Nurse to patient ratios and acuity in YOUR PICU

Okay, here goes. Hope this helps!

1. We have a cardiothoracic surgery program, with many of them sicker than snot post-op. We don't do transplants or ECMO, we do use CRRT, traumas, complex ENT, neurosurg, hem-oc. Lots of weird genetic anomolies, some of the sickest kids I've ever had.
2. We have 23 beds, all are private rooms, the unit is shaped in a large "U", with 4 nurse's stations in corners. All tubed patients are 1:1, regardless. We have a very low self-extubation occurance rate. Sicker non-intubated pts may also be 1:1 if busy, usually hem-oc pts. Most non-intubated post-op hearts are 1:1, many are so busy they are 2:1 for the first 24-48hrs. CRRT patients are 2:1, I've only ever seen one that was not. Stable, non-intubated pts are 1:2.
3. My children's hospital does not employ CNAs, but we have MAs on the general care floors, and the occasional techs in the PICU. The techs assist the RNs with pt care, feed and rock babies, stock, go-fer, act as scribe during a code, may watch a stable non-intubated pt for the RN to take a lunch if needed.
4. We have specific staffing protocols based on the amount of 1:1 and 2:1 pts on the unit that provide us with either 1 or 2 "RP" nurses. "Resource persons" are not assigned to a certain pt, they do relieve lunch breaks, assist with admissions, respond to general floor codes, pt care on the big kids, road trips to CT and the like, and basically run around like a crazy person for 12 hours. Very busy position, usually needs to be an experienced nurse. As for our paired-up pts, if they are in proximity to another pair, those nurses may sometimes relive each other for breaks. Our charge nurses also help.
5. Most continuing education is available for us online to do when we have time, always with a deadline. We have to nurse educators for the unit, I believe they are both considered parttime, but both seem to put in a lot of hours. One of these two makes herself available for nights, the other primarily days. Hospital-wide education is online.
6. We hire new grads...we have many. They are provided an extensive orientation, usually about 4 months with a nurse preceptor, also provided several classes. I should point out that EVERY new hire into PICU gets the same extensive orientation, but nurses with prior ICU experience may move through faster.
7. Most kids transfer to the floor without a problem. Cardiac babies go back to NICU for feeding/growing and D/C from there. We do D/C home right from PICU occasionally. Usually they are trached chronic ventilator patients as our general care floors are not trained to have vents. Sometimes a long-term cardiac kid is D/C'd from PICU to home.
8. I'm not sure how to answer this. We kind of go in spurts. We have recently hired in many new grads, but we have also greatly increased our bedspace in the last few years. We do frequently have a larger number of new nurses on compared to experienced, which is a little unsettling. Hence the need for experienced RP nurses.

Hope this helps, I'm a little longwinded tonight!

I forgot to add, our transport team is a completely SEPARATE department, staffed with RNs, Respiratory therapists and paramedics. We also have docs at night, always one attending and one resident, and recently started having a nightshift nurse practicioner 3-4 days of the week as well.

I could not imagine not seeing my charge nurse all shift. Unless she/he is coding a kid all night, they usually pop in my room to check on me once/twice a shift. The docs, NP, RPs, charge RN and respiratory all carry portable phones, so they're easy to get if you need them.

Okay, think I'm done now!

Hi! I actually work in the NICU but spent some time as a student in a PICU before I graduated. Hope some of this helps, even though I may know have as detailed of answers.

1. Big cardiac surgical program, providind half or more of the PICU patients at any given time. ECMO, CRRT. Transport. Complex ENT. Neurosurgery. No transplants. No trauma.

2. 20 beds. Private rooms arranged in a square with glass front walls for ease of viewing. Five beds are in an open bay area. Report room, stock supplies, HUC, charge, etc. are in the middle of this square. Most patients are 1:1. You might have a paired assignment if they should be ready for the floor or for step-down that day. Or otherwise very very stable. Occasional 2:1, and ECMO patients have a separate RN for the pump.

3. RNs are responsible for total care with the exception of RT.

4. You and your neighbor nurse try to cover for each other. There is also a CRN without assignment and charge without assignment. The CRN helps with breaks if there aren't other fires to put out. If you were 2:1 you wouldn't cover breaks for another 2:1 assignment. That's too many to keep track of.

5. Various continuing education classes and talks are offered hospital-wide and are often PICU pertinent. CEUs are offered fairly regularly. At least every 1-2 months, often with several CEUs in one opportunity. Clinical practice updates are also released that are pertinent to patient care. There are multiple bulletin boards that have various topics, updates, etc. for educational purposes.

6. New grads are hired at times. Orientation is supposed to be 6 months. I don't know much about the actual quality. I can tell you as a new grad to the NICU I had the typical 1+ weeks of general hospital orientation, 3 months with a preceptor doing patient care, and 6 days of neonatal specific classroom time.

7. Generally beds are available as needed for kids coming out of PICU. There is a stepdwon capable of taking stable cardiac kids and chronic trach vents who will be vented at home. In addition, if kids who are vented at home come in the hospital for some reason, they can go to the regular floors assuming airway/ventilation is not the reason for admission. It is typically more difficult to transfer our patients out of NICU than PICU.

8. Turnover is alright. Could be a bit better but is good I think relative to other places. People wait years for day shifts, but there are typically a few openings posted. There are many *very seasoned* nurses on this unit.

Additional thoughts. As mentioned, there is always a charge and a CRN without assignment. An intensivist is always available 24/7 either in the unit or nearby in the hospital, and if it's truly a crisis, he/she will be there within 1-2 minutes. We don't utilize residents, students, or fellows. Our daily cxrs are done 03-04. No IV team--RNs responsible for IV starts, art sticks, venous draws, etc. Most labs drawn by the bedside RN. HUCs are very helpful but consumed by transcribing doctor's orders into the computer. Charting done on the computer--slow as a snail. There is usually 1-2 float team RNs available to the whole house to assist with road trips.

Hope this helps!

I want to work at kessadawn's hospital!

To add: our unit has 14 of the beds arranged in a U around back-to-back central nurse's stations. The other 6 beds are in a back offshoot that's not terribly well-stocked and it's scary back there. When we did hearts, they would often go back there because it was next to the cath lab. it scared us all to death because, as we used to say "no one hears you scream." All private rooms with sliding glass doors and a central monitoring system.

We have a unit secretary. usually. Docs enter all orders on computer and we're not allowed to take verbal orders, which helped. It's a locked unit, so when there's no secretary, the RNs closest to the front desk spend their entire shift ringing people in and out of the unit. Which isn't cool, because hte really sick kids usually get placed in the front rooms there.

Our patients sometimes got moved around to make pairs possible. The best was opening and then closing the back unit (those extra 6 beds) in one day. I must say, though, I do a great deal more shuffling patients around here on the ship. Just the other week I got handed a list of pretty much all the patients with new bed numbers and just had to move everyone around because they wanted to close a ward for the weekend. Oh well. It's not so hard when the beds are 2 feet away from each other...

What exactly does your unit secretary do, Jan? Ours are wonderful, a godsend. The enter all orders into the computer, take care of consults, put together the chart, there really isn't much to file since we're paperless. When there is a code in PICU, they are there, with a portable laptop, entering orders as fast as they are yelled out, calling xray, etc.

Sometimes we play musical patients too, in order to arrange our less critical kiddos near each other so they can be paired. If the only 2 stable, non-intubated patients are 12 rooms apart, and can't be rearranged, they won't be paired, and bed control doesn't like that! We don't have any type of step-down, so sometimes our pts can be "floor-worthy" but still hanging out for whatever reason.

Yep, Jan!
I think you need unit secs like some of the rest of us! I feel like they are more informed than the charge nurse as to what is going on on the unit half the time! They put in all of the orders(very quickly), file the results, aswer the phones, direct "traffic",make phone calls for us(where is my blood? where are my stat lab results?ect ect). I swear I would NEVER want that job--- talk about stress!!! Our secretary is a GODSEND!