Critical Care Staffing Patterns

  1. I am a fairly experianced manager of an 10 bed ICU/CCU in a Suburban Hospital with an average daily census of 6 but lately we have been experiancing low census days. Lately my Chief Nursing Officer has asked me to staff the unit when census(1-2patients) is low with One RN and on assistive person ie tech, nurses aide. I have not felt that this is a safe staffing pattern. She feels that we have to think out of the box. My question is does any critical care unit staff in this manner?


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    Kate
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  2. 13 Comments

  3. by   Erbn Girl
    Our ICU has also been experiencing it's share of low-census also, but..we have a mandatory 2-RN staff when there is 1 or 2 patients. Sounds like the hospital is cutting corners and patient safety will be compromised. I wish you luck in finding a safer alternative.
  4. by   Sophie
    I believe what you are describing is unsafe. It would not be allowed at the hospital where I work. What happens if you are in the restroom or on your break(you ARE getting your breaks aren't you?), and the pt goes into VT? The tech can't give Lido or cardiovert the patient, so this would endanger the patients care (and life).Although an extreme example, but we are there to be able to handle sudden emergent situations and must be prepared for them, not concerned about saving the $. How would it look for the hospital if the pt in the example died, would the subsequent lawsuit be saving the hospital money? (since the hospital is more concerned about how they appear to the public rather than providing safe care). Sophie
  5. by   Rae
    Our hospital would not allow that kind of staffing pattern. Even if we have only 1 patient in our ICU, we would have 2 RN's. This decision was recommended by our corporate legal advice. I suggest your manager look into weighing the options of cutting costs now or paying high prices during a possible litigation situation.
  6. by   RNfelgood
    We have 3 bed unit and I have 2 years experience in Critical Care. Our Hospital is also trying to staff this way. Our nurses are really upset about this but the new CNO is trying to save money for his bonuses I guess. What can we do to fix this?. I have written to our State Board of Nurses but have not received a reply as of yet. Any suggestions? Texan RN
  7. by   lyraesullivan
    Check with your state department of health to see if they have guidelines for staffing in specialty areas.
  8. by   txrn1
    Our units are cutting corners, too. Just last week, the hospital staffed the NICU with a nursery LVN who admitted in report that she was uncomfortable being in the NICU and was more used to well babies. Turns out, the hospital cancelled and experienced NICU nurse who has been working in this NICU for a long time, all because she was agency. Sure, they saved money, but they put an unqualified nurse in the unit.
    The pedi floor used a CCU nurse <who told me she never had been on a pedi floor before> who pumped a teen full of Morphine and Demerol all shift long...then she tells me that pregnancy test results are still pending. Is the girl active, I ask, why is the test being done, routine or what? She shrugs. The girl was in for something else entirely <GI infection, I believe>.
    I blame the hospitals, yes, but i also question why nurses GO to these units..fearful they will lose their jobs? Can they not call the state board and find out their rights?
  9. by   Socrates
    Boy, this is all bringing back bad memories! I just joined today. Hello.
    Nursing can be such a great thing, euphoric in making you feel in control, nurturing, etc, etc. BUT....We are at the whim of too many people that don't know what is necessary for the pt. Yeah, I've been the 1 RN in the unit with just 1 pt. Sure, I was told to call the supervisor for a bathroom break, lunch, etc, but, God forbid...whatever you do don't get diarrhea!! It could be anywhere from 10 minutes to 2 hours before she shows. Why do we do this to ourselves? You're right, fear. Nurses are a dime a dozen, and the administrators DO have the cash to pay. They're all on a power trip!

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    Socrates
  10. by   bluesboyj
    txrn1, it is EXACTLY because of a fear of job loss that nurses float to areas where they don't feel comfortable. Too many judges have ruled that if a nurse refuses to float to an area where they don't feel qualified, they can be fired because nurse-hospital relationships are considered "at will" which means the nurse can quit or be fired for "no reason". Scary huh.
  11. by   Joanne D
    Originally posted by k.Sheldon:
    I am a fairly experianced manager of an 10 bed ICU/CCU in a Suburban Hospital with an average daily census of 6 but lately we have been experiancing low census days. Lately my Chief Nursing Officer has asked me to staff the unit when census(1-2patients) is low with One RN and on assistive person ie tech, nurses aide. I have not felt that this is a safe staffing pattern. She feels that we have to think out of the box. My question is does any critical care unit staff in this manner?


    Our hopital would not staff with only one RN. Not even if there is only one patient.
    A suggestion would be to move the patient out into a stepdown unit with one nurse at the bedside and other RN's equally qualified to care for the patient. All of our stepdown nurses have the same education and can float between the ICU/CCU and progressive care unit. That way the one patient would have quality care with no extra staff needed. You would also get your breaks and lunch. Just a thought/ides/out of the box. Joanne

  12. by   Oldtimer
    Hi!
    As a general rule my Hospital would always put 2 nurses on duty. We transfer other ICU pts. to fill an area with espically low census.
    However, I got stuck one 12 hr. night shift as the only RN in the CVICU with one patient on an IABP. I did not have any ancillary help assigned. I had to do secretary duties as well. The night Supervisor could not relieve me because she has no ICU experience and had not worked as a bedside nurse in over 20 years. I wrote the incident up as unsafe and came very close to being fired. I paid a very heavy price for standing up for safe patient practices. It is very interesting that Nurses in Management are the very ones who end up working so hard to defeat us. Lesson learned - If you need your job keep your mouth shut!
  13. by   Shadog
    Originally posted by Oldtimer:
    Hi!
    As a general rule my Hospital would always put 2 nurses on duty. We transfer other ICU pts. to fill an area with espically low census.
    However, I got stuck one 12 hr. night shift as the only RN in the CVICU with one patient on an IABP. I did not have any ancillary help assigned. I had to do secretary duties as well. The night Supervisor could not relieve me because she has no ICU experience and had not worked as a bedside nurse in over 20 years. I wrote the incident up as unsafe and came very close to being fired. I paid a very heavy price for standing up for safe patient practices. It is very interesting that Nurses in Management are the very ones who end up working so hard to defeat us. Lesson learned - If you need your job keep your mouth shut!
    How unfortunate that the Nursing Managers you have worked with left you with the feeling that Managers are the enemy. A good manager realizes that the RN staff are the greatest resource he/she has. Anyway, I have handled this difficult situation of having only 1-2 pts in the ICU by moving them to the Telemetry floor PROVIDED I could care for them there and there were CC crosstraind nurses for back up. Otherwise, I would have staffed the ICU with 2 RN's.
  14. by   NurseRachet
    We always have 2 nurses in the ICU when the census is down to 1-2 patients. We have also opted to move the patient to the CCU area to adjust staffing since the level of care is the same. I agree, that is pretty skimpy staffing. Could your other nurse carry a pager and work elsewhere in the hospital? We sometimes do that also. Good luck.

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Critical Care Staffing Patterns