I am interested in knowing how units like mine staff the assignments. I am in a 26 bed cardiac interventional unit. Our main patient population consists of post PTCA/Stent patients, with and without femoral arterial lines. We pull our own lines on the floor when their ACT's are less than 150. The majority of our patients come back with closure devices or are radial procedures who come back with hemobands on. Up until now, if a patient with lines was on reopro or integrilin, they went to CCU (due to the increased chance for bleeding), but now they want to put these patients on our floor. We also take stable MI's, chest pain R/O MI, and any other tele patient they don't have a bed for (there are two other tele units where I work). We use heparin, Nitro (titrating), dopamine (rarely titrate, but has happened), dobutamine, amniodarone, lidocaine, pronestyl, cardizem, adenocard, covert and most other gtts. No nipride. At present, an assignment starts with 4-5 patients per nurse, and then one nurse occassionally gets 6 patients. Our patients are admitted on a day surgery floor, go to the cath lab, and then come to us. We recover them and they stay overnight and are discharged the next morning, and then we start all over with a new group of post procedures. We have a charge nurse without patients, who is bed control and usually is very busy making beds for the patients coming out of the 3 cath labs. If your unit is like this, can you tell me your ratios, as I am this units' manager and my boss says I have to staff it as other like units do and I think my nurses are already overworked. Thank you
Last edit by stellaCat4 on Aug 28, '01
Aug 30, '01
I haven't worked on a unit like that, in both hospitals I have worked in who do interventional procedures, the pt's always return to the ICU/CCU. The ratio there is never more than 3:1. The nurse pulls her own lines, or if not line-pull certified, someone else pulls her lines, while she watches their pt's. Though, the line pull nurses in the one hospital often will not pull lines alone, they request that the pt nurse also be present for the first 10 min or so. Let me tell you, I have seen a few pt's go down the drain real fast with, and after, line pulls. I am not talking just a vasovagal, but major MI, fire hats on the ekg.
I just wanted to say mostly, that I admire you for backing up your staff. Try writing to AACN, the amer assoc for critical care nurses, they may have a standard for staffing this kind of unit. I know ASPAN (Assoc for post-anesthesia nurses) has standards for staffing PACU's, so maybe AACN does too, not sure. Good luck.
Aug 30, '01
I work in a similar setting but with some differences. We have an 10-ish bed area strictly for the recovery of interventional cath pts. The nurse pt. ratio in this area is 2-3 pts per nurse. These nurses handle the line pulls, drips, etc. The other area that is adjacent to this is a 24 bed tele area with a nurse pt ratio of 4-6 pts. per nurse. The nurses rotate through each area, but only a select group are cross trained to work in this post interventional area. Hope this info helps. I too manage this and other areas, and struggle with tryng to keep the ratios safe.
Oct 11, '01
I work in a similar unit. Up to 36 beds.
We do post PCI, post PPM, 24 hour post OHS, r/o MI, CHF, cardioversion and whatever else they think is not sick enough for ICU but too sick for the floor. We sometimes do TEE's at the bedside. We do our own sedation for procedures (i.e. chest tubes, cardioversion, TEE, ect.)
We use and may titrate as needed NTG, Nipride, Dopamine. We use dobutamine, amiodarone, primacor, lasix gtts, cardizem, corvert, ... well the only thing we dont' take is levophed. How about that. All levophed has to go to ICU.
We have patients with and without lines, with and without closure devices. We use integrilin, and reopro. Radial and femoral approaches to PCI.
We monitor by tele, no hardwires.
We often get AMI and don't send to ICU because of physician preference for our unit. Go figure.
Our ratio is 3:1. And as the person making the assignments I can tell you that this is often an overwhelming load. My manager is also looking for information on staffing ratios because admin thinks we should be able to do more. Would love to hear whatever you come up with.
Nov 2, '01
I work on a cardiac step down unit where we get rule out MI's, observation patients (from cath lab) and other tele patients that should be in the CCU. Our RN to patient ratio is 6:1, sometimes 7:1 depending on if we are full and what end of the hall you are on. The unit is very stressful and has a high turnover rate. We have added LPN's to help with the load and have tried team nursing where an RN is paired with an LPN. Needless to say this has not worked out because it increased the patient load. With the LPN's taking their own assignments now, an RN still has to perform procedures that the LPN can't do. Also an RN is still responsible for at least one assessment during the day for the patient. Having the LPN's has added more help to our unit. I don't know if your unit has a high turnover rate, but if it does, that should tell administration something! Patients are a lot sicker now a days and it is really taking a toll on our nurses! I would suggest having someone from administration follow the nurses around for a shift for a whole week so they see how stressful the conditions are. But, as you know this is easier said than done. Good luck.
Nov 16, '01
Similar scenario here........I work on a 24 bed interventional cardiac unit with a 12 bed CICU net door. As several posters have already said, there is a very high turnover, hence lots of paperwork. We have 6 PCI labs, plus EPS, so we are busy.
Assignments: Days 4:1, with a charge nurse; Nights 6:1, charge nurse has full assignment. We generally pull our own lines, and the MDs have been encouraged to use closure devices as much as possible(for all of the many benefits).
This RN staffing level is fine, provided you have good ancillary support--secretaries and CNAs. There are always shifts when 6 pts are fine, and then the next night 2 will keep you runnning. There's no real magical number.
Nov 24, '01
I work on a 45 bed CCU. We take acute and r/o MI's, 24hr post OH (lately we've been getting them just over 16 hrs though), cardiac caths with lines pulled by us, run all drips except levo, and trauma patients not sick enough for our ICU. Of course we see a lot of surgical, CHF, sepsis, and CVA's as well. All RN's float ICU/CCU but most of us "live" in one or the other. Our CCU is staffed 5-6pts to 1 RN and 1 LPN. In ICU they staff 1-2pts per RN. Acuity is always taken into account.
Dec 16, '01
I work on a 30 bed tele unit with 22 monitored beds. we use pagers for alarms on our computerized monitors. we have 4 rns and 2 rpn's on days, 3 rn's and 2 rpn's on pm shift, 3 rn's on nights. ratio is 1:8, 1:10, 1:10.
we recieve cardiac cath pts, r/o mi, chf, unstable angina, and pts waiting CABG, PTCA. , along with post op pts that need monitoring that are not going to icu
we do not hang gtts on our unit like nitro, amiodarone, etc but there is talk of this happening. we run our own codes. we do not give anti-thrombitics on our unit.
we have a high pt turnover rate. our staff turnover is probably better than other units in our hospital. please see my posting for hs care, i need some feedback.(in general nursing discussion)
Last edit by melodebbz on Dec 16, '01
Apr 10, '02
Hi there, I'm an RN in a step-down telemetry unit. Our situation sounds a bit like yours only we do take patients on integrilin and reapro. We are 28 bed unit that takes mostly r/o MIs and any pt needing telemetry that isn't critical enough to be in ICU, we also receive OHS pts on their 2nd day post-op. We have a 3 bed intervention section on our unit where our post heart cath pts are recovered which is where I generally work. What usually happens is a cath is either scheduled or goes through ED to the cath lab, then after the cath they go to ambulatory care if they have a clean cath (if not already an admitted pt on the floor). If they had an intervention performed then these patients come to me in the intervention room. I can (and usually do have) 3 patients at a time in the intervention room all with sheaths in and with integrilin or reapro running. Not to mention the fact that they still need their admission H & Ps done most of the time as well as routine care and assessment! I am currently fighting this staffing ratio and I believe you should fight obtaining patients on reapro and integrilin unless they want to give you better staffing. On our unit everyone with an intervention is on reapro or integrilin and a femoral approach is always used and these pts come to us with sheaths in almost always (very rarely they may have a perclose). These patients have a much longer wait before their sheaths may come out and have many more complications (ie: bleeding, arrythmias, extreme bradycardia and hypotension). They also must lie flat longer (6hrs post femoral hemostasis). Where I work we do not have ancillary staff to help either, no phlebotomist or NACs or LPNs to help. It is one RN to the 3 patients to perform all care and to put in admission information. We do have the charge nurse present for at least the first 10min after sheath pull. Also, up until yesterday we were required to use manual pressure for all sheath pulls for a minum of 30minutes. The last time I worked I pulled 5 sheaths in 1 shift! Now we may use femstops or C-clamps.
I believe you should fight receiving the patients they are pressuring you to take. Patients on integrilin and reapro are a much busier bunch than those who are not. I speak from experience after recovering numerous of both types of pt.
Jul 1, '02
I am working on a 33 bed med/surg/tele unit, we also have chemo. the ratio for tele nurse is 1:4-6 on days and usually 1:6 nights, our max tele now is 6 since we are a new tele unit
Oct 9, '02
I work on a 48 bed tele floor. We have OH's, sometimes as many as 17 on the floor. We have post MI's, post HC/Plasty's/ablations/ICD's/pacers etc. We see alot of angioseals and have alot of problems with bleeds when they are on integ. and or reapro. Often using c-clamp on the floor to control the bleed. They have just recently started to use the perclose and can't make a statement about that yet. Our OH's usually come to us post-op day 1. Sometimes with CT and some have temp pacers. We have a large turnover of both pts. and staff. They have just made major changes in our staffing on the floor. Our ratio now is 5-1 with the help of a CNA. And are finding that most days are spent on the run. We have all drips except for NTG and levo. I've been a nurse for over 20 years and find that it's just about impossible to give the kind of care that I'm used to giving and feel I need to give. I find that the age of our OH's has gone up and the acuity is much higher than a few years ago and yet they expect you to do more. Pt's are confused, less mobile and over all more needy. We have alot more complaints from pt's and their families and the Docs. regarding thier care. We have more med. errors and more incidents happening. But management continues to deny that it has anything to do with increased pt. ratio. And we have many new grads every year. JUst a sad state of affairs!
Oct 9, '02
I work on a post-cardiac intervential floor.
Our nurse rati0 is 1:3-4 on days/afternoons...midnights 1:5-6.
(though lately we haven't had enough staff so on afternoons I take up to 5 patients) We are supposed to have 3 aides but usually only have 1.
Our patients are on different drips. We also get post-op ICD's and do cardioversions on our floor.
At our hospital they tried to divert angioplasties on regular cardiac floors, where the nurses had up to 6 patients each but that didn't pan out.
On our floor we pull with an ACT below 170.
Our V/S ... groin checks on arrival back from the CCl are every 15 minutes x 4/ q 30 minutes x4/ 1 hour x 4...we check the the ACT every hour....after we pull the line....which we use syvek (to speed up the clotting process) we start the V.S./groin check all over again.
Also our Dr.'s were using perclose...but for the most part no Dr.'s use it anymore (they didn't like it) so most patients that come to our unit have lines in. (unless it was a fem cath which is rare)
I'm glad the patients stayed on our unit and no longer go to other floors b/c inventional patients need to be watch very closely.
Actually our staffings been sub-par...so I'm job searching.
Oct 13, '02
I worked on a 20 bed interventional unit (PTCA, Cath, ICD?PM, TEE, Cardioversion). We did the admission assessment, pre labs, sent for procedure, rec'd. post procedure with reopro, integrillen, aggrestat, dopamine, ntg.,dobutamine, lido, cardizem, milrinone, any drip except nipride and levophed. 99% of plastys and caths returned with sheaths, which we pulled and used c-clamp. There were hard wire monitors at each bedside. There was one aide who for the most part was useless. When meal trays came, she went to break. When I started on that unit the ratio was 3:1. Charge nurse had no patients but was available to accompany you for sheath pulls she also had to constantly juggle beds. The work was busy but we worked well together and helped each other and got everything done. Did I mention that we did all our own phlebotomy. Well administration felt that we could domore and increased our ratio to 4:1 and then to 5:1. That was a totally impossible work load. Pulling sheaths require your undivided attention until you get the clamp off. Well needless to say, I don't work there anymore, just too scary.
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