and it was awful. There were 14 beds filled, we had gotten two admissions, had a class 5 pt coding every couple of hours, three nurses left at 11p and only one came in. There were only 5RNs on my floor of the unit, 1 ended up with 4 pts because she picked up the pt that was originally paired with the class 5. She had three vents, one on dopa and vaso, one having issues with O2 sats, and one chronic, very needy vent, as well as a perfed bowel. The class 5 was vented, on Heparin, Lido, Amio, Levo at 80, and Neo at 120...so definitely a legitimate class 5. One RN had two GIBs and admitted a resp distress pt. One had one vent, admitted another vent, and picked up a pre-op CABG pt at 11, and I started off with a vent, titrating a lady on Levo, and picked up a new admit pancreatitis who had morphine 2mg q4 as her only pain meds, and nothing for nausea at all. Levo lady was also supposed to have a TEE in the morning to R/O endocarditis, and possible OR trip for toe amputation...oh, and did I mention I was charge? We also very rarely have techs to go around, either because of being stuck in 1:1s, or just because we don't have enough of them. It's a lucky night if we have 1 for each floor. We do our own BGs, empty garbages, linen, do all the baths (on night shift), and are expected to T&P these 300lb pts every two hours by ourselves.

    I HATE charge, if for no other reason than it blows having to tell someone who already has two sick pts that they have to admit a third and there's nothing I can do about it. Our supervisors, depending on who's on, are less than supportive, and I have been told in the past on a night when I was charge and everyone was already tripled, that the supervisor " would keep it in mind, but couldn't promise that we wouldn't get beeped with another admission." We are now expected to bend over and take a 4th if one popped up on the bed board, regardless of the safety issues involved.

    Our nurse managers are coming and going like the unit is a revolving door, but nothing changes. We did get agency and some travel nurses in for a little while, but as soon as JACHO came and went so did the extra help.

    Sigh...I've been on the unit for 5 1/2 years now, and it's getting really hard to justify not leaving. We've had really great nurses leave because of the ridiculous staffing. Ok, I feel better now for venting...sorry for the long rant.
    I do believe I would have walked off the job 5.5 years ago.
    DeLanaHarvickWannabe and PMFB-RN like this.


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