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!
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.
Last edit by kayern on Aug 18, '13
: Reason: I needed to complete a thought.