A "magnet" hospital and this particular ICU had previously rarely had the charge nurse take patients. There are plenty of float staff and RNs willing to work extra shifts; but now it is becoming common for the charge nurse to take her own two patients as well as having two patients while one may be on CRRT. Understood, this is a cost saving strategy.
Although in the long term, can only lead to legal issues in regards to safety, obviously. Which seems much more costly.
I'm probably naive, but how common a practice is this? Of course, this state does not have a union. Otherwise I am sure this would not be happening.
The problem is that when something does occur; i.e.: an RN has to go home because of their own medical emergency, there is no one to care for the patient/s for hours because of this kind of staffing practice. Besides the obvious problems with this practice; being just impossible to properly monitor an entire unit (this one with 28 beds) as well as provide good care to the two patients of the charge.
I've seen it quite commonly on less acute units...but the ICU!!?
I've been retired from critical care for over 5 years now, but I can't imagine having a Prisma patient paired with another one. I recently returned to the unit for a retirement tea for a friend and don't recall hearing people complain about assignments as much as the new evaluation system (which I was very happy to be retired when I heard about it). Our charge nurse normally took no assignment. If there was an LPN scheduled, the charge would cover what was not in her scope of practice, which was very little as LPNs here have a full scope of practice with few limitations. Occasionally, they may take a reduced assignment (one 1:2 or 1:3) who was getting ready to go upstairs, but even that was avoided if possible. However, when push comes to shove, there was sometimes no choice. I even remember in the old days when the house supervisor had to come to the ICU to take an assignment (and in those days the house supervisor COULD).
Worked in a 24 bed SICU recovering hearts. Was usually charge, usually had three patients, if I didn't have three patients it was because I was admitting a heart. I felt like I'd rather have the three patients knowing I could take care of them instead of throwing a new grad to the wolves and endangering the patient. Obviously this wasn't the best arrangement but what can you do when they staff a 24 bed unit with 8 nurses
Yep, this was the norm in a busy academic medical center ICU where I used to work. As charge, I'd either take a stable CRRT 1:1 or stable pair. One night, it was so bad that the charge that night had to take on a triple assignment because our acuity was so high and we were just so short-staffed.
At my small regional hospital, the charge nurses do not take patients, since they have to respond to codes on our unit and others. We're always 1:1 with CRRT. Didn't realize we have good here.
Wow, CRRT always 1:1? That sounds like a dream. We nearly always pair these pts (unless they're a "true 1:1"), and at times we do pair 2 CRRT/SLED pts (if they already have proven to tolerate it well).
I don't mean to sound like an idiot (or a jerk, for that matter, if this is taken another way), but with these 1:1 pts - are you initiating the dialysis/changing out the dialysate/maintaining the machine (like a dialysis nurse), or just monitoring it and doing the required labs? I really don't mean for that question to sound hateful, I really am just wondering because I've only worked in one ICU. Here we have dialysis nurses who take care of everything except for the labs that coincide with whichever anticoagulant is being used. If an alarm goes off that we are unable to troubleshoot, we call and they come up and take care of it.
I don't mean to sound like an idiot (or a jerk, for that matter, if this is taken another way), but with these 1:1 pts - are you initiating the dialysis/changing out the dialysate/maintaining the machine (like a dialysis nurse), or just monitoring it and doing the required labs? I really don't mean for that question to sound hateful, I really am just wondering because I've only worked in one ICU. Here we have dialysis nurses who take care of everything except for the labs that coincide with whichever anticoagulant is being used. If an alarm goes off that we are unable to troubleshoot, we call and they come up and take care of it.
In my ICU, the CRRT is 1:1 because there is no dialysis RN involved at all, we do everything with the machine. Setup, initiation, troubleshooting, hourly numbers, labs, bags, everything.
I don't mean to sound like an idiot (or a jerk, for that matter, if this is taken another way), but with these 1:1 pts - are you initiating the dialysis/changing out the dialysate/maintaining the machine (like a dialysis nurse), or just monitoring it and doing the required labs? I really don't mean for that question to sound hateful, I really am just wondering because I've only worked in one ICU. Here we have dialysis nurses who take care of everything except for the labs that coincide with whichever anticoagulant is being used. If an alarm goes off that we are unable to troubleshoot, we call and they come up and take care of it.
We do 1:1s for CRRT and we do sort of a mix of you and the last poster. We change out all the fluids, draw the labs, and troubleshoot the machine ourselves. However, dialysis starts the therapy, and if the patient needs to be re-strung, dialysis does that, too. Other than that, the machine's on us.
CRRT is the only patient type we single, though. Hypothermias are doubled and they weren't at my last job unless they were in maintenance. Here, we double them the whole time. I think this is a little messed up - it's really difficult to get q15 water temps off the machine, which don't cross into the computer, when you're doubled with one of these patients.
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HazelLPN, LPN
492 Posts
I've been retired from critical care for over 5 years now, but I can't imagine having a Prisma patient paired with another one. I recently returned to the unit for a retirement tea for a friend and don't recall hearing people complain about assignments as much as the new evaluation system (which I was very happy to be retired when I heard about it). Our charge nurse normally took no assignment. If there was an LPN scheduled, the charge would cover what was not in her scope of practice, which was very little as LPNs here have a full scope of practice with few limitations. Occasionally, they may take a reduced assignment (one 1:2 or 1:3) who was getting ready to go upstairs, but even that was avoided if possible. However, when push comes to shove, there was sometimes no choice. I even remember in the old days when the house supervisor had to come to the ICU to take an assignment (and in those days the house supervisor COULD).