Jump to content

Any ICUs or critical care settings where the standard ratio is 1:1?

Posted

I ask because in my ICU (and in the other ICUs in my hospital) 90-95% of the time each nurse gets a two patient assignment- usually two busy, vented patients with families who have a million different questions and demands.:uhoh3: Not to mention all the specialists and other disciplines who round on the patient and want a piece of your time. I'm a new graduate (I've been off orientation for 2 months now) and I still struggle to meet all the needs of 2 patients. I find, however, that I actually get things done on time (or ahead of time) and get to know my patient a heck of a lot better if it's a 1:1- even if the patient is really sick. I don't mind close monitoring of patients and working to maintain airway/resp/hemodynamic stability; I actually really like that part of my job. Next to time management, it's the longer-term care stuff (eg- nutrition, skin/wound care) that trips me up. Maintaining the hemodynamic stability of two patients AND re-dressing their 6 different wounds (each with a different order) AND appeasing family members AND giving their meds on time (or even during my shift) AND providing mouth care AND turning heavy patients q2hours AND documenting everything accurately/on time seems near impossible more often than not. I mean, I get all the really important short term things done when it comes to ABCs, fluids, correcting electrolytes, giving meds, etc- it's wound/skin care and documentation that presents a problem. I just hope I will improve with time and experience. I still feel like I can provide (and have provided) much better care to patients in 1:1 situations, though. I think any nurse would feel the same way.

ShaunES

Specializes in ICU. Has 1 years experience.

Australian ICUs are 1:1 for ventilated patients, and 99% of patients are 1:1 anyway.

Come on over!

General E. Speaking, RN, RN

Specializes in floor to ICU.

The only time our ratios allow for a 1:1 is for fresh open hearts. Meaning this is standard. All fresh open hearts get 1:1. Sometimes, they (mgmt) allows for a 1:1 on POD #2 if the patient is really unstable.

Otherwise, our staffing is 2:1. Most times if you have a patient that ends up being a 1:1, you spend most of your time with that patient and the other patient suffers. Meaning that you end up having the other nurses or charge nurse check on their status, help you give meds, etc. I consider myself lucky if there is a nurse on call and they can bring them in to take over the second patient. It is really hard to juggle- especially since you KNOW that second patient needs more attention than you can physically give. It makes me nervous because it is dangerous. Fortunately, if the day shift nurse (or vise versa) has been unable to leave the patients bedside because they have become so unstable, they will try and staff better the next shift and let them have the 1:1.

Our cardiac ICU is 1:1 on nearly everyone. Post open hearts mostly though. Plenty of bypasses as well. Most of the time when we saw open a chest, you get a 1:1. We also do 1:1 on brain death patients or behavioral issue patients in the ICU.

After my mom cardiac arrested (PEA), the standard protocal called for 1:1 during induced hypothermia.

The 1:1 ratio was appropriate given the need to use paralytics, titrating multiple drips, manage an A-line. Our nurse was a nurse with 5-7 years of experiance, and was running to get everything done.

Actually, we had almost 1:2 ratio with the nurse manager in the room a good portion of the day.

Jenn329

Specializes in Cardiac Surgical ICU.

We have 1:1 if the pt is on CVVH or is really unstable. 1:2 if the patient comes back from open heart with an open chest and LVAD.

Our ratio is 1:2 unless we have them in induced hypothermia, severe brain injury with drains, icp monitor, a-line, etc.... what makes is worse for our unit now is out trauma docs has seen it necessary to have our level 1 traumas brought straight to us after gettin off the chopper and going to ct, completely bypassing the er. Yah us

XB9S, BSN, MSN, EdD, RN, APN

Specializes in Advanced Practice, surgery. Has 33 years experience.

most ICU in the UK nurse level 3 patients as 1:1

CrabbyPatty

Specializes in ICU. Has 3 years experience.

It's 2:1 and sometimes 3:1 where I work. We're a "country hospital" (in a suburban setting) so not all of our patients are "critical". However, I've had a couple of situations where I've had 2 CRITICAL patients and a 3rd not-so-critical all at once and very little help from my co-workers. I should've refused, but I was new. As you gain more experience (& confidence) you will hopefully be able to stand up for yourself and for patient safety!

WSU_Ally_RN, BSN, RN

Specializes in MICU for 4 years, now PICU for 3 years!. Has 7 years experience.

I'm in a Peds ICU and we routinely are 1:1 for any intubated kiddo... The long term, more stable kiddos are 2:1... I have heard, but haven't seen yet that occasionally they have kids that are sick enough to need 2 nurses...

Leanne62499

Specializes in ICU. Has 10 years experience.

Unfortunately not where I work. It is becoming almost standard to have 3 patients assignment, and I think it is down right unsafe ! I used to love my job, but know the 12 hour shift turns into 14 just trying to catch up with my documentation, and not forget something. Some days by the end of the day we end up having 4 patients, because the empty beds are made to be filled by fresh emergencies. So we transfer patients out just so they can be MET calls same day or a day later! :-(:confused:

I'm in a Peds ICU and we routinely are 1:1 for any intubated kiddo... The long term, more stable kiddos are 2:1... I have heard, but haven't seen yet that occasionally they have kids that are sick enough to need 2 nurses...

The only situation in which we officially have 2 nurses taking care of one patient is when a preceptor and their orientee take care of a sick patient who is 1:1. I did this a few times during my orientation- such as one night where my preceptor and I had a septic patient who was on propofol, fentanyl, levo, vaso, multiple antibiotics, insulin drip- well, it seemed like you name it, the patient was on it. It got so busy that I basically acted as the documentor while my preceptor provided the majority of the patient care (because things had to happen that fast). Other than that, if there's a really sick 1:1 on the unit, a float nurse might help out the nurse who is assigned to that patient; the float isn't "dedicated" to that patient, however.

porterwoman

Specializes in ABMT. Has 8 years experience.

How about burn ICUs? Don't they usually have a 1:1 or even 2:1 ratio with all the constant dsg changes & fluid shifts & drips & pain management & stuff? No experience in burns, so I'm only going by what I've heard.

Anyone have burns experience?

ObtundedRN, BSN, RN

Specializes in Critical Care. Has 6 years experience.

At my hospital, all of the ICUs are 2:1. The only unit that does 1:1 is our CVRU, and they do it for new open hearts, and other specific CV surgeries. And they mostly do this because of their very aggressive ventilator weaning and other very strict hemodynamic monitoring with appropriate interventions.

However, on the ICUs with their 2:1 ratios, if one of your patients are crashing and you're stuck in the room doing tons of interventions, the other staff on the unit and the charge nurse is usually really good about helping you out.

SRNA4U, BSN, DNP, RN, CRNA

Specializes in Anesthesia, ICU, OR, Med-Surg. Has 20 years experience.

Hello,

I'm in the Air Force but I work at a Naval hospital on a medical, surgical, neuro, trauma, and CT ICU unit. The norm for us is 1:1 and on some occasions, we may get 2 patients but it's very seldom that it happens. The military is very different since we use Corpsmen and if a nurse is assigned 2 patients, the nurse will also be assigned a corpsmen, who can take their own patient and do assessments and some medications. We always check over them since they work under our license. It's pretty nice to have the extra help but I always do my own meds and my own assessment.

Air Force RN

littleneoRN

Specializes in NICU. Has 6 years experience.

In my NICU, we have a lot of 1:1 patients. Most vents are 1:1, occasionally paired with another stable baby if staffing dictates. If we have stepdown type of kids who just haven't made the move to the actual stepdown yet, then we have two patients. It is possible, I guess, but extremely rare, to have two vented patients. This isn't true in all NICUs though. Not all have very great staffing ratios, and some NICUs are both intensive care and stepdown all in one unit.

MomRN0913

Specializes in ICU.

we are never 1:1 unless we get really lucky, by means of transferring out a patient and not receiving another. We are a med ICU, community hospitals. seems these days the ratio is 3:1.... sometimes with charge nursing responsibilites, 2 vented patients, multiple drips.... I am starting my new job in nurse management monday, but this was what its like in my MICU unit lately. Short staffed, lots of call outs, low budget, it's been awful, and scary. I wasn't eating until 2 or 3 pm. I felt like I wasn't giving my patient the care they deserved, especially as an ICu patient.

Maybe I'll move to Australlia...

ghillbert, MSN, NP

Specializes in CTICU. Has 20 years experience.

Honestly, the problem is not so much the patient assignment as your time management and priorization skills. Why not take this as a challenge? Anyone entering critical care needs to work out how to manage both the acute and chronic patient physical needs, psychosocial issues, and family demands along with rounds, consults etc. Are you working with a preceptor who can offer advice on how to get things done? 4 months is a very short time to have worked in ICU so give yourself a break - it's a "critical care" area just because the patients are complicated and demanding, and it takes time to get proficient at that.