Nurse: Patient ratios - page 3

Hi, I was wondering what kind of nurse: patient ratios you have in the ICU. Here in NM we try to stick to 2:1 (1:1 for the very ill), but I have also worked in TX where we routinely had 3:1 and in... Read More

  1. by   pickledpepperRN
    If you work in Pennsylvania or Arizona here are links for organizations working to achieve safe staffing laws. I California ICUs have had the 1:2 law for almost 30 years. Now working on all acute care units:
    http://www.pennanurses.org/
    http://cna.igc.org/saznc/letteronicu.html
    http://www.calnurse.org/gr/aanestad.html
    http://www.calnurse.org/gr/tenyearhist.html

    The State of Victoria in Australia has ratios.
    Anywhere else?
  2. by   healingtouchRN
    It's always a struggle in these ruff financial times & with the shortage of experienced RN's....I usually staff 2:1 sometimes 3:1 in my CCU if the pt's are moving out to the floor in the a.m. I have recently had a case of 4:1 when I had a nurse get injured on the job & had to go to the ER for tx. Suck it when I have to. Only for a few hours. Priority & TEAM work is a must. I am blessed to have a good team. :kiss
  3. by   Shaydh
    Hi there. I am a nurse manager in Montana. Our hospital is trying to cut staffing ratios. I am looking for feedback. Currently we do 2:1 in the ICU and 3-4:1 for stepdowns. The new target HWPPD is 14.2. The lowest I have heard of is 15, and that blows our current ratios out of the water! I would love to hear from you to hear what your HWPPD are if you know. Thanks.
  4. by   Shaydh
    Quote from healingtouchRN
    It's always a struggle in these ruff financial times & with the shortage of experienced RN's....I usually staff 2:1 sometimes 3:1 in my CCU if the pt's are moving out to the floor in the a.m. I have recently had a case of 4:1 when I had a nurse get injured on the job & had to go to the ER for tx. Suck it when I have to. Only for a few hours. Priority & TEAM work is a must. I am blessed to have a good team. :kiss
    what are your target HWPPD? My staffing is the same as yours, but of course with budget cuts they want to make changes. We had an efficiency expert in and they want to get our HWPPD from 16 to 14.2. I think this is unsafe!
  5. by   healingtouchRN
    what is HWPPD? I don't know this abbrev. Healers with Post Partum Depression? Just kidding... I really dont' know what this is....
  6. by   Celia M
    Here in California we are are guided by title 22 and the new ratio law enacted this year. Our ratio is 2 patients for one nurse for ICU/CCU. This applies even if the patients are not ICU/CCU status but are "overflow". If a patient occupies an ICU bed that the ratio is 2:1. We may also not have more than 50% of the staff as LVNs. This has been the standard for at least 15 years and I have never seen it broken. We get good support from administration
  7. by   healingtouchRN
    We could only have it so good here. My best friend travels to CA every other month to work but resides here in AL, she is on the plane home today after a 6 week assignment in Redding. She loves the rules in CA & the traveler pay. It's hard not seeing her kids & hubby though. She comes back to AL & works for/with me in CCU & gets frustrated because we don't have the rules. We get soooo dumped on. No union, people are scared to start one. I tried to several years back & boy do find out who is scared to talk to ya! Oh, well, I just want ya'll in CA to know that kudos to you who try to employ safety where the clients are concerned. :hatparty:
  8. by   SouthFloridaTrauma
    We have a nursing union here in Miami and it makes all the difference. We tabled nursing/patient ratios at the last contract negotiations in October 2003--Florida's legislature is currently considering legislation similar to California's. This is the future for nursing. Hopefully it will go national. But, having the union definitely helps to maintain safe working conditions including keeping a safe level of nurse/patient ratios.
  9. by   my2sons
    I just finished a shift where I was in charge, had an extremely unstable LVAD, had to hold a new nurse's hand who never took care of a fresh open heart before, and had to deal with an agency LVN who would not respond to her patient's ventilator alarm because she "doesn't do vents." We have staffing guidelines (for example 5 nurses and 1 PCA for 10 patients) but that doesn't take ACUITY or nurse ability into consideration, nor does is factor in the unexpected admissions we seem to routinely get. We are a SICU/CVICU that also functions as MICU overflow (they're always full) and Cath Lab overflow (they can't stay a minute past 10 pm or they will melt!) I have refused admissions due to no staff on my shift only to have the patient wheeled up anyways, accompanied by the nursing supervisor and the patient's family, the supervisor saying loudly, "see, I knew thay had a bed!" I'm afraid for our patients and would never EVER let one of my family members be a patient in my unit.
  10. by   lyndac918
    I work in a small community hospital in the ICU. Our ratios are 2:1 and 3:1 most of the time. We do not have open hearts but our patient population is aortic aneurysms, ventilator patients, ETOH withdrawl, sepsis, acute MI's and any surgery that doesnt go as expected. We had a patient last week that had 11 drips and that wasnt even considered an 1:1. How are your organizations evaluating acuity? Do you have a grid of some type? I think our hospital just counts heads.
  11. by   PJMommy
    We are combined SICU/MICU/trauma - no union, no state laws. 1:1's on IABP, CRRT, and first 4 hours (or until extub) fresh hearts. Otherwise 2:1 unless except in the instances when we have a couple pt's with xfer orders to med/surg floors -- then a 3:1 is very do-able. The RNs have actually had a second pt "taken away" and taken by charge or a float when one of the patients proves to be too time-consuming. I think all the difference is the charges and the manager willing to stand up for acceptable staffing levels on the unit.
  12. by   ratchit
    Quote from my2sons
    ... had to deal with an agency LVN who would not respond to her patient's ventilator alarm because she "doesn't do vents." ... Cath Lab overflow (they can't stay a minute past 10 pm or they will melt!) ...I have refused admissions due to no staff on my shift only to have the patient wheeled up anyways, accompanied by the nursing supervisor and the patient's family, the supervisor saying loudly, "see, I knew thay had a bed!" I'm afraid for our patients and would never EVER let one of my family members be a patient in my unit.
    The problem with the agency LVN isn't that she works for an agency. The problem is that her assignment doesn't match her skills. She shouldn't respond to a vent alarm if she doesn't know how to fix the problem. If she can't handle the patients in your unit, then she shouldn't be there. She is wrong for accepting the assignment, the hospital is wrong for accepting her from the agency, and I don't know what the board would say the charge RN's responsibility is for assigning a vented patient to her. Nothing good about that situation- hope it was a one time screw up.

    So Cath Lab gets to go home at the end of their shift and dump their problems on you? Sounds like they fought harder or have more support than you do. The ICU has to be supported just as much. I feel the same way I do about ER nurses complaining that ICU gets to say no to more patients than they do.. Don't blame the other unit for doing it right. Applaud them- and follow their lead. Make your safe staffing as much a priority as theirs. Maybe a deal to accept their overflow only when you have staff to do so? An emergent case likely needs to go to the unit anyway. A planned case should be finished early enough in the day for cath lab to recover them. If their cases routinely run late, then cath lab needs to change something about their patient or nurse scheduling. If the problem is the docs are running late, than the doc needs to feel the pain- either he needs to pay for and find a nurse to stay/come in to recover the patient, or that last case needs to be cancelled (sorry, patient...)

    A supervisor who embarrasses an RN into taking an unsafe assignment by challenging you to refuse the patient in front of them and their family should hand her license in at the door at the end of the shift. Absolutely unacceptable. Write it up. When I was a new nurse I would have accepted it or been cowed into it. Now I would say "Mary, I told you we have a bed but you know we do not have enough nurses to take care of that patient safely. You need to bring them back until you find us a nurse." Refuse report. If she leaves the patient, it's abandonment. I feel so badly for that one patient. But hopefully it will protect all the patients she'll never do that to again.
  13. by   lyndac918
    Rachit,

    You seem to have a lot of things going for you. Sounds like you have been there and done that...Good for you. Maybe you can help me out. I am a manager of ICU and CCU. I have no director because my VP fired her and now I have to interact with the VP directly. She is not a reasonable woman. There is no negotiation. Just her way or the highway. She has never worked critical care and her background is home health. I have worked as a staff nurse in ICU for 17 years before I took the management position. I fight for staffing al the time and get no where with her. She tells me that ICU is use to those types of patients and should be able to handle 3 patients each. She doesnt believe in acuity. She counts heads on a regular basis. She decided that we needed to change the way we do report. I argued my case and her response was..."Im the VP of Nursing and I have the final decision." We have had 15 managers and directors leave in the last 2 years she has been VP. We have had over 30 nurses leave due to her. We will probably have more. Why cant our CEO or COO see whats going on? What can I do to maintain my position yet fight for my staff?:imbar


    Quote from ratchit
    The problem with the agency LVN isn't that she works for an agency. The problem is that her assignment doesn't match her skills. She shouldn't respond to a vent alarm if she doesn't know how to fix the problem. If she can't handle the patients in your unit, then she shouldn't be there. She is wrong for accepting the assignment, the hospital is wrong for accepting her from the agency, and I don't know what the board would say the charge RN's responsibility is for assigning a vented patient to her. Nothing good about that situation- hope it was a one time screw up.

    So Cath Lab gets to go home at the end of their shift and dump their problems on you? Sounds like they fought harder or have more support than you do. The ICU has to be supported just as much. I feel the same way I do about ER nurses complaining that ICU gets to say no to more patients than they do.. Don't blame the other unit for doing it right. Applaud them- and follow their lead. Make your safe staffing as much a priority as theirs. Maybe a deal to accept their overflow only when you have staff to do so? An emergent case likely needs to go to the unit anyway. A planned case should be finished early enough in the day for cath lab to recover them. If their cases routinely run late, then cath lab needs to change something about their patient or nurse scheduling. If the problem is the docs are running late, than the doc needs to feel the pain- either he needs to pay for and find a nurse to stay/come in to recover the patient, or that last case needs to be cancelled (sorry, patient...)

    A supervisor who embarrasses an RN into taking an unsafe assignment by challenging you to refuse the patient in front of them and their family should hand her license in at the door at the end of the shift. Absolutely unacceptable. Write it up. When I was a new nurse I would have accepted it or been cowed into it. Now I would say "Mary, I told you we have a bed but you know we do not have enough nurses to take care of that patient safely. You need to bring them back until you find us a nurse." Refuse report. If she leaves the patient, it's abandonment. I feel so badly for that one patient. But hopefully it will protect all the patients she'll never do that to again.

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