staffing

  1. 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?
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  2. 13 Comments

  3. by   NotReady4PrimeTime
    We haven't yet gotten to the point where we have to pair vented patients, but I think it's coming. We are short-staffed as a rule, and some shifts it's downright unsafe. We too are giving meds to patients not because they really need them, but to snow them so that we can do other things. How sad. And being unionized hasn't made one darn bit of difference. They go through the motions, but nothing that is deemed necessary is ever binding on the facility. Right now, there are only three nurses in the unit... period. If there were to be a code, two of us would go, as that is what seems to be expected of us, and there would be an unsafe situation in the unit. We've filled out workload and staffing forms until we could do them in our sleep, but things don't change, at least not for the better. Our staffing for nights is no better today. let's hope there are no MVAs on the TransCanada Highway today.
    Last edit by NotReady4PrimeTime on Oct 20, '01
  4. by   Rileycat
    Our staffing is based on acuity. We have a wide range of patients, so in our PICU we also have an intermediate section for those too sick to be on the general peds floor, but not sick enough to be in the ICU. In intermediate the ratio is generally 3-4 patients to one nurse. In PICU we have 1-2 patients per nurse. If we have a fresh open heart, the hospital staffs two nurses to one patient for the first night, then it becomes 1:1. Once the open heart patient is stable, the regular 2 pts to 1 nurse applies. I think our regular pediatric floor gets 5-7 patients. I work in a teaching hospital so if a code arises, all the peds residents come running. My hospital is hiring a few more night shifters so hopefully we won't have to work as many weekends as we do now. I am curious to know how other hospitals staff for nights.
  5. by   ninaldunn
    I am a float nurse in my hospital. We recently opened a PICU. It's 4 PICU beds, 2 swing beds that can swing to PICU or IMCU or back to general peds.

    The last time I floated there they had 3 patients, 2 PICU nurses and me. - no unit clerk. They had a scheduled MRI for a vent patient so they knew one nurse had to go. Sure enough, the other 2 got busy, we were hanging blood, there was no unit clerk, the phones were ringing off the hook, etc. The 2 of us together were fine, but if that nurse was alone she'd be toast.

    Our pediatric floor will help out if they aren't too busy. They usually have 3 or 4 on days and pms. They have a lot of chemo patients.

    We also have SWAT nurses. They are the best since sliced bread. They come rescue us in so many ways. They are not assigned to a floor like float team. Supervisor assigns them, or they make rounds to see who's busy. They start hard IV's, they insert PICC lines, they help with admissions. They often pick up the patient from ER, get the history, get your vitals, start your IV's, give any admission meds, then they just give you report. It's wonderful. They respond to codes not as part of the code team but to see if the nurse has other stuff to take care of such as meds for other patients, start packing up the patient for unit transfers, make phone calls to family - whatever you need. They will irrigate a clotted catheter - whatever.

    We only have 1 or 2 SWAT nurses on per shift. So she has to prioritize when she gets more than 1 call. They work 10Hr shifts so they overlap our 8Hr shifts.
  6. by   NotReady4PrimeTime
    Your SWAT team sounds like the answer to our prayers! I wonder if I could sell the idea to our administration...
  7. by   blueinplaid
    Union smooonun. I am a travel nurse up in ny at the moment but hail from Texas. I am not a union fan and feel that they are obsolete from my experiences here. I have noticed the use of more paralytics and sedation due to staffing issues more than anything else. I think I had a good experience at my home hospital because most of the time we did well with having only 1-2 patients per nurse. We had a charge nurse that did not have a patient assignment unless absolutely necessary and a transport nurse that assisted with everything. I think we were pretty lucky looking back at it now.
  8. by   Mishnoah
    I'm so glad to see some recent posts, haven't checked in awhile but wondered where all the PICU nurses were. Allow me to introduce myself, I'm a relatively old woman still kind of new to nursing, 1996 grad. I've worked in PICU for 2 years. In my former lives I was a waitress, secretary, teacher, social worker, pretty much have done every job traditionally done by women except nun and hooker. I work in a medium sized hospital. Our PICU sees mostly trauma and kids sicker than snot [RSV, DKA, asthma, seizures, newly or still to be dx Cancers], we don't do transplants but have had more than our share of donors in the last couple of months. As far as staffing on my unit, sometimes it's good, other times it's not. We're an aging group, 3 of us out on FMLA through the holidays and into the new year. We have a 10 bed unit, was 6 until 2 years ago. Then we opened PICA [pike-ahhh], 4 beds for intermediate pts, too sick for the floor, not ICU. All 10 beds could be used for PICU pts, or we could have 10 PICA. Mostly it's a mix and we average 3-5 pts at any given time. Most of the docs don't have a clue what PICA is all about, so we often end up babysitting kids who could have gone home after a couple hours monitoring in the ED. When we're fully staffed we start with 4 RNs per shift. We work 12's so that's 4 days/4nocs. We are hardly ever fully staffed so it's usually more like 4 days/2 nocs. PICA is 3 to 1. PICU is 1 or 2 to 1. We too have begun pairing vented kids with others, a practice my more experienced colleagues have mixed reactions to. For some it seems the pairing is acceptable only if it's not their assignment, kids also have a remarkable way of being upgraded at 1900, so sick they were 1:1 all day but miraculously pairable as we move into the twilight hours. Oops, too much of my bias showing. I am a night nurse, tried days, too many people to trip over and nowhere to sit when I wanted to chart. We have a Pedi Flex team that covers our unit, children's and the dreaded NICU. The Flex nurses are mostly great. I'd like to hear more about the SWAT team I read about in another posting. How's morale on your units? How about bereavement, how do you process pt deaths, we've been talking about doing some sort of m&m for the nurses but so far nothings come of it. Looking forward to your replies
  9. by   UK2USA
    Here in the UK we staff 1:1 for patients in the PICU (at least in the hospital that I work in). For an 11 bedded ward that meeans that we usually have 13 staff (1 charge nurse, 1 runner / support, 11 bedside nurses). If we need help with further admissions then we have a clinical response team within the hospital that usually has at least 1 other PICU trained nurse.

    I have found in interviews with US hospitals that unit managers are very surprised at this staffing level and are concerned that British nurses may not cope with a higher ratio than that, but let me put your minds at ease.
    The 1:1 allocation is mandatory here in the UK (Department of Health: Bridge to the Future 1997).

    However, just to show you guys that our days are not spent with our feet up:
    We are responsible for all of the care given to that patient, so....
    We make up and administer meds, we turn and wash the patients, we analyse ABG's and alter ventilation settings, we provide most of the respiratory therapy, we assess nutritional status and commence feeds as appropriate, we manage the RRT (and ECMO) and make the adjustments to these therapies that we feel are necessary, we often manage the codes etc.

    Do the US nurses have the same tasks in their work, or are these tasks allocated throughout the multi-disciplinary team? I would be interested to learn prior to arriving in the US with my green-card.
  10. by   suzanne4
    When I used to work PICU alot, I always had two vented kids. And especially during bad RSV seasons, every kid was on a vent, and some were on two, with the jet. (this was in the US)

    But I have to say that this can only be safely done with a fabulous respiratory therapy team..................
  11. by   Nurse GOODNIGHT
    UK2USA: In my hospital the nurse aides do all the baths/beds, vital signs, keep up with I&Os. But quite frequently they are short-staffed also. Vents,etc are done by rts.
  12. by   dutchesstee
    I work in Minnesota, we do have resp therapists that actually set up the vents and change the settings on the vents but we help with intubations, start IVs draw labs, do the baths, wts and all the other care. And because we have residents that change every month we need to be very ontop of all the normal orders and accepted practices and doses as these residents are only there for a month and as residents are learning. It is very scary to not ber able to rely on the MD to do the best thing as far as the pts medical needes go, and the intensivist expect that we will "catch ' the residents mistakes.[FO./NT=Comic Sans MS]undefined
    Quote from UK2USA
    Here in the UK we staff 1:1 for patients in the PICU (at least in the hospital that I work in). For an 11 bedded ward that meeans that we usually have 13 staff (1 charge nurse, 1 runner / support, 11 bedside nurses). If we need help with further admissions then we have a clinical response team within the hospital that usually has at least 1 other PICU trained nurse.

    I have found in interviews with US hospitals that unit managers are very surprised at this staffing level and are concerned that British nurses may not cope with a higher ratio than that, but let me put your minds at ease.
    The 1:1 allocation is mandatory here in the UK (Department of Health: Bridge to the Future 1997).

    However, just to show you guys that our days are not spent with our feet up:
    We are responsible for all of the care given to that patient, so....
    We make up and administer meds, we turn and wash the patients, we analyse ABG's and alter ventilation settings, we provide most of the respiratory therapy, we assess nutritional status and commence feeds as appropriate, we manage the RRT (and ECMO) and make the adjustments to these therapies that we feel are necessary, we often manage the codes etc.

    Do the US nurses have the same tasks in their work, or are these tasks allocated throughout the multi-disciplinary team? I would be interested to learn prior to arriving in the US with my green-card.
  13. by   megcaffrey
    The number of vents relative to the number of PICU nurses is what determines our assignments. We try to split them up, but given the staffing crisis and the lack of experienced PICU nurses, us old-timers are taking 2 vents at a time more often then not. I feel like the SWAT team you mentioned is the answer to all of our prayers!! Do you have guidelines or a policy or job description about their role? I'd love to initiate that here!!
  14. by   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.

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