ICU Staffing Ratio & (Floating icu nurses)

detroitdano · Oct 20, 2009

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.

PMFB-RN, RN · Oct 26, 2009

Hi all
I work in a combined MICU/SICU/Trauma unit. I' m just wondering what the typical staffing ratio for your units are. If you are given tech and if staffing pull your ICU nurses to other floors, including Med/Surg. This situation has been happening quite a bit in my unit where they pull our nurse from ICU to CCU, Stepdown, Tele and recently Med/Surg. Also quite often we are only given 1 tech or none. To make matters worse, they pull a nurse sometimes as many as 3 of our nurse at one to to staff other units and leave our unit short. Normally we get 2pt to 1 nurse ratio but have been getting 3:1 lately. To compound the situation, my hospital is the only trauma hospital in the county and we getting some crazy S--T. mostly at night which is the shift I work.
What are your thoughts??

*** 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.

luvinursing · Aug 21, 2010

You need to notify the director, annonously if you like, but that way, you give her the opportunity to address the situation. No action taken? Contact OSHA, and the trauma certification agencies---there ARE staffing requirements to be maintained. They've done it to my unit before, and a coworker said mgt will back you if anything happens. WHAT? Who the heck wants anything to happen to a patient, let alone staff! Working these units is tough, and risky at times, depending on the patients, etc. You should be one of the most valued staff members to the hospital, and it should be made OBVIOUS by them, because if none of you showed up for work tomorrow--WHO would do your job? The med-surg nurses? No. The ob nurses? No. The step-downs? Mmm, they might be able to, depending on acutity and knowledge, but for SOME reason, it seems to be more common that the more irreplaceable the nurses, the LESS they are valued and taken for granted. Pulling nursing staff period, is not a good idea. It decreases morale, increases stress, and mistakes happen from being displaced and unfamiliar. Pulling SPECIALIZED NURSING STAFF, even to cover similar units is a no-no that WILL cost them dearly one day down the road when lack of staff (and state violations) causes injury or death-and all that money they saved screwing the nursing staff over, is LOST in settlement and lawsuits!! Don't stand for it.

luvinursing · Aug 21, 2010

dang, girl, where do YOU work?! i want to work THERE! we run at dangerous levels quite often, just us two or three rns, no assistants, no secretary half the time, with not the least concern from mgt or director, nor comment to our complaints other than ''yeah, it's rough'' or ''lucky to have a job''. because we care, are damn good and have pulled it off, and not killed a patient yet, hey, works for them.

grandmawrinkle · Aug 22, 2010

I feel your pain.

We are small -- an 8 bed ICU (there is one other ICU) in a ~250 bed non-trauma teaching hospital. We are supposed to staff 5 RNs and 1 NA to meet our numbers (the charge only takes 1 patient, and that leaves room for a 1:1 if necessary). Our aide is constantly floated off. If all our beds aren't full, they float our nurses to stepdown that for some gosh-awful reason has managed to negotiate an MOU through the union to maintain 7 RNs at all times, every shift, with an ANM (that functions as charge) with no patients, and two NAs, REGARDLESS of what their census is (they have 21 beds.) So, even if their census is down and they only have 10 patients, they have to staff 7 freaking nurses!!!!! It makes us in the ICUs SOOOOOO mad because we float out there and have 1, maybe two walkie talkies when the ICU is at capacity with the staff they have with no NA -- and the patients are MUCH SICKER! BUT -- we NEVER take 3. That is against OUR MOU. The supes would know better than to leave us that short.

I'm with other posters and I agree 3:1 is not safe and should be done only in an absolute emergency. Your hospital should know better. Our hospital has a policy that you cannot float from one unit to another if it's going to leave that unit short. They have to call agency in or pull from other areas. Why aren't the charge nurses protesting? Is there someone saying "No, we can't float"? Someone needs to stand up for you guys.

sunnycalifRN · Aug 23, 2010

We also get floated any time that we are overstaffed and we often don't have an NA, we just have to help each other. Fortunately, 1 RN : 2 pts is the maximum patient assignment by state law. And, to make matters worse, if a code occurs or the patient acuity changes dramatically, we can't get the floated RN back because he/she now has 3-5 patients somewhere else. We just have to "do the best that we can!" All hail the bean counters!!

JoyfulRN14, BSN, RN · Aug 26, 2010

I'm at a Level III Trauma center, in an 18 bed ICU. We staff 2:1 mostly, 1:1 for patients with IABP, on CRRT, or sometimes if they are just really "heavy" if we have the staff. Our hospital also has a CVICU where all open-hearts go, and generally any other "cardiac" pts, although we do see IABPs on the floor fairly often too.

I'm working day shift - we have an amazing unit secretary and an aide at all times. Our hospital also has a "lift team" that we can call to help us turn a patient, move the patient during a dressing change, or even just bring something up/down to lab for us. They are readily available when needed and very friendly.

I've been there for a month now (I'm a new grad) and have had a great experience so far. We do multidisciplinary rounds every morning at 9, in which the physician, pharmacist, RT, and RN participate in. It's a great time to bring up any concerns to the physician and ask for any orders you're wanting for your pt. There seems to be amazing team work on this floor, and I feel SO lucky to work there!

ChristopherB, BSN, RN · Sep 16, 2010

Our ratio is typically 2 patients per RN in the ICU. However, if we have two patients who are stable enough to be transferred out the next morning, we sometimes start out with those two and get an admission or transfer later that shift.

APRN., DNP, RN, APRN, NP · Sep 17, 2010

Disclosure: I work in California where there is a legal requirement to not go above 2 patients per RN in the ICU.

In the ICU where I work, we are staffed for 1 RN to 2 patients, along with a charge RN who never takes patients.

baweRN · Sep 25, 2010

I work in a 24 bed CVICU/ICU in a 370 bed non-trauma hospital. We do occasionally get "tripled" but it only happens when there is a severe shortage or if it's only for a couple hours. Example: I work night shift so if there's a patient coming from ER at 0400 and everyone is already 2:1, one of us will get tripled for a few hours. It is definitely not a habit though.

RNFELICITY · Oct 13, 2010

My last ICU was 24 bed MICU that took everything except open hearts. The staffing was 3 patients to one nurse. They also got the brilliant idea to start sending overflow into the ICU not to mention that they wanted to improve patient scores so they started keeping ALL rooms private and my ICU was getting not only tele overflow but also medical overflow that did not even require monitors!!! Then, because they always kept us full, when someone went bad on the floors, we had to rush to move out a paitent to get in a bad one.