ICU nurses, Is 3:1 patient to nurse ratio a common occurence or am I just tripping? - page 9

by Scrubs911 35,304 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. 2
    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.
    Really?

    Honestly I never put much thought into it because as a new nurse (8 years ago) starting on a Med-Surg floor, I was required to have ACLS (as were all RNs) and all employees of the hospital had BLS training.
    Z71RN and qaqueen like this.
  2. 0
    Hmmmm. Interesting to hear this. I only have experience in the northeast and mid Atlantic regions. Med surg nurses are welcome to get acls but they will be paying for it themselves. CCRNs, and to a lesser extent PCRNs, are required to have acls and the hospital/unit will pay for it. I guess theoretically it sounds nice for all RNs to have acls but they would so very rarely use it I doubt how useful it would really be. My hospital is a laaaarge academic teaching hospital with a toooon of ICUs and step downs. True codes on the floors are very rare. A condition C is really all med surg nurses would be dealing with. The step downs have a much higher chance and then of course the ICUs deal with them all the time.
  3. 0
    Quote from Dodongo
    Hmmmm. Interesting to hear this. I only have experience in the northeast and mid Atlantic regions. Med surg nurses are welcome to get acls but they will be paying for it themselves. CCRNs, and to a lesser extent PCRNs, are required to have acls and the hospital/unit will pay for it. I guess theoretically it sounds nice for all RNs to have acls but they would so very rarely use it I doubt how useful it would really be. My hospital is a laaaarge academic teaching hospital with a toooon of ICUs and step downs. True codes on the floors are very rare. A condition C is really all med surg nurses would be dealing with. The step downs have a much higher chance and then of course the ICUs deal with them all the time.
    *** Not all RNs have to have ACLS in our hospital. Just acute care RNs. There are lots of nurses in psych, rehab, clinics and similar units that do not have ACLS. For us it's ICU RNs (obviously), step down RNs, and medsurg RNs. Also of courses units like IR, ER cath lab etc would be ALCS. All of our med-surg units are tele units. We are also a teaching hospital with scads of interns and residents hanging around duirng the day, many fewer at night.
    It really isn't very expensive to train people to ACLS. Any nures who needs the initial 2 day class does it during orientation. Re-cert is online (I highly recommend it) Either the nurse manager gives them the 5 hours required to do the online recert during work hours, or nurses do it from home and get 5 hours OT pay when they hand the printed completion certificate to their NM. All of our RRT RNs are ACLS instuctors and can do the hands on skill check any time when the nurses has a few min free.
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    Quote from PMFB-RN
    *** Not all RNs have to have ACLS in our hospital. Just acute care RNs. There are lots of nurses in psych, rehab, clinics and similar units that do not have ACLS. For us it's ICU RNs (obviously), step down RNs, and medsurg RNs. Also of courses units like IR, ER cath lab etc would be ALCS. All of our med-surg units are tele units. We are also a teaching hospital with scads of interns and residents hanging around duirng the day, many fewer at night. It really isn't very expensive to train people to ACLS. Any nures who needs the initial 2 day class does it during orientation. Re-cert is online (I highly recommend it) Either the nurse manager gives them the 5 hours required to do the online recert during work hours, or nurses do it from home and get 5 hours OT pay when they hand the printed completion certificate to their NM. All of our RRT RNs are ACLS instuctors and can do the hands on skill check any time when the nurses has a few min free.
    I guess my line of thinking is this - most med surg nurses don't experience code situations often enough for this to matter. The majority hardly use BLS enough to know how to properly do compressions or even use a zoll. I just don't see the point for them having ACLS as they won't use it often enough to remember it or utilize it properly. If a med surg nurse finds a pulseless pt, for example, they'll hopefully start CPR, call a code and within minutes the code team will be there to take over. I'm not saying there's anything wrong at all with your nurses having ACLS. But if you don't use something at least sometimes, you aren't going to be able to utilize it properly after even just a few months. I could maybe see med surg nurses having ACLS at a hospital without appropriate step downs available.
  5. 0
    Quote from Dodongo
    I guess my line of thinking is this - most med surg nurses don't experience code situations often enough for this to matter. The majority hardly use BLS enough to know how to properly do compressions or even use a zoll. I just don't see the point for them having ACLS as they won't use it often enough to remember it or utilize it properly. If a med surg nurse finds a pulseless pt, for example, they'll hopefully start CPR, call a code and within minutes the code team will be there to take over. I'm not saying there's anything wrong at all with your nurses having ACLS. But if you don't use something at least sometimes, you aren't going to be able to utilize it properly after even just a few months. I could maybe see med surg nurses having ACLS at a hospital without appropriate step downs available.
    Awwww snap. Waiting for a backlash. Haha. I think this would be an interesting study to carry out. Comparing the outcomes of codes on med surg floors at hospitals where all nurses take ACLS with hospitals where med surg nurses take BLS only. I wonder if there would be a significant result?Like I said before, if the hospital has a good intermediate care set up and a good rapid response team, then ACLS for med surg nurses is probably over kill. IMO. Just my 2 cents. FWIW.
  6. 1
    Quote from Dodongo
    I guess my line of thinking is this - most med surg nurses don't experience code situations often enough for this to matter. The majority hardly use BLS enough to know how to properly do compressions or even use a zoll. I just don't see the point for them having ACLS as they won't use it often enough to remember it or utilize it properly. If a med surg nurse finds a pulseless pt, for example, they'll hopefully start CPR, call a code and within minutes the code team will be there to take over. I'm not saying there's anything wrong at all with your nurses having ACLS. But if you don't use something at least sometimes, you aren't going to be able to utilize it properly after even just a few months. I could maybe see med surg nurses having ACLS at a hospital without appropriate step downs available.
    *** I agree with you and consider it a waste of money. I didn't say it was my idea. I consider it like Magnet or scripting. A money waster that the hospital engages in to be part of the cool crowd. That said of the ways that hopitals flush money down the toilet, training nurses is the least offensive to me. The one real justification for it I have heard from managment is that they get a significant break on their insurance as a result of having more ACLS trained nurses.
    icuRNmaggie likes this.
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    I stand corrected, when I went back to work I started inquiring as to whether the floor nurses had to have ACLS.
    It is not required; they can schedule themselves for the class when it is offered, but priority is given to the ED, ICU, and cath lab nurses, etc.
    BLS is required.
  8. 1
    1:1 Balloon Pump or CRRT.
    1:2 is our goal for the rest of the unit (we are a SICU).

    However once a week we see 1:3 due to staffing problems, it's not a big deal we manage.
    I live in Tennessee though and I got a transfer from California one time last year and he about
    had a stroke when he got a 1:3 assignment.
    PMFB-RN likes this.
  9. 0
    Quote from *LadyNurse*
    I stand corrected, when I went back to work I started inquiring as to whether the floor nurses had to have ACLS. It is not required; they can schedule themselves for the class when it is offered, but priority is given to the ED, ICU, and cath lab nurses, etc.BLS is required.
    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.
  10. 0
    1:1 Balloon Pump or CRRT.
    *** CRRT I get. Balloon pump I don't. Do you run your own IABPs's or do you have a prefusionist who comes and manages them?

    1:2 is our goal for the rest of the unit (we are a SICU).

    However once a week we see 1:3 due to staffing problems, it's not a big deal we manage.
    I live in Tennessee though and I got a transfer from California one time last year and he about
    had a stroke when he got a 1:3 assignment.
    *** Probably cause in California it is illegal to staff 1:3 in ICU.


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