I am interested in the staffing ratios of cardiac recovery units. What is your nurse patient ratio for open hearts? If it's 1:1--how many hours? what is staffing for LVAD patients? Do you limit the number of surgeries performed each day? If so, How? Do you schedule open hearts on the weekends? How many? Is your area a closed unit? What do you do when you are short staffed and no one will work overtime? If you don't schedule opens on the weekends how do you get around insurance company requirements? I need all the info I can get so I can present other hospital staffing plans to management.
Feb 27, '99
.It's been a few years since I've worked in a CSICU, but ALL of our patients spent the first 24 hours in the ICU and were all 1:1's. But then they were all on vents, had multiple drips titrated to cardiac output and SVR, and if they had concommitent valve replacements, also had Swans, left atrial and left ventricular lines.....some may also be on an IABP..........so I would think that if all or some of these things applied to a particular patient, they shoud be considered a 1:1 also. We had a closed unit, which worked out quite well.......We only did surgeries M-F, and were scheduled to work every other weekend, but would often request "first off if not needed" for those weekends.
The other side of that coin was that we would have to staff ourselves if OT became necessary. It never really became a problem, because the net result was that we frequently got extra weekend days off, and everyone was reasonable about pitching in for needed OT......and the extra money was nice too! We were able to handle the emergent open-hearts this way too.......BTW, this was a 10 bed unit, and I think it also worked well also because all our routine open hearts were transfered to a CVTICU the morning after surgery.......Hope this info is useful!
Mar 2, '99
Our Hearts are 1:1 only during the recovery time which varies from 3-5 hours (baring any complications).. then that nurse will pick up a second lower acuity (yeah right) patient..
Our hospital doesn't do LVAD, we ship them to our sister hospital in the same city...
We do not limit the number of surgeries... and have a good relationship with surgery so that we're notified if they're even THINKING of adding an unscheduled surgery.. this helps a bunch in staffing as you can imagine..
We don't schedule Hearts on the weekends but sometimes have them emergently...
Our unit was closed for years.. but as of 6 months ago is now OPEN OPEN OPEN.. ugh.
As a result, the step down nurses cross train in our general ICU and we cross train there.. so when we're understaffed we try to get our own staff to work OT... then we try to float someone from the step down unit.. and finally we ask for agency.. we used to get agency when we needed them without it being a big deal.. but now our hospital has elimnated our float pool and bought 50% of an agency and that's the only agency we can use.. as a result.. we RARELY get adequate staffing.. yesterday our AHN nurse and myself had 4 patients each.. 2 of my 4 patients were admits from the ER.. who arrived within one minute of one another.. one on the verge of having to be intubated.. the other in the process of having an MI.. my 3rd patient on the vent and numero 4 diabetic coma.. uhmmm can you say FRUSTRATED?? you bet..
Our staff is worn out from working overtime OR from being worn to a frazzle during a normal shift.. and we're refusing to work.. now it falls on our AHN who stay and stay and stay.. as a result of yesterday's fiasco our AHN gave her notice.. WHEN WILL THEY LEARN??
If I sound frustrated it's because **I AM**
Mar 3, '99
............what a day you had! Thank God here in California we have Title 22, which will not allow ICU nurses to take more than 2 patients, which is not to say that it doesn't sometimes happen, but at least not intentionally.......nurses may call in sick at the last minute for example, or absolutely no one can be found to work extra.
My "cap" is off to you and your AHN, you shouldn't have to put up with that!