Unsafe staffing with 4:1 ICU ratios 8:1 on floor.

Nurses General Nursing

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I really need advice on how to advocate for change.

I work in the SICU of a 350ish bed hospital that does cardiac surgery. We got a new CNO two years ago during a nursing shortage. She gave us a slight pay raise and blocked off rooms on the med surg floors when we did not have staff so that they would only have a 6:1 patient ratio at the most and swore that she would keep us from unsafe staffing.

Two years later, the med surg floors are back to 1:8 and there's a plan to make the ICU patient staff ratio 4:1 with no 1:1 patients (our normal 1:1 patients are fresh, still intubated open hearts, therapeutic hypothermias, CRRT patients, balloon pumps, and Imepellas). We are currently at 3:1 with charge nurses back into staffing and we are feeling a major strain. This is mostly due to staff illness at the moment, but our CNO has been very open about the fact that this is her goal. I can already tell that patient care is suffering. It's manageable when we have less sick patients, but I'm afraid patient acuity will greatly increase as we get further into flu season and we will start having adverse patient outcomes because we've missed something.

There is no law to prevent this from being made our standard of care. Is there anything we can do to start making changes?

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I really need advice on how to advocate for change.

I work in the SICU of a 350ish bed hospital that does cardiac surgery. We got a new CNO two years ago during a nursing shortage. She gave us a slight pay raise and blocked off rooms on the med surg floors when we did not have staff so that they would only have a 6:1 patient ratio at the most and swore that she would keep us from unsafe staffing.

Two years later, the med surg floors are back to 1:8 and there's a plan to make the ICU patient staff ratio 4:1 with no 1:1 patients (our normal 1:1 patients are fresh, still intubated open hearts, therapeutic hypothermias, CRRT patients, balloon pumps, and Imepellas). We are currently at 3:1 with charge nurses back into staffing and we are feeling a major strain. This is mostly due to staff illness at the moment, but our CNO has been very open about the fact that this is her goal. I can already tell that patient care is suffering. It's manageable when we have less sick patients, but I'm afraid patient acuity will greatly increase as we get further into flu season and we will start having adverse patient outcomes because we've missed something.

There is no law to prevent this from being made our standard of care. Is there anything we can do to start making changes?

You can leave. As long as people are willing to accept the conditions, they're not going to change.

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Specializes in school nurse.

Yeah they have no vested interest in changing.

Lots of money would be magically found by management for advertising campaigns and propaganda if your state were to have a vote on a safe staffing bill, but ask for appropriate staffing and poor mouth will be cried...

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Specializes in Vents, Telemetry, Home Care, Home infusion.

SAFE staffing involves BEDSIDE staff and management determining appropriate staffing on a shift by shift basis based on patient acuity needs.

Staffing in Acute & Critical Care - AACN

https://www.aacn.org/clinical-resources/staffing

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Organize. When nurses get together on any problematic workplace issue, it's a force for positive change. Hospital administrations fear when nurses gather, and want a robust bottom line often going to Nursing to make cuts to save money. Check out how nurses in California with CNA organized over the last few decades to ensure patient safety and justice in the workplace. CA has a safe staffing law. Take your specific unit issue, ie staffing, with any/all data re: poor patient outcomes or dangerously high staffing ratios and report it to JCAHO, for example.

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Specializes in Pedi.

Unionize, leave or lobby for a law to mandate ICU staffing ratios.

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The surgeons and intensivists would be strong allies for safe staffing , as soon as their patients start dropping like flies.

In the meantime... vote with your feet. That is beyond unsafe.

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Specializes in ICU/community health/school nursing.

Two years later, the med surg floors are back to 1:8 and there's a plan to make the ICU patient staff ratio 4:1 with no 1:1 patients (our normal 1:1 patients are fresh, still intubated open hearts, therapeutic hypothermias, CRRT patients, balloon pumps, and Imepellas). We are currently at 3:1 with charge nurses back into staffing and we are feeling a major strain.

?

Oh sweet baby Moses - NO. I'm anxious on your behalf and I no longer work in ICU. Hang in there. You've already gotten good advice.

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This why nurses should not have defeated the bill in Massachusetts. It makes me so angry that so many of our own colleagues defeated that.

I would leave. As a fellow ICU nurse, that is unsafe. Some hospitals have safe ratios. Mine is one. But I know if one particular hospital in my area wanting to go to 4:1 in the icu. You could not pay me enough to work there.

It's not just the intubated patients, it's the ones on all the drips. Imagine 4 patients on insulin drips or nicardipine. The charting itself is insane. Hourly vitals and I/O, plus we chart full head to toe assessments.

Crazy.

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Wow. A strong testament that upper management clearly values the almighty dollar over the safety of their patients. There's no other reason they'd mandate it.

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I've emailed the state nursing association for more information on how to move towards making this illegal. Unfortunately, there aren't any jobs close to me at the moment. I also really really love my job and the patient population I serve. I'm just sick of corporate bull ****. Hopefully they'll realize how ridiculous this is and stop it quickly. We are set to lose 8 nurses by the end of the year (Before this was ever mentioned), so maybe when upper management gets called in to take patients they'll change their mind.

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I've emailed the state nursing association for more information on how to move towards making this illegal. Unfortunately, there aren't any jobs close to me at the moment. I also really really love my job and the patient population I serve. I'm just sick of corporate bull ****. Hopefully they'll realize how ridiculous this is and stop it quickly. We are set to lose 8 nurses by the end of the year (Before this was ever mentioned), so maybe when upper management gets called in to take patients they'll change their mind.

Upper management will NEVER administer nursing care. For # 1 , they don't know how.

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