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.

Specializes in MICU/CCU.
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. ;)
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Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
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.

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Specializes in SICU.

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.

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Specializes in Emergency Dept, ICU.

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.

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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.
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.
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Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
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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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.
CRRT makes sense. We are 1:1 for that. But why IABPs? We manage our own and it doesn't add much more work to the RNs workload. Just keep track of the timing (frequently) and adjust as necessary. And, to be honest, if I showed up to work and had a 1:3 assignment, I'd about have a stroke too. I'd be running around like a mad person.
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Specializes in Dialysis.
*** Probably cause in California it is illegal to staff 1:3 in ICU.

And yet California hospitals can still make a profit despite having mandatory staffing requirements.

"The average operating margin for California hospitals was 3.4% at the end of last year, according to the Office of Statewide Planning and Development".

Embattled HCA reaps strong profits from California hospitals - Los Angeles Times

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Specializes in ICU/CCU/CVICU.
CRRT makes sense. We are 1:1 for that. But why IABPs? We manage our own and it doesn't add much more work to the RNs workload. Just keep track of the timing (frequently) and adjust as necessary. And to be honest, if I showed up to work and had a 1:3 assignment, I'd about have a stroke too. I'd be running around like a mad person.[/quote']

Same here. We run our own is balloon pumps and they are not a cause to make a pt 1:1.

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Specializes in Rehab, critical care.

Run an epi drip at 999?? Just because the ER doc told you to, and you didn't know the concentration?! Yikes. This is why I don't ever want to be a patient in the hospital. Loss of control. I almost wish I didn't know what I do know because being a patient in a hospital down the road will be very anxiety producing every time you meet your nurse and on call MD (if there) for that shift. After an hour or so, you can probably see how things will go. Are they smart? Competent? Caring? Don't leave me laying in a pile of poo for a year?

I wish I could hand pick my nurses now that I will need 40 years from now lol.

1:1 is appropriate sometimes. Most times, 2:1 ratios are appropriate. 3:1 is only appropriate in an intermediate ICU/step-down.

1:1 is not appropriate for all vented patients. Just does not make sense economically. Vented patients do not equal unstable. Some vented patients are very stable, more stable than the guy on 2 L of NC about to be transferred tomorrow that is rapidly decompensating 30 mins after you walked in the door.

Some vented patients just hang out on their PRVC settings for days, unable to wean. Why on earth would they need to be 1:1?

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Specializes in Cardiovascular ICU.

I work CVICU and we are tripled on occasion. If we are, one or two of the patients will have orders to be transferred to the cardiac floor and are just waiting on an available bed (i.e. POD #2 or #3 CABG w/ Swan and chest tubes out).

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Honestly, sometimes 2:1 is hard enough, these patients are unpredictable, but 2:1 is appropriate. However, 3:1 is unsafe IMO. Even if you have a pt that is a q4 hour vs, he or she can be a "dinger' or very needy. Sometimes I find myself in that pt's room than in my critical patients. A pt like that can take up your whole time, and next thing you know... your other patients are tanking. And who is going to get blamed if something happens to your other patients? Yep... You... and only you... I understand that there are a lot of staffing shortages and budget cuts going around, but it is unsafe for our patients and is a disaster looming against us and our licenses.

On top of that, in our hospital, we have no techs or secretaries at night.

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