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

[Natef26]

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.

[midazoalm1953]

Hmmm....no to little sedation and rare restraints! Well most of our patients are sedated, usually diprivan 75-85%, and restriants @ 90%....unless a family member is at bedside, then we release restraints....but no sedation? My experience it it is very difficult to ventilate a pt w/o sedation...too much high pressure and asynchrony with the vent......

[cardiacRN2006, ADN, RN]

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.

Well, my last pt had 250mcg of Fentanyl and 20mg of Versed per hour. That seemed to do her alright. No restraints for that one.

For the pts who aren't so sedated they are restrained and on something likne 50-100 mcg of Fent and 2-10 of Versed.

And sometimes we interchange Propofol with one of those, and sometimes, pts get all three. But they always get 2 of the 3 when they are vented.

[RNFELICITY]

Frankly, if I were ever to be intubated, I would want my butt knocked out prior to the tube insertion and not alert and awake until after it was removed. I can't imagine laying in bed with that big honking tube down my throat.

[TERRY1945]

does anyone have experience with stable vented pt on a general care unit. Policy?? staffing ratio. we are opening a 4 bed cluster on a med surg floor. Terry

[alianeco]

I'm new to my ICU, but it seems that we generally have a 2:1 ratio. I've seen the occasional 3:1, but those patients are generally less acute.

I'm in a small hospital and it seems our ICU frequently hangs on to patients who do not require ICU care simply because the floors are full or the floor nurses aren't comfortable taking a particular patient. I think these patients can easily be tripled with one ICU nurse, but it's not really an appropriate use of resources.

[alianeco]

We have RTs, but we do our own suctioning and ABGs. The RTs do rounds several times per shift and we call them if there is a big problem. They also make ventilator changes and take part in decision making.

[midazoalm1953]

Just to let you all know...I don't know whether the tides are changing...but the past 2 weeks has found myself and another RN each with 2 unstable vented pt's...I'm talking levophed and vasopressin gtt's, insulin gtt's and heparin gtt's.....our 16 bed combined ICU/SSD has been full at all times, occaisonaly a "tech" is sent to help, whom is usually a SNAP nursing student....which translates as I don't do labs, only ekg's and general FSG and UO. And the pt's...geez, all of the 7 vented pt's are all stage 4 CA and full codes....so you can imagine the "families" we have to deal with....I'm telling you....working at Home Depot is looking better than ever!

[alangdale]

We typically have 1 nurse to 2 pts. Lately, we've had a LOT of sickies....and we've been doing a lot of hypothermia cases...which are all 2:1 care.

[sicushells, RN]

Most of our patients are 2:1. That includes open-hearts straight from the OR, vented patients, confused withdrawl patients, liver transplants (which can be very unstable, we don't know til they come over from the OR). CRRT, IABP, VADs, and known very unstable patients (i.e. we can plan to staff for them) are 1:1. Our nursing assistants (whatever job title you want to give them) are... less than helpful. Eye rolling and attitude when you ask for help turning or ambultating, don't consistently do mouth care or... well anything but talk on the phone(that's a whole new post though...) RT does suction when they round, but generally it's our responsibility. Our vented patients are often restrainted, especially if they're fresh from the OR and we're planning on extubating within a few hours. We do have a recovery nurse that just helps stablize fresh ORs.

[Yendis, LPN, LVN]

Sorry to stray away from the main topic!! But I have an upcoming interview on a Progressive care unit and I would like to know what is it like and is it easy to make the ICU transition from there?

[liezel77]

Great AACN articles to read about staffing...

http://www.aacn.org/WD/Practice/Content/staffing.pcms?menu=Practice&lastmenu=

and the days where I feel that my patient isn't provided with adequate care because of staffing issues i won't hesitate to file a complaint.

http://www.jointcommission.org/GeneralPublic/Complaint/

So far we've never had to take a third patient even if they have floor, stepdown orders.

[chani]

From the land downunder

OMIGOD I have just read through the horrendous nurse patient ratios they expect what I assume to be US nurses. Are you kidding me! the hospitals a committing way mega fraud charging patients for 'intensive care nursing'. WHAT A CROOK!. I know you have respiratory techs plus other aids however it appears this doesn't happen all the time and in all units. No wonder you long for heavily sedated vented patients. And you do it for 12 hrs.:bow:

Here is Oz its 1:1 for everyday ventilated, 2:1 for extremely unstable (all the machines plus the one that goes ping!) 1:2 (sometimes 3) for non-vented patients who may be on bipap but certainly NOT on inotropes etc. Post op Cardiac SX are 1:1 but extubated fairly quickly then the ratio changes. Its amazing to me more things don't go wrong! So in the absence of a smilie that says 'hats of to you' :urck: