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Discussion

CA ICU staffing guidelines

Hello

I was hoping someone can help me find a law or some insight into this topic.

I work in the ICU. I am a new graduate nurse (5months). Three times I have came to work and been paired with a med surg, ER or L&D nurse as my back up. I have been told that this is illegal by other experienced RN and that I should refuse assignment. We are the only two nurses on the unit since this is a small ICU. I do not feel comfortable with this. Especially because the other RN do not have access to the pyxis for things like insulin etc. I have to call house supervisor and wait which can be very dangerous for my patient!. Thank goodness nothing has happened but the potential is there. The next time this happens I want to refuse assignment until they bring an ICU nurse.

Is there a law that states I have this right?

Does having ANY RN on the unit as long as ratios are intact allow for compliance or do they have to be ICU RN?

Sometimes they put the house sup on the unit however not all the sups are ICU RN'S some are ER, MED SURG ETC. Is this complain't or even considered safe??!

Thanks in advance and please point me in direction of some law so I will be prepared when I refuse this next!!

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    • Featured Replies

    In California, ICU RNs are 2:1 or 1:1.

    If you the other person you are working with have critical care background/training, regardless of where they working right now then it should be okay. Like you said, it is a small ICU. If the biggest concern you have at the moment is that they do not have access to the pyxis to get insulin, that's not really something you should focus on.

    http://www.cdph.ca.gov/services/DPOPP/regs/Documents/R-37-01_Regulation_Text.pdf

    70217.1 - Talks about staffing ratio for ICU

    http://www.nurseallianceca.org/files/2012/06/Title-22-Chapter-5.pdf

    70491 - Intensive Care Unit definition

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    • Author

    [

    Thanks a bunch. I just used the insulin as a small example. These RNs do not have critical care experience. They wouldn't be prepared to run a code or even have access to emergency medications if I am stcu at the bedside. Some of them still have problems reading Tele which is the job of the second nurse when census is 1 to 2. One RN takes patients the other takes the desk. But what I think you are saying is the ER nurses should be okay since they have critical experience? Someone at work stated that it is against the law when there are not two ICU RN in the unit with ICU patients. I was trying to find this law. Thanks for your direction! :)

    QUOTE=Nurse_;8213133]In California, ICU RNs are 2:1 or 1:1.

    If you the other person you are working with have critical care background/training, regardless of where they working right now then it should be okay. Like you said, it is a small ICU. If the biggest concern you have at the moment is that they do not have access to the pyxis to get insulin, that's not really something you should focus on.

    http://www.cdph.ca.gov/services/DPOPP/regs/Documents/R-37-01_Regulation_Text.pdf

    70217.1 - Talks about staffing ratio for ICU

    http://www.nurseallianceca.org/files/2012/06/Title-22-Chapter-5.pdf

    70491 - Intensive Care Unit definition

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    I suggest checking the Nurse Practice Act/BORN regulations for that state.

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    [

    Thanks a bunch. I just used the insulin as a small example. These RNs do not have critical care experience. They wouldn't be prepared to run a code or even have access to emergency medications if I am stcu at the bedside.

    How do you know this?

    I have no critical care experience, and have no issues with calling a code, have done it.

    With all due respect you are a new nurse of five months experience. I think its incredibly arrogant to dismiss your colleagues because they arent specifically ICU trained.

    Some of them still have problems reading Tele which is the job of the second nurse when census is 1 to 2. One RN takes patients the other takes the desk. But what I think you are saying is the ER nurses should be okay since they have critical experience? Someone at work stated that it is against the law when there are not two ICU RN in the unit with ICU patients. I was trying to find this law. Thanks for your direction! :)
    Document any unsafe situations. Most facilities have an incident form use it. Because if something goes wrong, one of the first questions will be 'why was nothing said'
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    Are you taking about for the entire shift or just break relief so ratios can be maintained. The law in California pertains to ratios and it is 2 to 1 in ICU which must be maintained at all times. It is the hospitals and the nurses responsibility to make certain that the nurses have the skills and resources to perform their duties to the standard of care in any given situation.

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