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

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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.

Specializes in Dialysis.

Chani,

I have read where this is also the practice in England. Could you explain how this came about? I'm especially interested if it was established from the "top down" in that legislative bodies established these rules or "bottom up" from nurses experience at the bedside. In the states the only limits on nurse patient ratio has come about from individual states legislating after pressure from nursing orginizations. I'm wondering if there is another way?

Our professional groups here (ANA and AACN) are very timid on this issue.

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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

I work on an ICU step down that the hospital has not "coded" as an ICU step down so they do not have to follow ICU step down ratios. We are technically labelled as a telemetry floor but that is sooo not what we are. We have stable vent patients and generally during the day the ratio is 1:3 if you have a vent and 1:4 at night. But there have been day shift RNs who have been assigned 1:4. I think 1:4 with an a stable vent is doable at night, depending on the acuity of your other patients and also how good of a nursing assistant you have as they often require a complete bath, q2 hour turning etc! Trach care and all of that takes me about 10 minutes, so that is not bad at all. We also have respiratory therapists who really are "in charge" of the vent and are excellent resources.

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Specializes in IMCU.
All "ICU" patients are 1:1. All "HDU" patients will be 1:2 (what constitutes ICU and HDU is another story) ALL ventilated pt's are 1:1. Always.

Staffing here (like any ward) is an issue but we deal with it as best we can. We do overtime (only if we want to) and have an on-call roster to help cover retrievals. If we cant staff the unit, Nursing Admin will get us staff (sometimes very reluctantly!) or some poor bugger from the ward will get flicked up to us. The casuals/ward staff will have HDU patients and core ICU staff will staff your vents/critically ill patients.

That being said, I work in a public hospital in a regional area in Australia, a very different system to that of the US (from my understanding). Our Management do give a damn (they know its on their head if we cant staff). Just last night (while i was doing my arvo/night double!) i had to forward a call onto the Team Leader from an irate anaesthetist who accused her of putting patients lives in danger by not having a bed for a post-op, and subsequently tried to lecture her on the state of the health care service. Do the maths mate, all 12 beds full = no more space for anyone. We ended up having to push a pt that wasn't really wardable up to the wards at 3am to get this post-op (now you tell me that accepting that ICU patient and therefore pushing the "ward" pt out isn't putting their life at risk?)

needless to say, i don't ever see myself entering into management :nuke:

Do you have respiratory therapists or do you do all your respiratory treatments? I work in IMCU with 3 patients which can be 3 vented patients but we do have a respiratory therapist available who does the respiratory meds and trouble shoots any problems with the vents.

Thanks,

Mahage

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Specializes in ICU, Education.

Yeah.... here in the US ventilated patients do not warrant 1:1 nursing. I have even gotten crumping patients that required intubation, max prressors, scanning, lining, etc. and had a 2nd patient... ONly lifeline for me was when thay needed CRRT and then I could officially make them 1:1 per hospital policy (even though they should have been 1:1 all along)

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Specializes in ICU/CVU.

For us it is usually 2:1 with an occasional triple, but that is rare. R/T handles all resp meds for vents.

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It's usually 1:2 unless the patient is severely critical - then 1:1

The MICU step down unit is 1:2 as well, but they are generally the ICU overflow.

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Specializes in MICU.

In our MICU we have 2:1 ratio. Patients become a 1:1 if they are on CVVH or extremely busy i.e. the nurse is so busy she can not even leave the room to use the restroom or answer a phone call.

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Specializes in ICU Nursing.

Our norm is 1 RN: 2 patients. Sometimes we have a 1:1 (a really critical, difficult patient or IABP, post-CABG, etc.). It's rarely 1:3...and if you have three patients they are SAC patients.

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Specializes in CVICU.
To those of you who report strict 1:2 RN/pt ratios, how does your unit handle the situation where there are no step down/general beds available, so ICU pt's are "stuck" in ICU, although being billed at the appropriate (i.e. stepdown) rate? This has happened with some degree of regularity recently, so the OOU pt's that are written out with or without tele/pulse ox are "stuck" in ICU until beds open up elsewhere. We have actually discharged patients directly from the ICU home (although rarely) because of this. I am curious to know how other units handle this, perhaps there may be something to pass on!

This happens all the time on my unit. It sucks, especially when you consider that a typical ICU room doesn't have things like a regular toilet, a shower, or many of the other things a "normal" patient wants. Plus, I get bored when I'm stuck with a patient with transfer orders... :p

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Specializes in CVICU.

A typical staffing ratio is 1:2, 1:1 with citrate SLED/extremely critical, and 2:1 with ECMO going.

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