Variable staffing based on patient acuity & census in ICU

  1. 0
    Hi Everyone...kinda new here on allnurses... just hoping to gain some insight as to how you all staff your units. We have had unusual fluctuations in both census and acuity and are either overstaffed for low census (and RNs get pulled or called off) or understaffed for high census (to prevent getting pulled or called off). What are some strategies your unit uses to account for this?
    Thanks for your input!

    -Lauren
    RN, BSN, BS - MICU Staff RN, 2 1/2 years
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  4. 14 Comments so far...

  5. 0
    We (SICU unit) are staffed based on the acuity of our patients. Our ratio is 2:1 and if we have any 1:1's then that increases our need. We are a 20 bed unit and typically have 2-4 1:1's (ECMO, VAD's, CVVHD, etc) we keep an average of 13 nurses plus one charge plus 3 in management who can jump in if necessary. There is usually 2 aides as well.

    if we are overstaffed (rare) we send our RN's to other units who are not. If we feel we are understaffed, we call resource and they will send us who we need.
  6. 0
    Hello,
    I usually work in the MICU -1 of 12 beds or MICU -2 of 6 beds and are staffed based upon acuity of patients also. Our ratio is 2:1 or 1:1(CRRT, High Acuity), MICU -1 is staffed for 6 RNs and plus one Charge nurse (no assignment) if additional RN is needed. the Charge RN is pulled into staffing if a 7 RN is needed. MICU-2 is staffed the same but the Charge RN takes an assignment. If our census is low, we are pulled to other ICUs (such as Neuro, Surgical, or Burns) or shift is cancelled for the day. We usually do not have problems with low census because it rarely happens. But when are understaffed here are the following options: 1.) Offer RN staff bonus pay or ask to come in to work, 2.)Pulled SWAT Rn into staffing. 3.) We also have a Corporate RN Pool that we utilize 4.) Using an Nursing Agency. Well I hope this answers your question.

    Have a good day
  7. 0
    Our ICU is staffed based on acuity. Most of the time the assignments are 2:1 unless a 1:1 is needed. In an extreme circumstance, the nurses will take up to 3 patients if they are short staffed. Charge RN always takes a full assignment. Our ICU has 10 beds so typically we have 5 nurses if everyone is 2:1. ICU nurses never float to other areas on their regular scheduled days (they can float elsewhere if they pick up extra shifts). Progressive nurses like myself or CCU nurses get pulled to ICU from time to time.
  8. 0
    For those of you who posted about a 1:1 for CRRT is that automatically singled in your unit? Or just if they are high acuity? We rarely single assign CRRT in our unit unless they happen to be proned for example.
  9. 0
    Our ICU (community hospital ICU) is basically staffed based on budgeting- apparently, we have 12 beds and they are budgeted to take care of 12 patients who are generally 2pts:1nurse. So, we generally can have up to 6 nurses on at any given time depending on census. Although there are times they are short nurses and the assignments will vary (sometimes as much as 1 ICU nurse getting 2 ICU pts and 1 tele downgraded pt that happens to still be in ICU because tele is full.) ICU nurses will also float to the tele unit as needed (as well as observation unit, since we all fall under same manager) for staffing purposes.

    It's not ideal.

    Quote from lcsmithrn
    Hi Everyone...kinda new here on allnurses... just hoping to gain some insight as to how you all staff your units. We have had unusual fluctuations in both census and acuity and are either overstaffed for low census (and RNs get pulled or called off) or understaffed for high census (to prevent getting pulled or called off). What are some strategies your unit uses to account for this?
    Thanks for your input!

    -Lauren
    RN, BSN, BS - MICU Staff RN, 2 1/2 years
  10. 0
    CRRT is automatically a 1:1 in our unit
  11. 1
    Vents are 1:1 in Australia. I work in a 16 bedded unit and we staff for 16 beds, plus in charge and access/float nurse. Non-vented patients can be paired (and we will often move them to be next to each other so they can be paired) if the unit is busy (e.g. there are a large number of vented patients and admissions expected). We very rarely have more than two patients (I've not seen it) and vents are always 1:1.
    Esme12 likes this.
  12. 0
    Quote from jcmelhorn
    For those of you who posted about a 1:1 for CRRT is that automatically singled in your unit? Or just if they are high acuity? We rarely single assign CRRT in our unit unless they happen to be proned for example.

    CRRT is for patients who are hemodynamically unstable. If they were stable they would receive hemodialysis. Measure their acuity and you will have a strong argument that they need 1:1 nursing care.
  13. 0
    I want to come work, where there are aides!


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