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. 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.
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.
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.
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.
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.
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.
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.
Most ICUs will give you two patients, even with numerous drips. Time management will come to you, it just takes (how ironic) ----TIME. We have all been through this as new grads. Hang in there you will get it.... it becomes easier as TIME goes by. I have worked in CCU's where, of course, fresh CABGs or valves are 1:1, or LVADs, IABP's, CRRT's etc are 1:1...but the typical ICU pt is just another pt. You will have to learn to bite the bullet and ask for help if help is available, or be able to prioritize what absolutely HAS to be done, and what can wait. Hang in there.
In Australia, at the large public hospital ICU I work out, we are 1:1 for all patients. At the private hospital ICU I previously worked out, all vented and/or dialysed pts, or particularly confused pts were 1:1, the non-vented pts were 2:1.
I work in a big public ICU in Adelaide Australia. We are 1:1 ratio. Definitely for vented patients. Very infrequently you get 2 patients, but are HDU or ward transfer types. I worked in the UK and they double up their vented pts now. But they maintain higher levels of sedation on their pts to maintain safety.
At my old inner city SICU in San Antonio, we saw everything from CABGs to guts to respiratory failures to DKAs. We were always understaffed, and often staffed with brand new nurses.
I was charging on nights as a new nurse with 8 months experience, had more experience than 80% of the other nurses, and still took two patients, often both ventilated and on multiple drips. One of the more experienced nurses was doubled as charge one night with a CRRT (that, according to our protocols should always be 1:1) an unstable balloon pump.
I saw nurses kill patients in that ICU. And even with best of intentions on my part, when I stopped and thought about it, I realized how dangerous of a situation this could and eventually would be. I don't work there anymore. :)
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.
I would partially agree since the OP is a new nurse, but I think is largely false also. I believe that ICUs who do not give vented patients with multiple titrating drips 1:1 care are doing their patients and staff a great disservice. I realize there are tight situations when you get short-staffed for reasons out of your control, but this should not be the routine. I realize this is all too common, but it's not time to just accept poor staffing ratios. For new nurses reading this, it WILL get better as you gain experience and comfort. But it CAN get better yet when hospitals provide appropriate staffing for the needs of the patients.
The time is long past that hospital management should ever be allowed to determine what is safe staffing. That needs to be driven by the nurses at the bedside. I would encourage those nurses that feel they are practicing in unsafe environments to contact their state legislators and speak out. Also become familar with acuity systems and document what is happening in your units.
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.
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porterwoman
185 Posts
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?