How do they rationalize staffing??...

Nurses Safety

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I work at a small community hospital in ICU. We are what is called "critical access". Our ICU is only 4 beds. We usually have 2 RNs and a CNA on dayshift and 2 RNs on night shift. In addition we watch the tele for the rest of the hospital. That doesn't sound that bad..and it isn't when they staff us appropriately. However, there are times they will put one of the nurses on call on both day and night and have 1 RN and 1 CNA staff the ICU. The policy is RN to pt ratio 1:3. So 1 RN is expected to care for 2 ICU pt's and watch the tele for the entire facility. On the flip side.....on our medsurg unit, regardless of the number of pt's they have....there will never be less than 2 RNs there. If they got down to 1 pt they get 2 RNs. So, my question is how do you rationalize that it takes 2 RNs to care for a few medsurg stable pt's and expect 1 ICU RN to care for 3 ICU pt's and do all the tele. There argument is that's the policy and that some of our ICU pt's could really be overflow/medsurg. If that's the case then have the MD change the pt to medsurg and put them on the MS floor instead of expecting 1 RN to do that. Am I being overly dramatic??? It just doesn't make logical sense to me!

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Are there any CNAs on the med surg floor? I've been the sole nurse before but the hospital had a policy that the nurse would not be alone. If there was no CNA, there would be 2 RNs. When I worked in the unit, it was 36 beds so I can't really relate to being the only RN there. We had a monitor tech to watch the tele. We did have a staffing ratio of up to 1:3 depending on acuity though.

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They will put the CNAs on call on MS to let nurses work. Do the opposite in ICU

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Melissa,

Speaking from the administrative side, sometimes organizations will jeopardize patient safety vs. profit dollars. If I were you, I would make my argument valid and develop an ICU grid with the demands that you would like and have an on-call rotation schedule to make things fair. If there are medical overflow patients within your unit and available beds, I would have the patient transferred out of the ICU to the medical floor. To ensure success, please get your supervisor, physician and ICU staff involvement to make it a win-win situation for all if at all possible. Good luck!! :)

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You can charge more money for icu level care.....

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
You can charge more money for icu level care.....

NO you can't...these are med surg boarders and charged accordingly....these patients get the benefit of extra nurses and extra care without the ICU cost.

The problem with being the only ICU nurse in the building is leaving that patient in the event of a code.

melissakc as a previous administrator of a critical access facility....ask your facility about boarding the tele patients in the ICU so the 2 ICU nurses are in the building and place the medsurg RN or CNA on call. This ensures that the ICU patient has a nurse present when the other ICU nurse answers the CODE on medsurg. There is extra physical work in transferring patients in and out at odd hours at times...but over all is a safe cost effective plan.

Win Win....good luck

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I worked in a 6 bed ICU unit for 14 years. 98 times out of 100 we had 2 RNs at all times @ night and 3 RNs or 2 RNs and a LPN on day shift. If a code took place, the medical unit right out side of our door would send one of their nurses back to stay in the unit until the status of the coding pt. was determined. We also watched the tellies for the medical unit.

You really can't go to administration unless you have your concerns in written form. It would help if you could give specific incidents where care was directly affected in a negative matter. As another poster stated, get everyone involved and come up with some ideas to deal with your particular issues. We all know that sometimes higher ups have tunnel vision as far as dealing with problems.

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Specializes in Certified Med/Surg tele, and other stuff.

If you are union, I would file unsafe staffing grievances if it truly is unsafe.

Second, what does your law in your state say about ICU and staffing? In my state the ratio is ALWAYS two RN's when there is an ICU pt in house. I too work in a critical access hospital and understand how difficult it can be to staff a floor. My manager used to bend that rule all the time with no concern for our licenses or patient safety.

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Specializes in Medical Surgical & Nursing Manaagement.

First.......are your ICU patients truly ICU patients?????I would have to guess no! Are they intubated? On multiple pressers?

I truly believe that if a M/S unit was down to one patient, it would not be cost effective to leave two nurses to care for one M/S patient. Do I think you are being overly dramatic...........yes, a little. I will, however, give you the telemetry piece. I think monitored patients should be monitored by the nurses/staff caring for them. Tell me what you do if there is an arrhythmia? Call the unit where the patient is?

Staffing should be based on acuity of the patients. It seems many ICU nurses base their assignments on numbers, i.e., a ratio of 2or3 patients :l. But what these nurses should be asking...........are these really ICU patients? I managed a Surgical ICU and the nurses had a very difficult time with staffing according to acuity.

You don't say how big the M/S unit is. I've seen rations as high as 8:1 for telemetry M/S patients.

I would challenge any critical care nurse to do what the M/S nurse does without even thinking, i.e., take care of 6, 7 or 8 patients.

Here is something to think about.......administration CAN NOT pull nurses out of the woodwork when your peers are calling out sick. Perhaps, you should be holding your peers accountable for being at work when they are scheduled and your unit should think about instituting an available list for when your peers do call in sick.

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Specializes in SICU/CVICU.
First.......are your ICU patients truly ICU patients?????I would have to guess no! Are they intubated? On multiple pressers?

I truly believe that if a M/S unit was down to one patient, it would not be cost effective to leave two nurses to care for one M/S patient. Do I think you are being overly dramatic...........yes, a little. I will, however, give you the telemetry piece. I think monitored patients should be monitored by the nurses/staff caring for them. Tell me what you do if there is an arrhythmia? Call the unit where the patient is?

Staffing should be based on acuity of the patients. It seems many ICU nurses base their assignments on numbers, i.e., a ratio of 2or3 patients :l. But what these nurses should be asking...........are these really ICU patients? I managed a Surgical ICU and the nurses had a very difficult time with staffing according to acuity.

You don't say how big the M/S unit is. I've seen rations as high as 8:1 for telemetry M/S patients.

I would challenge any critical care nurse to do what the M/S nurse does without even thinking, i.e., take care of 6, 7 or 8 patients.

Here is something to think about.......administration CAN NOT pull nurses out of the woodwork when your peers are calling out sick. Perhaps, you should be holding your peers accountable for being at work when they are scheduled and your unit should think about instituting an available list for when your peers do call in sick.

Have you ever worked as an ICU nurse--other than as a manager? If the patients are not really unit patients, why are they there?

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Specializes in OB.
First.......are your ICU patients truly ICU patients?????I would have to guess no! Are they intubated? On multiple pressers?

I truly believe that if a M/S unit was down to one patient, it would not be cost effective to leave two nurses to care for one M/S patient. Do I think you are being overly dramatic...........yes, a little. I will, however, give you the telemetry piece. I think monitored patients should be monitored by the nurses/staff caring for them. Tell me what you do if there is an arrhythmia? Call the unit where the patient is?

Staffing should be based on acuity of the patients. It seems many ICU nurses base their assignments on numbers, i.e., a ratio of 2or3 patients :l. But what these nurses should be asking...........are these really ICU patients? I managed a Surgical ICU and the nurses had a very difficult time with staffing according to acuity.

You don't say how big the M/S unit is. I've seen rations as high as 8:1 for telemetry M/S patients.

I would challenge any critical care nurse to do what the M/S nurse does without even thinking, i.e., take care of 6, 7 or 8 patients.

Here is something to think about.......administration CAN NOT pull nurses out of the woodwork when your peers are calling out sick. Perhaps, you should be holding your peers accountable for being at work when they are scheduled and your unit should think about instituting an available list for when your peers do call in sick.

The truly great managers I've known will put on scrubs and work the floor when noone else is available. I even know one DON who will do so.

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Specializes in Dialysis.

My DON is one of those that doesn't hesitate to help when we are short. One time comes to mind....

A nurse had to go to ICU to dialyze a critical patient and a tech had called in. They called for me to come early and I got there as soon as I could get myself showered and ready.

When I rounded the corner to the desk to go into the locker room there was our DON in capris with a jacket on pulling needles and our medical director helping to assess patients! If I didn't know before that morning I definately knew after it that I am truly blessed to work where I do.

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