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.

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

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

Specializes in Pediatrics, Emergency, Trauma.
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...

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!! Aloha

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
First of all, no, I'm not a manager. Second of all, the poster said that a pt on a vent, regardless of anything else going on with the pt, was 1:1. I have never heard of this. If this were the case then almost every pt in my ICU would be 1:1. Like I said, acuity of pts is a huge factor. Last night I had 2 vented pts. One was maxed on dopamine and close with dobutamine. Receiving blood products constantly. The other was rewarming from hypothermia on amio, lido and neo, and would probably be placed on CRRT today. Then he would be 1:1. Again, simply being on a vent should not make a pt 1:1. That would make some step down patients at my hospital 1:1.

Septic shock+Titrating ALL pressors+VENT+Swan=1:1. Again, think about why they are on the vent...Not just because they are on the vent.

Septic shock+Titrating ALL pressors+VENT+Swan=1:1. Again, think about why they are on the vent...Not just because they are on the vent.
This sounds like a normal ICU patient... What's your point? I've had plenty of patients in a shock state, pressors, swans and on the vent. They were not 1:1. Still 2:1.
Specializes in MICU/CCU.
This sounds like a normal ICU patient... What's your point? I've had plenty of patients in a shock state, pressors, swans and on the vent. They were not 1:1. Still 2:1.
I completely agree. I work in a mixed MICU/CCU (just like you according to your profile) and shock, pressors, IABPs, vents are totally common and are not considered criteria for 1:1. (Swans make things easier btw, i love them) Stable vents, stable pressors etc aren't even necessarily criteria for ICU, just step down. This is ICU nursing at a large academic hospital. My hospital has over 1600 beds. People from states away are transferred there. If other hospitals cant fix them - they come to us. If we can't fix them - they go to heaven.

at my hospital, a level 1. ours is either 2:1 or 1:1 if on CRRT

Point--How are you going to help your "other pt." that is swimming in sh*t when your are titrating gtts every minute for 12 hours??

Specializes in MICU/CCU.
Point--How are you going to help your "other pt." that is swimming in sh*t when your are titrating gtts every minute for 12 hours??
Hundreds and hundreds of critical care RNs manage it everyday they go to work - myself included. You're busy every second of your shift. We have computers on the wall in all of our patients rooms so I usually do my charting in one of my patients rooms. The monitors show you what's happening in your other patients room so if you gotta go do something you go do it. We have clinicians and 2 charges covering so if you need help then you ask (or call the RIC nurse).

Not every facility has the luxury that you have. So, there are true 1:1 ICU pts "on the vent" somewhere...

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