staffing

[krisfroggie]

How has staffing changed in the past two or three years for others around the country? We personally take much higher acuity assignments and and pair vent assignment much more often than just a few short years ago. I am concerned that this is becoming the norm and no cushion for codes or procedures or even unexpected admissions is allowed. I am giving my patients medications more for staffing issued than true need. This bothers me and I do not feel that the administrators care anymore. We are not unionised in central Texas.. for those of you that are, does it help this?

[linds2480]

I have worked PICU for the past 2 1/2 years now (right out of nursing school). Taking care of 2 vented patients is the norm around here. Our docs are pretty good about making sure the kids are on enough sedation to make it safe for them and us to leave the room. About the only time I have been 1:1 with a vented kid is if there are other circumstances necesitating (sp?) that staffing ratio. On instance would be HFOV. Otherwise, unless they are extremely sick and on several inotropes, they are paired.

[NotReady4PrimeTime, RN]

Multiple inotropes... we routinely have patients on epinephrine, norepinephrine, milrinone, sodium nitroprusside and maybe vasopressin too. (We rarely use phenylephrine, though.) It's also not unusual for our patients to have more than a dozen infusions running at the same time, intracardiac lines, multiple chest tubes, external pacemakers and are being actively cooled. We try to staff these kids 1:1 except for breaks, when we cross cover. The only patients who are not routinely cross covered are the ECMO patients, and even that has been changing. Our upper management is trying to do away with our resource nurse role which will effectively take away the only flex we have in our staffing. Things may get very dicey, given that our acuity is only going up...