Nurse to patient ratios and acuity in YOUR PICU

Thanks, for your input. How's your staff turnover? Do you have a lot of people "taking advantage of other opportunities"? That's what our management says when we ask why we're losing staff left and right, they left to take advantage of other opportunities.

You're all going to think this is a trick question. It's not.

Do you ever take patients off the unit for social purposes? By this I mean taking them outside to watch the traffic, or to the playroom, or just for a walk around the hospital. And I mean ICU patients, not those waiting for beds on the floor. Real ICU patients who are intubated and ventilated, on multiple infusions such as pressors like norepinephrine, with drains or open abdomens. If you do this, what are your protocols?

Well I usually find an excuse why we can't go. Like there aren't enough RTs to go off the unit for non-urgent reasons, or something. But we have one intensivist who writes in the orders, "Take Jane to the playroom for 30 minutes today. RT and RN to attend. May go physicianless." On Saturday they took one of our chronically critical kids outside... this kid is a hypoplast>transplant x 2 months but inotrope dependent/CRF on CVVH/myopathy of critical illness (no trach, parents refuse)/FTT never out of hospital or off the vent with cortical blindness. When the CVVH filter clotted off and they had to discontinue treatment to prime a new one, Doc Holiday says, "No time like the present... off you go!" Last summer he had us taking a liver tranpslant patient who was actively dying and comatose out for walks because it made the parents feel better. We're not staffed for crap like that!!!!!!!!

That's exactly how we feel about it, and because he's the medical director of our unit and he usually makes these kinds of orders in front of the parents (you know the 'parents' I mean, too), we're kinda stuck. (In our unit we don't practice family-centered care, it's family directed care!) He knows exactly how far away from the building we can go without needing EMS for an emergency, and will even suggest that we sit under the ambulance bay canopy so the kids can "watch" the traffic! A few years ago he left orders that a five month old with such extreme PHN that we were running a Flolan infusion (along with the usual norepi and epi) who was being nursed on an overbed warmer be taken for a walk. The nurse assigned to that patient that day refused and told him if it was so important to him that this kid go off the unit for a social reason, he should do it. The kid didn't go.