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.
Hello there, in our icu the ratio is ALWAYS 1nurse:3 patients.Most people say that quantity kills the quality, but we are doing our best,and in the end of the day it seems we can be proud of ourselves...cause after all there's no other choice.
Imagine how exhausting this can be since we admit all kinds of patients (surgeo-cardio-ards-H1N1-etc). Ihope this can give you a bit of courage.
We are usually 1 RN : 2 patients. Only 1:1 for fresh post-op hearts, CVVH, extremely unstable ( 5 pressors ), or extremely agitated and we're unable to get a bedside sitter.
where i work it is generally a 2:1 ratio. I have had paired CCVH coming off my orientation and plenty of times where you have to titrate multiple drips at the same time, but you make it work. I had a great preceptor who taught me how to really manage my time and most of the time there is always someone to help ya out whether that be a charge nurse or someone with a less busy assignment. Occasionally we'll have a 1:1 if that person is on multiple drips, pressors, and is being paralyzed or one time i had a pt on the rapid infuser who had many other interventions and meds being pushed and that was a 1:1 but i had the charge nurse and float nurse in my room in order to get everything done. I think the more time goes on the better it gets, and the more you are able to do and see. Goodluck!!
OP here- I'm 1.4 years into my ICU experience. My time management and prioritization skills have gotten better. If by no other measure, I used to routinely leave by 9pm (shift ends at 7:30pm) because I needed that much catch-up time for documentation. I now usually leave around 8pm at the latest- which feels a lot better. However, I still feel that having two patients in an ICU setting (even one vented and one non-vented patient) is a challenge to juggle. Especially if a nurse has a vented patient like I did not too long ago who required heavy sedation, was on q1h neuro checks/IVC drainage/ICP monitoring + a non-vented patient who was quite anxious, dyspneic, and required an hour-long road trip (and of course the nurse who was "watching" my neuro patient never did my neuro check when I was off the floor). I still feel that, even though my time management and prioritization skills have improved, I still end up spending more time with one patient while my other patient doesn't get all the care and attention they deserve. Every day I'm forced to prioritize what is immediately important vs what can be put off or (sometimes) not done at all on my shift. And forget q2h, on-the-dot turning and mouth care if we're short on techs (or have no techs at all). Or giving all the patient's medications when they're supposed to be given. Overall, I feel like I'm forced to compromise my standard of nursing care for one patient so that I can spend more time with my other patient- who is almost always more sick. I'm not a "super nurse" and RNs who appear to get everything done on their shift for two busy patients really just take multiple shortcuts (some that are questionable) to get everything done. Sorry, I'm just not going to accept the status quo of 1:2 ICU patients- it's just not safe for vented patients- especially when tech and nurse staffing is low. Something needs to be done. Every vented ICU patient deserves their own nurse. I don't care what the established leadership thinks. That's my opinion based on my experience. And that kind of nurse: patient ratio can happen if something is done about the nursing shortage (yes- it still exists). ICU's in Australia routinely staff 1:1 for vented patients- why can't we?
Same in Canada, usually 1:1. Where I work now in the U.S., always have 2 Patients. Often they are both very sick, multiple drips, vents, and no help ect...The one thing I miss about working in Canada is the ratios. I was able to do so much more for my patients.
1:1? What's that? Granted, I work in a small community hospital, our "critical" may be another hospitals "step-down", but in my ICU there is no 1:1, usually no 1:2. I almost always have at least 3, sometimes 4, and one of the more experienced nurses had 5 the other day. That likely won't happen again, as she followed her chain of command right up to the CEO who nixed it. We don't have CNAs either, just a unit secretary sometimes. Am I working in the wrong place?
I work in a rural hospital and our ratio is always 1:2, occasionally 1:3 if we're short staffed. Rarely do we get 1:1, that's only for one nurse on the unit usually that's only given 1:1 to leave room for admits during the shift. Our charge nurses don't even get 1:1, we take 1:2 or 1:3 just like everyone else during the shift. It's almost like, what's the point of the charge nurse? If they're taking care of their patients, how can they charge? We just simply don't have the staff to allow free charging. We do for some reason have 2:1 for day 1 post open heart patients, our only cardiothoracic surgeon has requested that we do that. Any time they're still in the unit they're a 1:1 patient, even if they'll be most likely going to the post surgical floor that day. It sure makes it hard to have 2:1 ratio when there's other nurses on the floor who are working 1:3.
It's very sad, the norm in the ICU where I used ot work is becoming 1:3 due to staffing and budget issues. 2 of those patients can be on vents and drips.
WOuld love to move to sunny CA and have a mandated 1:1 ICU ratio.
That is incredible that a BiPAP is 1:1 in australia. We have pt.s on BiPAP on the medical floors where i work, they are relatively stable BiPAP patients but if someone is stable enough for biPAP they dont need a nurse to themselves. Must be boring working ICU in aus.
At the hospital I work at in Australia, pts on Bipap in Respiratory HDU are 2:1, but are watched very closely for a decline that will need ICU admission. We do have Bipap pts in ICU that are 1:1, but they generally have other issues going on.
Specializes in Medsurg/ICU, Mental Health, Home Health.
Australian ICUs are 1:1 for ventilated patients, and 99% of patients are 1:1 anyway.
Come on over!
*Sigh*
I studied abroad in Australia, and I loved it there. If it wasn't a 20 hour flight away from my family, I would be there in a heartbeat! (And if Sarah Palin ever ends up as President, that is where I am moving to, but that's another story entirely. :))
I don't work ICU, but at my facility, I know fresh OHS is 1:1 as well as s/p PEA arrest. Probably some PACU and SICU patients as well. The "average" ICU patient is 2:1.
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.
Viktoria.84
3 Posts
Hello there, in our icu the ratio is ALWAYS 1nurse:3 patients.Most people say that quantity kills the quality, but we are doing our best,and in the end of the day it seems we can be proud of ourselves...cause after all there's no other choice.
Imagine how exhausting this can be since we admit all kinds of patients (surgeo-cardio-ards-H1N1-etc). Ihope this can give you a bit of courage.