ICU Staffing Ratio & (Floating icu nurses)

I'd speak up, 3:1 is a lot to handle even in a well-functioning ICU with a good team effort.

We have a max of 2:1 on our unit. It's 8 beds, so typically we get 4 nurses and a nurse assistant, or 5 nurses and no nurse assistant. If things are horrendous and we need 6 nurses we can make it happen, but I've only seen it a handful of times. Don't let the 8 beds thing fool you though, we have (IIRC) a total of 80 MICU beds throughout the hospital, not including CICU, SICU, and neuro ICU.

The pull order is agency/overtime/staffed. Our hospital is huge and is staffed fairly well and I've never heard of an ICU nurse covering a med-surg/GPU.

*** I work in a 24 bed trauma / CVICU / SICU. We are the only trauma hospital in the region and we also take post op open heart patients with IABP, CRRT, PA cath, etc. We always staff 1:2 and often 1:1. The only time we do 1:3 is in emergency like severe snow storm that prevents other staff from getting to the hospital. On night shift the charge only has one patient and on day shift we have dedicated charge. We also always have at least one and more often two nurses who have one patient and are open for the admit. We also have one CNA on all the time and two on between 1500-1900. 1:3 is not safe in critical care I would refuse to do it except in limited emergency situations. The lack of an aid and being short of nurses is only going to result in increased pressure ulcer, central line infection, and VAP rates and in the end end up costing the hospital much more money than proper staffing would have.
Our nurses are only required to float to the MICU, never other units and certainly NEVER to med-surg, though many do by choice.