Questions about ICU staffing
- 0May 2, '02 by PRFICURNI work in the ICU of a small community hospital in Western Pennsylvania. We currently have 12 beds. The nursing shortage has hit us hard. My question to you all is, What is the typical nurse patient ratio in your unit?
Our charge nurses take a full patient assignment as well. I have worked reciently where the ratio was 1 nurse for 3 patients with one of those patients on a ventilator.
Administration has given us little support and now nurses are not only leaving the unit but are leaving the facility for sign on bonuses at bigger medical centers.
Please let me know your staffing situations.
- 0May 3, '02 by fedupnurseI work in a 24 bed level 2 trauma center, open heart, interventional cardiology, etc. type hospital. My unit takes CCU, MICU and surgery pts. that SICU won't take (if it ain't a trauma or a cabg they usually end up with us!!). The staff on nights consists of 4 nurses with 10 or more years ICU experience, a couple with 5 or 6 years and the rest 3 years or less. 5 are here less than a year. Days is actually shorter than nights and has about the same numbers as far as experience in ICU goes. We are supposed to have 12 nurses on each shift every day. We are lucky if we have 8 who are actually from the unit. The suits think nothing of pulling staff from other floors even if they have no unit experience. We also rely very heavily on Agency staff, most of whom are great nurses and wonderful to work with. A few months ago I had 3 vented patients (all have their own rooms) one of whom was desating, one who had no BP and one who needed a ton of emotional support and was dying (but still a full code). That is not exactly an unusual night. While I do prefer to be busy at work, that kind of assignment is simply ridiculous. Our managers will only take an assignment if all of the staff have 3 patients. IABP and CVVHD pts. are 1:1. The suits are trying desparately to change that. The suits were nurses many years ago when hospitals were set up as ward rooms and you could eyeball each patient you had. Now they are in their own rooms and sometimes spaced across the hall from each other. I swear our managers sometimes do assignments by picking room numbers out of a suction cannister! Our SICU has a 1:2 max and many are 1:1. Some is due to state regs (which are ignored for our unit) but it mostly has to do with the doctors going to bat with the suits on behalf of the patients and staff. Someday things will improve! Don't know if I will still be working there but someday they will wake up and smell the coffee and realize they can't do this and still advertise safe, quality patient care.
Good luck in your unit.
- 0May 6, '02 by Zee_RNI also work in an community hospital in SW Pennsylvania. We have an 18-bed ICU. Patient assignment is usually 1:2 but can be 1:3 depending on acuity. Our charge nurses do not take a patient assignment. We also have a unit secretary from 7A to 11P which is a tremendous help. We're doing pretty good right now, staffing-wise, for which I'm very grateful. It's a nice unit to work in.
- 0Jul 29, '02 by nimbexwork both in Cardiac surgery ICU and CCU. CSICU or CVICU.. will depend. a fresh open heart, out from 1-3 pm will be paired with a post op day 1 by night shift, 7pm, if not on IABP, LVAD, BVAD. those are 1:1. However an IABP who was placed on precuationay pre surg. may be paired too! Only the IABP's who were required to get off pump are 1:1.
Mostly the CSICU/CVICU takes a 2 pt's to 1 RN ratio, many nights this is hairy because they are paired prematurely due to to staffing shortages.... usually by 2am... they have stabalized out and you play catch up. We are a "private non profit facility with no interns/ residents which requires more RN work with many standing protocols.
My CCU, a 10 bed unit varries, we will work 5 nurses one night 4 the other based on staffing, not acuity. Really, in a CCU you can take 3 fresh MI's or post plasty's if not titrating vasoactive drips. so 3:1 works sometimes...... It's when overflow of mICU occurs and you have GI bleeds with a HgB of 3 with a fresh MI going through 3rd degree heart block with a fresh plasty that gets things very hairy!!!!!
To summarize I have seen adequate and ideal staffing with less than ideal staffing... it varries.. sometimes you're maxed out and have the only unit patient that can transfer when a code on the floor is called and you sacrifice "ideal patient care" to care for the patient in less than ideal circumstances.
We do pair IABP's if weaning them and they are not titrating on drips and have DNR's run us ragged to the point of being 1:1's at times.
COPA patients are always 1:1 sometimes even 2:1 when unstable, and god love COPA, they run you ragged sorry, organ donation patients.
So long story short, acuity and STAFFING determine our criteria, not always ideal, but teamwork..... makes it work
- 0Feb 5, '03 by Jay-ZI really should be 1:1 in Intensive Care. Even if the patient is not that acute the in the UK would be too much. Your hospital should really look into designated Medical and Surgical High Dependancy Units. there the ratio can be 1:2 or even 1:3 but if an ICU patient can be ratioed at 1:3 then either you're being overworked or your patient really isnt that ill.