Avg nurse to patient ratio in NICU and PICU?

marilynmom, LPN, NP · Nov 1, 2007

In the PICU where I work there is a 1:1 or 1:2 RN to pt ratio. Never any more than that.

AliRae · Nov 1, 2007

I'm a PICU girl (but only for 12 more shifts!). In our PICU we're 1:1 or 1:2. On rare occasions that the floor is full and we have floor overflow kids, we can be 1:3-4, but that's only when those kids have been signed out to the floor, are off the monitors and we're charting on them like floor kids.

scucer · Nov 1, 2007

In the PICU where I work you'll have one or two patients, two being the max. It's funny to hear the old nurses talk about patient ratio though, and how things have changed. Our hospital has gotten so full recently with really higher-need patients and with low staffing, a lot of time all the nurses are paired. Before if your patient was on any type of pressor it'd be a one-on-one. Now unfortunately it's not uncommon to have two ventilated patients who are one three or four drips. I'm sure some floor nurses will never understand how "only one or two" patients will keep you so busy for twelve hours, but there's been many, many days where my butt's never sat down!

iHeartNICU · Nov 1, 2007

our NICU is 1:1 or 1:2....in the whole 6 months I have been working there I think I have seen 1:3 one time only and one of those kids was more a feeder/grower.

philosophical · Nov 2, 2007

our NICU is 1:1 or 1:2....in the whole 6 months I have been working there I think I have seen 1:3 one time only and one of those kids was more a feeder/grower.

What problems do NICU patients usually have besides low birth weight/ early gestational age? How many patients on average die each month?

elizabells, BSN, RN · Nov 2, 2007

What problems do NICU patients usually have besides low birth weight/ early gestational age? How many patients on average die each month?

Off the top of my head; I'm sure many more nurses can add to this: Congenital heart disease, malformations of the gut, bones, lungs, brain, kidneys, congenital infections, meconium aspiration, congenital diaphramatic hernia, tumors/masses, metabolic disorders, ABO/Rh incompatibility, hypoglycemia, hyperbilirubinemia, genetic disorders (trisomies, etc), feeding problems, skin pathologies, and many more.

Deaths seem to come in waves. On our 65 bed level IV, I'd say average 2-3/month? Sometimes we lose a bunch in a week, sometimes we go awhile without one.

And as per the original question: we can be anywhere from 1:1-3 on the unit with as many as four in our step-down. Last night was particularly bad: I had my primary, who is a six month old ex-CDHer, s/p ECMO, nissen, GT, developed respiratory failure a month ago and is still intubated on high settings with Nitric and frequent neb treatments, feeding q3, has terrible bronchospasm when agitated, requiring sedation and sometimes bagging. Then I had a four month old ex-32wk kid with multiple anomalies, including TEF that they've somehow been unable to fix, has a chest tube and J-G tube, just started feeding right before my shift, so had to monitor for problems with that, with neuro issues that make him scream inconsolably for periods of time, and if you give him anything stronger than acetaminophen he loses his respiratory drive and tries to die. Oh, and he coded the day before when he was in the OR for JT revision, been fine since, but you never know. Then I had a feeder with no major issues, but it still takes time to feed/change a kid, and with that first one, you have to respond to his little episodes pretty much immediately, so the time it takes to even put her back in the isolette and get to the next room is really scary. Oh, and she was also a rocket pooper, so there was a lot of cleaning going on.

Sorry to hijack the thread! :trout: I need chocolate.

NursingAgainstdaOdds · Nov 2, 2007

Great thread - I'm interested in NICU after I get my training wheels off.

Experienced nurses - keep the info coming! :)

VegRNmom · Nov 2, 2007

I'm currently not working (going back soon, my baby girl just turned one!), but in my NICU, for the sick kids, it was 1:1 or 1:2. We had feeder/growers which was always 1:3. In the level one area, they tried to pair nurses with a vented kids and a CPAP or nasal cannula. I did have 2 vents ocassionally. If the baby was on a jet vent or an OV, they tried to do 1:1. We did have a very sick baby with NEC who had 2 nurses caring for him (very unusal, but he was crashing regularly and had so many meds, that way the nurses could just check meds with one another all night).

We didn't lose too many babies. 52 bed, although usually only had between 30-45, and some of those were feeder growers.

If you are interested in NICU, go for it! I love it and I don't want to work in any other unit. Plus you are able to have patient continuity and in our NICU and others I've heard, you can request to care for a specific baby every time you work (primary care).

Good luck!

nurserynurse55 · Nov 2, 2007

My hospital has two separate units for sick newborns. In the NICU it can be 1:1 all the way to 4:1. It is usally 2 or 3 :1. Our step-down nursery can be 3:1 to 5:1. The tep-down unit has one room with healthy babies (usually their mom's are sick or in trouble with the law) and they can be up to 8:1.