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

Specialties MICU

Published

*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.

Wowzers ..... In a LPN to ADN bridge program with the goal to be an ICU nurse ... I hope this is not the norm everywhere :/

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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.

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Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
I do believe I would have walked off the job 5.5 years ago.

Right? That anyone would tolerate such staffing blows my mind. They get away with it cause the nurses in that unit tolerate it.

I will tripple in the ICU if it is a real emergency. Like here we occasionaly get huge snow storms that shut down the roads for a little while. Another occasion we had a mass casuality situation when there was an accident at a local factory. When things like that happen we need to be team players and do the best we can for the patients.

Short of a true emergency I won't tripple and would walk away from any job that required it.

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Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
Where I work, it's always 3:1, unfortunately

Why is that OK with you?

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Specializes in ER, TRAUMA, MED-SURG.

I do believe I would have walked off the job 5.5 years ago.

No doubt!! NO way that would be safe.

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Like I said, it was t always so horrific. It's been bad for a long time now, but there was a time when it was usually 1:2, or 1:1. The issue I have now with leaving, aside from losing all seniority and familiarity with the facility and staff, the hospital I work at is the highest paying in the area. That's the only reason some people have stayed. I can't afford a pay cut while I am the sole source of income, have a mortgage and a 2 yr old to think about. So, we work with constant triples, have a manager who I was just told has said she would t have a problem with starting 1:4 assignments, and we constantly fill out protest papers. I'm not really sure what our union is accomplishing, because its been at least two years of these conditions.

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Seniority, familiarity with your facility and colleagues means absolutely nothing when it comes to your sanity and safety. If this has been going on for 2+ years...nothing is going to change anytime soon.

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I agree, but circumstances being what they are, I don't have the option of leaving the hospital I'm at, short of completely uprooting myself and daughter, selling my house, etc etc. I have been looking for other positions that are sort of close by, and so far, no luck. Either there are no positions available, the pay cut would be too much, or the distance doesn't work with my extremely limited child care options.

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Specializes in ICU.

Wowww I would report 4:1 ratios to whoever has authority over the hospital- the state, JCAHO??? I can barely get through a night of being tripled, and luckily where I work even that is fairly rare. Our step-down has a 3:1 ratio, for petes sake. Sorry about your situation!! :(

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Specializes in ICU.

I do think 3:1 ratio will be undoing of US based Nurses in ICU due to younger generation not tolerating that type of 'factory worker' mindset bestowed upon. What I think will happen is nurses will have to be brought in from foreign counties on much larger scale. Then not only will they keep 3:1 ratio but ICU nurses will also take over Respiratory Therapist (RT) role and manage the vents themselves - resulting in fairly significant savings for hospital. While I am on topic of how I see this all shaking out. I see hospitals as basically becoming large ICU settings as most tele and med surg patients will be taken care of from home with apps on mobile devices for communications between MD & patients and BP, glucose results and telehealth with skilled home care nurses.

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On my unit currently, when we are short staffed we sometimes have 3:1 but usually it's 2:1.

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Specializes in SICU, NTICU.

I have been present during a code when we were slamming a Liter of epi. It was the 1st time I saw this during a code and of course I asked the rationale. The recorder charted on the code sheet the dosage/bolus. Pt was middle age and family was there. We did get a rhythm, but not for long...he passed. BTW, pharmacist was there and made the bag. Rather than criticizing, use some of your critical thinking skills and ask WHY would this be done. There is a rational. :) We see many things in a level 1 facility.

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