How do they rationalize staffing??...

[melissakc]

I work at a small community hospital in ICU. We are what is called "critical access". Our ICU is only 4 beds. We usually have 2 RNs and a CNA on dayshift and 2 RNs on night shift. In addition we watch the tele for the rest of the hospital. That doesn't sound that bad..and it isn't when they staff us appropriately. However, there are times they will put one of the nurses on call on both day and night and have 1 RN and 1 CNA staff the ICU. The policy is RN to pt ratio 1:3. So 1 RN is expected to care for 2 ICU pt's and watch the tele for the entire facility. On the flip side.....on our medsurg unit, regardless of the number of pt's they have....there will never be less than 2 RNs there. If they got down to 1 pt they get 2 RNs. So, my question is how do you rationalize that it takes 2 RNs to care for a few medsurg stable pt's and expect 1 ICU RN to care for 3 ICU pt's and do all the tele. There argument is that's the policy and that some of our ICU pt's could really be overflow/medsurg. If that's the case then have the MD change the pt to medsurg and put them on the MS floor instead of expecting 1 RN to do that. Am I being overly dramatic??? It just doesn't make logical sense to me!

[HouTx, BSN, MSN, EdD]

Have you ever worked as an ICU nurse--other than as a manager? If the patients are not really unit patients, why are they there?

That's a pretty derogatory statement. It also reflects a lack of awareness of the different levels of "ICU" based on the type of hospital.

There are MANY reasons to keep a patient in "ICU", including the need for closer supervision than can be provided in a general unit. This may include patients with psych problems, incontinence, frequent vital signs, etc. In most small hospitals & certainly in Critical Access facilities - ICU patients are usually there because they need higher levels of nursing care, not because they are receiving critical medical interventions - those patients are transferred to a higher level facility.

I agree with the PP - shifting patients around to smooth out staffing problems would seem to be the best solution. If there is no 'slave' monitor for telemetry outside the ICU, the only solution would be to board MS patients in the ICU rather than move the ICU patient out to the general unit.

I have worked with small/rural facilities for decades. It's difficult to imagine the types of challenges that have to be faced in a Critical Access facility unless you have actually had that experience... Can you imagine being "The RN" to cover all clinical areas (ED, MS, OB, etc)? That is the norm for some of our colleagues in those tiny, very essential facilities. They have my profound admiration!