ICU nurse to pt ratio "norm" on your unit?

jedimasterr · Mar 27, 2008

Like most folks here have said, our ratio is one nurse to two ICU patients. Open hearts are one to one for a certain length of time. On the step down telly unit, the ratio is one nurse to four patients but they do have some help on that floor from the techs for vitals and accuchecks which are Q4H as opposed to our Q1H vitals. When the hospital is full and we can't transfer patients, we are expected to follow the protocols of the unit the patient should be on, and this can be a drag when you have four step down patients and no assistance like you do on the telly floor. Luckily, our unit is very team oriented and you are not left to hang when it comes to cleaning patients. That said, it is still a lot more work than would be expected otherwise.

Overall, I think our unit is safe. However, there are times you get stuck and can't get more help. So far I have seen nothing that indicates to me the unit manager or the hospital are OK with just "stuffing" the ICU nurses. For the most part though, we are expected to float to any unit except the ER and as you would expect just about no one likes that. Someday, we will have eICU and due to my experiences in another field prior to nursing, I have nothing but suspicion toward how eICU will be used. I can certainly see them using it someday to be that perceived "extra" help that allows patient ratios to climb. I have nothing to back this claim up right now so that is admittedly speculation on my part.

oneillk1 · Apr 1, 2008

I know typically ICU nurses get 2 patients standard. I'm curious how it is on your MICU unit?
At my hospital I would conservatively estimate that a good number of the MICU staff have 3 patients 65-70% of the time.Staffing is generally the pits.

We get 1:1 ventilated, sometimes 2:1 unventilated, sometimes 3:2 unventilated or even 1:2 if the patient is really sick (that is patient : nurse)

The only time we ever have more than 1 ventilated patient is when the nurse next door is on a break.

In saying this, we don't have techs, we do everything ourselves

:up:

cardiacRN2006, ADN, RN · Apr 1, 2008

We get 1:1 ventilated, sometimes 2:1 unventilated, sometimes 3:2 unventilated or even 1:2 if the patient is really sick (that is patient : nurse)
The only time we ever have more than 1 ventilated patient is when the nurse next door is on a break.
In saying this, we don't have techs, we do everything ourselves

WOW~! We don't have techs either, but the only reason for a 1:1 is impending code...

Why only 1:1 for ventilated patients? I find them to be the easiest...

sister s · Apr 7, 2008

In Australia if a patient is on invasive ventilation then they have 1:1 - like the UK I think.

Vikingnurse · Apr 9, 2008

I need some more information in your nurse to pt ratio. We are ALWAYS 1:1 day, evening and night. But then again we deal with everything medicin, personal care, ventilator "things" (suction, ABG's etc.) Both day and evening shift we have what we call serviceassistents. They do the cleaning, help with mobilisation and some other helpful things. In the daytime we have 2 ekstra nurses that also help with whatever.

If I understand it correctly you have respiratiory therapist and perhaps other similar proffessions around the patient.

What I would like to hear is how many healthcare proffessionals are around the patient.

sister s · Apr 9, 2008

Yep - so if the patient is ventilated they have 1:1 nurse. It's a 5 bed ICU ward (we don't separate surgical/medical etc, and there's a nursing float for the ward to fetch and help with stuff and answer met calls. Other than the Intensivist, physios visit once a day and the dietician visits once a day, but that's it. It seems to work. Other ICU patients can be 2:1 if they're not invasively ventilated. :nurse:

ICU_nurse · Apr 9, 2008

Why only 1:1 for ventilated patients? I find them to be the easiest...

It's a safety issue, not a matter of them being "easy" (which sometimes they most certainly are!!)

Ward policy states that our Ventilated patient's are never to be left unattended. We don't have assistants or anything (apart from the PSA, who we grab if we need a turn or to run bloods to pathology), you as that pt's nurse do all care for the whole day, there is noone (besides the nurse next door to you) who can step in if you are called away/need to grab supplies etc etc. If that happens (including covering for breaks) then you need to let them know and they step out of the room in a spot where they can see both patients and all monitoring systems. This is why when going for breaks, all your IMEDs need to be up to date, nothing should beep or alarm (you know, unless they're sick or something :lol2: ). The covering nurse should be able to sit at their desk and observe.

When the hospital is full and we can't transfer patients, we are expected to follow the protocols of the unit the patient should be on
For the most part though, we are expected to float to any unit except the ER and as you would expect just about no one likes that.

Yep, if the patient is wardable they go to 4th hourly obs.

You don't get flicked to ED? That's the first place we seem to end up!

Parko :-)

RNFELICITY · May 4, 2008

I am currently in an 18 bed ICU which gets a litle bit of everything. Routine staffing is one nurse to 2 patients and we go to 3 patients when push comes to shove or we can't get another nurse. We also will triple up if we have a non-Icu overflow pt.

CRRT pt's are always a 1:1 here.

I ahve worked in other ICU's where 1:3 was routine no matter what they were...EEK!!!

midazoalm1953 · May 4, 2008

WOW....reading all these stories...it is reallly getting out of hand in the ICU....my latest story....I was scheduled for my "week" in stepdown, came in last Sunday eve, ( my 5th nite that week in the stepdown hellhole) to find I was alone with 2 ICU overflow pt's! I immediately called the supervisor and asked if there was any help available and of course was told NO! So when I told her how my nursing notes would reflect that that no pt was going to be turned, am care would be forgone and no labs would be done because of the unsafe staffing......lo and behold a magical med-surg nurse was found and sent to help me. Amazing how if you state you are going to document unsafe staffing it is addressed.

Of course at 2am I was asked to do a recovery as I had "help" in the unit.....the RN was actually very helpful and was interested in all the things we do in ICU/Stepdown.....

RNFELICITY · May 5, 2008

WOW....reading all these stories...it is reallly getting out of hand in the ICU....my latest story....I was scheduled for my "week" in stepdown, came in last Sunday eve, ( my 5th nite that week in the stepdown hellhole) to find I was alone with 2 ICU overflow pt's! I immediately called the supervisor and asked if there was any help available and of course was told NO! So when I told her how my nursing notes would reflect that that no pt was going to be turned, am care would be forgone and no labs would be done because of the unsafe staffing......lo and behold a magical med-surg nurse was found and sent to help me. Amazing how if you state you are going to document unsafe staffing it is addressed.
Of course at 2am I was asked to do a recovery as I had "help" in the unit.....the RN was actually very helpful and was interested in all the things we do in ICU/Stepdown.....

it is just apalling sometimes. :madface:

cardiacRN2006, ADN, RN · May 5, 2008

It's a safety issue, not a matter of them being "easy" (which sometimes they most certainly are!!)
Ward policy states that our Ventilated patient's are never to be left unattended.

That's just so bizarre. I guess I don't understand the safety aspect of it. My vented pts are sedated and restrained. I find that sometimes non-vented pts warrent much more of my attention. But we rarely have unintubated pts in our ICU.

I would love to work where vented pts are 1:1! I'd even do overtime, lol.

ETA: I think I just remembered something...You guys don't have RTs down there right? So you are doing all the vent stuff. That makes way more sense now.

My apoligies...

Vikingnurse · May 8, 2008

That's just so bizarre. I guess I don't understand the safety aspect of it. My vented pts are sedated and restrained. I find that sometimes non-vented pts warrent much more of my attention. But we rarely have unintubated pts in our ICU.
I would love to work where vented pts are 1:1! I'd even do overtime, lol.

How sedated are your patients and how often do you use restraints?

We don't use restraints at all and we use little or no sedation (with a few exeptions).

If we have a patient in risk of selfextubation or could do harm to him or herself in any other way, we use nurse- or medstudents who want to earn some ekstra money. They make sure that central lines, arteriallines and all the other things stay in place and of course the patient stays in bed. And they are are an extra hand when needed. Workes perfectly.