ICU nurses, Is 3:1 patient to nurse ratio a common occurence or am I just tripping? - page 4

by Scrubs911

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*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


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    Quote from imaginations
    In my unit vents are 1:1. If census is low then HDU patients (stable, non-vented) are 1:1, if we're busy, one nurse will take two HDU patients, no more. Most other ICUs in the area are similar.
    This is very inefficient and costly. There is no reason a vented patient should be 1:1, purely for the fact s/he is on a ventilator. Paying for double the amount of RNs? My unit is 2:1 at the most and we are 1:1 in certain situations such as CRRT. Our step down units are 3 or 4:1 but the ICU is 2:1 tops. I think it all depends on acuity. I've seen a few ICUs that were more like step downs.
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    I also work in a general icu we rarely have 3 patients unless we are understaffed.....when we do care 3 that person usually has the 3 least sick pts
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    Nursing ratios differ state to state. It's 2:1 or 1:1 for us. I've had 3 ICU patients once in the decade I've done ICU but that night was worse than my worst med-surg experiences!
  4. 0
    Quote from Dodongo
    This is very inefficient and costly. There is no reason a vented patient should be 1:1, purely for the fact s/he is on a ventilator. Paying for double the amount of RNs? My unit is 2:1 at the most and we are 1:1 in certain situations such as CRRT. Our step down units are 3 or 4:1 but the ICU is 2:1 tops. I think it all depends on acuity. I've seen a few ICUs that were more like step downs.
    I believe this is the norm in Australia, in all critical care units for adults, children and neonates.
  5. 0
    MICU RN for 1 1/2 years now, we generally have 2:1 ration, with specfiics on 1:1 criteria for care (multiple pressor titration, IABP, Protective Hypothermia, or really really crashing) but we have done 3:1 usually with our step-down patients or those that are good to be transferred. When push comes to shove, it just happens.
  6. 1
    Quote from Scrubs911
    *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 very grateful I found a job in an area of nursing that I find interesting albeit challenging. When I interviewed for the job, I was told that the Patient:Nurse ration was 2:1, and very rarely would a nurse have 3 patients. Well as it turned out, 3:1 is the norm on the unit (we're chronically understaffed) as I've seen more nurses tripled than doubled on any given day. Is that the norm in ICUs? Or is it just because we're a general ICU? I personally think it's dangerous because there is no way a nurse can be in 3 rooms at a time, and inevitably, one or more patients receive less than optimum care, especially if one of the three patients is more critical than the others. I worry about liability should something go wrong on the nurses' watch (more like the absence of it). Should I be concerned about this or is this the way things are in most ICUs?

    PS: It's insane that nursing units across the country are so understaffed (putting more stress and workload on the nurses especially the more experienced ones) while thousands of nurses, new and old, remain without work.
    Good thing that I was off last night-otherwise my response would be a novel. 3:1, I think, is the "new norm", sad to say!! Work in a 30+ bed unit and do ♥'s, CRRT, IABP-you name it. 6 years in the ICU, and I still feel that I do not completely know the rationale behind it all b/c most of the time it's charting and meds for 3 and sometimes 4 true ICU pts...I feel that I have lost my knowledge on why my pts are on this or that. 90% charting/10% pt care. God forbid that I didn't chart foley care and get a ding email...
    mmutk likes this.
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    You must be a nurse manager...There are vented pts (sick as hell) that are maxed out on pressors. Think about why they are on the vent b/f you speak...Dodongo...Aloha
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    You must be a nurse manager...There are vented pts (sick as hell) that are maxed out on pressors. Think about why they are on the vent b/f you speak...Dodongo...Aloha
    Last edit by shakanurse on Jan 27, '13 : Reason: error
  9. 1
    Quote from shakanurse
    You must be a nurse manager...There are vented pts (sick as hell) that are maxed out on pressors. Think about why they are on the vent b/f you speak...Dodongo...Aloha
    ^^HA shakanurse!!! I was thinking the same thing

    I am a new grad who will be working in a PICU with vents, CRRT, sedation, you name it, they get it. I was able to shadow the unit and get a typical day of the unit before being hired. They are 1:1, they also have a Stepdown component with a 2:1, but most of the time, the care is high acuity, some complexity. They do post-anesthia care...they come on the unit from the OR. They still maintain the 1:1 or 2:1 ratio.

    As a pt, I was in ICU. My nurse had a continuously crashing death's door (two-three people were usually running in the room to stabilize the pt with a crash cart)
    along with me, a trauma pt with a consistently high BP, out of whack labs from being in shock. I still saw them regularly and they gave EXCELLENT care, with all the chaos that was going on when I was awake...Most of the time they would wake me to do care-I was ok with that...I wasn't sedated, had a deep wound, and other peripheral wounds, so I was complex and they were therapeutic...if they had 3 pts, I couldn't tell.

    I think that a lot of units are pushing the limit, but I always thought the rule of thumb was "no more than 2" in ICU. One of my friends has been an ICU for 20 years...IF she had 3 pts, the pt is waiting on a general Med-Surg bed and usually got transferred within the shift, never was there for too long. I would think that 2:1 rule will NEVER be broken...If I decide to mix it up and do Adult ICU, I would think it would be unsafe to have more than two pts...
    shakanurse likes this.
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    I am GLAD you are doing well! Congrats for getting through nursing school, as well as getting a job you want! Don't let exp nurses step on you and make you do their work. They will do it. It happened to me...I was an ER tech b/f and couldn't say no at first...Watch out for the "lazy ones". I "grind" me teeth every day knowing that when I go into work, I will have a crap assignment. You can always say "no" if they give you 3 sick pts b/f you take on the assignment.

    Best of luck to you [COLOR=#003366]LadyFree28[/COLOR]!! Aloha


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