How is your ICU staffing done?

[cmp424]

With recent budget cuts we are going to an acuity based staffing matrix. Rather than having the straight 2 patients to 1 nurse ratio we are being asked to take 3-4 ICU patients. I work at a small ICU at a community hospital, and I will admit some of the patients we have are floor patients with overly cautious physicians. How do you all staff the ICU? Common 2:1 ratio? Acuity? For those that do acuity based staffing, how are patients assigned?

[sapphire18]

If a patient is being classed as an ICU patient, they need to be treated like an ICU patient. That means 1 nurse : 2 patients. This will get very unsafe very quickly. A dumb way to try to save money by the hospital...gambling with people's lives. A "stable" ICU patient can become an unstable, critically ill patient very quickly.

[NPOaftermidnight, MSN, RN, NP]

We only very, very rarely will have a triple assignment and that's only if at least one of the patient's is on their way to the floor. The vast majority of the time we have a 1:2 or 1:1 ratio regardless of whether the patients are ICU, step down or floor. Like sapphire18 said, patients in the ICU should be receiving ICU care.

[RNforLongTime]

I will never take 4 patients! My max is 3. If they're in ICU, they're there for a reason. I'm in a small community hospital ICU as well & my max is 3. We only have 6 beds total.

[ChipNurse]

Our ratios are 1 RN: 2 Patients. Occassionally if a pt is sick enough it is 1:1. We never get tripled.

[ktliz]

If a patient is in the ICU, it's because they require close monitoring. Hourly vitals, Is&Os, q2 or q4 assessments. Constantly watching that cardiac monitor, spO2, etc. That is why they are 1:2. The only time I would accept a tripled assignment would be if 2 of the patients had transfer orders, and therefore could be treated with the same level of care they would receive on the floor, e.g. q8 assessments.

Edited to add: This is only theoretical. In reality I've never been tripled. Always 1:1 or 1:2.

[Nurse_Jessie]

ICU patients are always 1:2 or 1:1 (1:1 are rare, generally only if we are cooling them after a cardiac arrest, if they are on the balloon pump, or we are proning them for respiratory issues), however, if we have a lot of PCU and Med/tele or Med/surg patients in the ICU waiting for a bed on the appropriate floor we may have 3:1 nursing for those. That is only allowable if they already have the order for transfer, not based on our assessment of the level of care they need. However, if we are caring for even one ICU patient we are not permitted to take more than two patients total.

[Here.I.Stand, BSN, RN]

I don't think we ever get tripled, even if one of our pt's is stepdown or floor status. That sounds like a very, very, very very VERY very bad idea. The only way I would consider accepting an assignment like that is if ALL pt's were stepdown or floor status. Three pt's is a stepdown assignment.

[jen4me]

I work at a major tertiary referral center that is the area's only level I trauma center. Staffing in our ICUs used to be acuity based, but we've quickly adapted to these new so-called staffing models, requiring us to triple-up and I think it's ridiculous! Our normal assignments were 2:1 and 1:1 depending on acuity, i.e.; mode of ventilation, CRRT, or just fresh post-op traumas. I often am charge, with an assignment now and sometimes with an oriente or student. Up until we implemented a full time Rapid Response Team, the charge nurse from the ICUs were responsible for the RRT calls. What is the next responsibility that will be taxed onto the unit nurses? For an ever evolving profession, we sure don't seem to be moving forward right now.

[cmp424]

I completely agree with all of the above statements. Our hospital is very "lets do what everyone else is doing". It's nice to see others think this is an awful idea and not everyone is doing it this way. I hate it. Not only do we have normal ICU stuff to do (I.e. Neuro checks Q1H, full assessments Q2H, turning and all that jazz) but as a night shifter we are also responsible for giving everyone baths. I took 3 my three days last week like everyone else and literally was the most exhausted I've been since being a new grad. Hoping it's different this week.

[ChrisNZ]

I work only as an Health Care Assistant (my countries name for PCT), ICU patients here are strictly 1:1 ratio. HDU unit is generally 1:2

[JenHRN]

I work in a 10 bed ICU in a rural hospital, and we currently take 2-3 patients. Three is definitely exhausting and can be very unsafe depending on acuity. Our director just had it approved to drop our max ratio down to 2:1. There were too many mistakes being made and too many nurses leaving.