Nurse to patient ratios and acuity in YOUR PICU

Glad your meetings turned out well, Jan. Maybe things will finally turn around for you and your co-workers. Good luck!

Hi,

I work in a 16 bed PICU in a level I trauma center, large teaching hospital. We have a resident and fellow in house 24 hours a day and attending in house during the day and on call at night. Our attendings all live close and can get to the hospital in minutes if the fellow cannot handle the situation on their own. Our docs are wonderful but we are headed for a fellow shortage next year and that is going to be very difficult.

1: What level of care does your unit provide? (Do you have a cardiac surgery program? Do you have an ECLS/CRRT program? Do you have a transport team? Transplants? Neurosurgery? Complex ENT? Trauma?)
We have a seperate transport team with RNs and RTs. We do everything listed above although, we see transplants now and then and ECMO once every couple of months or so.

2: How many beds do you have? 16 but will expand to 20 beds early next year.What is your usual nurse to patient ratio? We never have more than 2 patients, patients that are singled are fresh post op hearts,critical airways that are chemically paralyzed and sedated, and any really sick kiddo requiring interventions frequently or one that needs close monitoring. Being on vent is not a reason for a patient to be singled unless they are on JET or the oscillator (although in a pinch I have had a kid on CVVH and the oscillator paired with a chronic stable trached pt but that only happens in a severe staffing crunch)

3: Does your unit employ ancillary staff such as CNAs or patient care techs to assist with hands-on care or is the nurse responsible for total care of the patient(s)?
There are a couple of NA's and/or nurse externs that work in our unit but they only work day shift and mostly help with traveling to scans, stocking and running to blood bank. On nights we do total pt care.

4: How do you manage breaks in your unit? We have combined our 30 min and 2 15 minute breaks, so we get an hour break . If the patient is really critical then the charge nurse (who does not carry an assignment unless we were really short staffed) watches your pt. Otherwise we just get another nurse to cover for us for the hour. We try to have everything done, make sure nothing will beep off, and our kid is well sedated before we leave. The goal is for the person covering for you to not have to do anything for your pt while you are gone. And we see our charge nurse frequently because they don't have an assignment they float around the unit helping where they can. They also have to do IV starts on the floors, and go to every pediatric code or rapid response call.

5: How is continuing education provided in your unit? We have hospital wide competencies that must be completed yearly and we have a PICU education committee that meets monthly to come up with quarterly competencies and other cont ed opportunities.

6: Does your unit hire new grads? Yes.What kind of orientation program are they given?12 week orientation rotating days and nights. Staff with nursing experience is given 8 weeks.

7: How difficult is it to transfer patients out to other levels of care when they're ready? Our main problem is bed space, most of the time we can get stable kids out as long as there are floor beds available. I do think we need a step down unit because some kids tend to hang out in our unit because of one issue that I think could easily be managed on the floor but the floor nurses don't feel comfortable taking them so they get stuck in our unit. Do you ever discharge patients home from your PICU? It happens rarely, most discharges from home are chronic home vent pts (our floors can't take home vents even if they are stable which I think is so silly considering these pts are managed by LPNs in a home setting!) or a kid that probably didn't need to be there in the first place and once problem is solved it just makes more sense for them to go home. I've only seen that happen a handful of times in 4 years though.

8: What is your turnover like?
our turnover isn't too bad, it's usually related to life changes, births, marriages, relocations of spouses, furthering education (NPs,CRNAs etc). Once in awhile we will have a group leave at once it seems like but most are not leaving because of the unit itself. Most people that come seem to like it if PICU is their thing. We have had a few nurses leave that couldn't deal with sick kids or they came from NICU and didn't like all the different diagnoses and big kiddos so they went back to NICU.

HTH!