How do they rationalize staffing??... - page 2

by melissakc 2,975 Views | 12 Comments

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... Read More


  1. 1
    Quote from kayern
    First.......are your ICU patients truly ICU patients?????I would have to guess no! Are they intubated? On multiple pressers?
    I truly believe that if a M/S unit was down to one patient, it would not be cost effective to leave two nurses to care for one M/S patient. Do I think you are being overly dramatic...........yes, a little. I will, however, give you the telemetry piece. I think monitored patients should be monitored by the nurses/staff caring for them. Tell me what you do if there is an arrhythmia? Call the unit where the patient is?
    Staffing should be based on acuity of the patients. It seems many ICU nurses base their assignments on numbers, i.e., a ratio of 2or3 patients :l. But what these nurses should be asking...........are these really ICU patients? I managed a Surgical ICU and the nurses had a very difficult time with staffing according to acuity.
    You don't say how big the M/S unit is. I've seen rations as high as 8:1 for telemetry M/S patients.
    I would challenge any critical care nurse to do what the M/S nurse does without even thinking, i.e., take care of 6, 7 or 8 patients.
    Here is something to think about.......administration CAN NOT pull nurses out of the woodwork when your peers are calling out sick. Perhaps, you should be holding your peers accountable for being at work when they are scheduled and your unit should think about instituting an available list for when your peers do call in sick.
    The truly great managers I've known will put on scrubs and work the floor when noone else is available. I even know one DON who will do so.
    monkeybug likes this.
  2. 0
    My DON is one of those that doesn't hesitate to help when we are short. One time comes to mind....

    A nurse had to go to ICU to dialyze a critical patient and a tech had called in. They called for me to come early and I got there as soon as I could get myself showered and ready.
    When I rounded the corner to the desk to go into the locker room there was our DON in capris with a jacket on pulling needles and our medical director helping to assess patients! If I didn't know before that morning I definately knew after it that I am truly blessed to work where I do.
  3. 0
    Quote from Laurie52
    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!


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