ICU nurses, Is 3:1 patient to nurse ratio a common occurence or am I just tripping? - page 8

by Scrubs911 | 36,300 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


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    And just to be clear I'm not, and was never, talking about panic yelling. I'm talking about yelling so that everyone is clear about what I'm doing and what I need them to do.
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    As a rapid response nurse you're probably arriving to a code after the more chaotic period has passed and everyone has decided what they're going to take care of during the code. Like dodongo said, usually it's just the first couple minutes when everyone is caught off guard that are helter skelter. Even for ICU nurses that do it all the time. It's unexpected, your adrenaline is going and you want to make damn sure that everyone hears you and gets what you need.
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    Pts on my unit are 1:1 if they are very unstable, on an oscillator vent, or receiving CVVH. Otherwise, they are 2:1, never 3. If they are well enough to be 3:1, they go to the IMC.
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    Quote from tothc2
    As a rapid response nurse you're probably arriving to a code after the more chaotic period has passed and everyone has decided what they're going to take care of during the code. Like dodongo said, usually it's just the first couple minutes when everyone is caught off guard that are helter skelter. Even for ICU nurses that do it all the time. It's unexpected, your adrenaline is going and you want to make damn sure that everyone hears you and gets what you need.
    I work at the same hopsital and PMFB. I would guess he is already on sceen in about half of the codes. many times there are indications before the code that some thing is going wrong and the RRT RN is already on the case. He is right, our codes are calm and well run, no yelling or excitment is allowed. Even our tele nurses have to go to Sim Man lab and run code senerios. About the only time we have yelling and excitment at a code is if a code is called in a non clinical area, like the cafeteria. Pretty normal to hear low key off topic conversations going on during a code since there isn't much stress or excitment. Our code team has worked very hard training staff to respond appropiatly. There is usally a mock code some place in the hospital every shift. By the time a med-surg RN faces her first code on her own patient she has already gone through dozens of Sim Man simulations, ACLS, several mock codes, and attended a real code or two during her stint on the code team (madatory for new hires).
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    Quote from IndiCRNA
    I work at the same hopsital and PMFB. I would guess he is already on sceen in about half of the codes. many times there are indications before the code that some thing is going wrong and the RRT RN is already on the case. He is right, our codes are calm and well run, no yelling or excitment is allowed. Even our tele nurses have to go to Sim Man lab and run code senerios. About the only time we have yelling and excitment at a code is if a code is called in a non clinical area, like the cafeteria. Pretty normal to hear low key off topic conversations going on during a code since there isn't much stress or excitment. Our code team has worked very hard training staff to respond appropiatly. There is usally a mock code some place in the hospital every shift. By the time a med-surg RN faces her first code on her own patient she has already gone through dozens of Sim Man simulations, ACLS, several mock codes, and attended a real code or two during her stint on the code team (madatory for new hires).
    Your med surg RNs take ACLS? And all nurses go to codes and simulations? You have to have meant something else here. Unless you are at an extremely small hospital. Even then, where's the money coming from for all of this? And maybe he can anticipate a code on a med surg floor if they go from one extreme to the next over a period of time. But in the ICU? There would have to be a rapid response nurse just hanging out in each of the ICUs in the hospital because there are MANY if not all patients on the verge of a code. Your hospital has a lot of resources and money.
    Last edit by tothc2 on Feb 4, '13
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    Your med surg RNs take ACLS?
    Naturaly.

    And all nurses go to codes and simulations? You have to have meant something else here. Unless you are at an extremely small hospital.
    Yes all new nurses, as part of the nurse residency, will spend time on the code team with an "orientee" badge on. All will go through the Sim Man lab initialy and then anually for refresher. Our hospital is fairly small, but at 580 beds I don't consider it extremely small.

    ven then, where's the money coming from for all of this?
    Dunno. Our hispital, like every one I have experienced, is always crying poor mouth and budget cuts, yet seems to have plenty of money to waste on silly ideas.

    And maybe he can anticipate a code on a med surg floor if they go from one extreme to the next over a period of time. But in the ICU?
    Yes but it's the ICUs. Those nurses are highly experienced and trained and take care of things themselves. Usually I just place a tube (if needed) and bug out. They have had everything well in hand.
    Due to the nature of our ICU patient population and our superb step down unit (means only the sickest of the sick are still in ICU or whould have been moved to the step down) codes are not ususual and the ICU staff well versed in dealing with them. As I have heard PMFB say when training nurses "Hey it's not YOU who is dead, why get all excited?".

    Your hospital has a lot of resources and money.
    Most hospitals do, despite their claims to the oppisit. I would bet than many nurses here have heard their hospital say there is no money for raises for nurses this year, only to see the hospital waste money doing something silly or stupid.
    PMFB-RN likes this.
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    Quote from IndiCRNA
    Naturaly.Yes all new nurses, as part of the nurse residency, will spend time on the code team with an "orientee" badge on. All will go through the Sim Man lab initialy and then anually for refresher. Our hospital is fairly small, but at 580 beds I don't consider it extremely small. Dunno. Our hispital, like every one I have experienced, is always crying poor mouth and budget cuts, yet seems to have plenty of money to waste on silly ideas. Yes but it's the ICUs. Those nurses are highly experienced and trained and take care of things themselves. Usually I just place a tube (if needed) and bug out. They have had everything well in hand.Due to the nature of our ICU patient population and our superb step down unit (means only the sickest of the sick are still in ICU or whould have been moved to the step down) codes are not ususual and the ICU staff well versed in dealing with them. As I have heard PMFB say when training nurses "Hey it's not YOU who is dead, why get all excited?". Most hospitals do, despite their claims to the oppisit. I would bet than many nurses here have heard their hospital say there is no money for raises for nurses this year, only to see the hospital waste money doing something silly or stupid.
    You say "naturally" like this is the norm. But it is not... All ICU nurses should have ACLS, the majority of step down RNs should, but I have never heard of med surg RNs having or being required to have ACLS. This is very strange and very much not the norm. At my hospital between the MICU, SICU, STICU, TICU, NICU, MSICU, CCU, CVICU, etc and all of their respective step downs, how there would be enough classes, money or time left for med surg nurses to get ACLS certification is beyond me. And if I were a med surg nurses not planning on going into critical care I wouldn't waste my time or money. And yes hospitals have a ton of money, but I'm saying when have they ever invested it into their nursing staff (to send all of them to sims, acls and code observations). Which from your post I see we agree on.
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    Quote from Dodongo

    You HAVE to know the concentration of anything you give. You just have to know. Would you give an unlabeled syringe of what pharmacy called epinephrine during a code? I wouldn't. I would want to know how much epinephrine I am giving with this syringe. If an unlabeled bag came from pharmacy I would go mix my own bag (or if you're busy with compressions have someone else mix it for you). Just because a physician tells you to do something doesn't mean you do it. Sometimes they get a little carried away during a code and get ahead of themselves too.

    Also - especially if it was a liter bag that came up. I've never seen epi in a liter bag. Red flag. I'll give you the benefit of the doubt though. Codes can be crazy and everyone is shouting and doing things and sometimes you don't know what you've got in your hands at first.

    But aren't codes the most exciting thing about your job? I loooooove them. So fun.
    Thank you for bringing that up tactfully! I was thinking the same exact thing. I hope this is a 1 in a million type situation. Just because its a code, it doesn't mean nurses can be careless. Even in the chaos of a code, we label our meds and use our drug mixing guide. Code carts have a bunch of different meds, so just because its a code, you don't double check our meds?! Scary ish. Epi wide open?! Scary.
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    Quote from tothc2
    You say "naturally" like this is the norm. But it is not... All ICU nurses should have ACLS, the majority of step down RNs should, but I have never heard of med surg RNs having or being required to have ACLS. This is very strange and very much not the norm.
    *** I remeber when med-surg nurses didn't have to be ACLS. However I have worked as full time staff in three larger hospitals in the last 6 years, and more hospitals on a casual or part time basis and all sent med-surg RNs to ACLS. All I can say is that it must be regional. This is the upper midwest and the hospitals I have worked in were/are in Wisconsin and Minnesota (only one in MN, my current one).
    Our current hospital (IndiCRNA & mine) is a very good hospital. Union and non Magnet. We are treated and paid very well. Lots of long time nurses here and few opening.
    qaqueen likes this.
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    Quote from IndiCRNA
    Most hospitals do, despite their claims to the oppisit. I would bet than many nurses here have heard their hospital say there is no money for raises for nurses this year, only to see the hospital waste money doing something silly or stupid.
    *** Case in point. One hospital I worked at a few years ago told us money was tight and there would be no cost of living raise for staff. At the same time they started their "Journy to Magnet" and even hired a nurse with an MSN to facilitate getting Magnet certified. I don't remeber how much they spend to get certified but it was a lot. That combined with the heavy handed tactics used to get the nurses to respond appropiatly to survayers questions caused moral to plumet. In the end they got their certification and we didn't get our raises


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