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 critical care/ Hospice.

Normally 1:2. With a critical unstable 1:1. But there have been nights due to staffing where the ratio 1:3. No one is happy with that but no one does anything about it! (I mean Nursing Adm when I say no one does anything).

Then there is the ISSUE of our Stepdown unit. This stupid unit was created as our CCU census was basically null. So our manager CREATED the stepdown unit to maintain staffing. Unfortunately stepdown has become synonomous with DUMPING. We get all the high risk surgical patients, aka elderly trainwrecks that no surgeon with a conscious would operate on normally. High dementia #'s, multiple co-morbidities, drug abusers. Here ratio is 1:3. Their 24hr stay often turns into 3 days.We also get "tele holds" from the ER when there are no beds. You should see their faces when we tell them there are no BATHROOMS in ICU/SSD. They would have been better off staying in the ER.:madface:

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at my facility they like to pull icu nurses all over the hospital to cover for call ins and leave us short 90% of the time, the other night i had a fresh open heart been out of the OR less than an hour and 2 other pts. another nurse had a patient on CRRT and Balloon Pump and had to take another patient while they floated 2 of our nurses out becuse another floor didnt staff enough for the weekend. if things dont change im outa their in a few weeks do to not wanting to risk my license anymore.....

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Specializes in critical care/ Hospice.

Floating USED to be a real issue with us too. They did the same to us, icu nurses, float us to cover call-ins and leave us short....but when people started leaving and in their exit interviews, all were complaining about floating, and no one ever floated into ICU to help us. The DON actually listened and we no longer can be made to float, but we can VOLUNTEER to float if we want,LOL....needless to say floating has stopped from the ICU.Try and organize a meeting with the DON ans see if you can accomplish anything...goodluck.:typing

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Specializes in CVICU, CCU, MICU, SICU, Transplant.
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!

In one of the places I worked, we had a method of "billing" the non ICU patients differently than the true ICU pt's. The ICU vs non ICU charge was entered every day in our computer system by our secretary. Of course if they were being billed as a non ICU player, then we treated them as such (vitals q4hrs, I/O once at the end of the shift, if transfer orders were for a med surg unit and no tele then the bedside monitor was turned off until we needed to do vitals, etc).

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Specializes in trauma, neuro, cardiovascula.

all our ICU's are typically 1 RN to 2 patients, however those that are unstable are 1:1.

our open heart patients are 1:1 until extubated or hemodynamically stable which can be up to 6 hours post op.

if patients have transfers to step down or general floors with no available bed, we go with their standards or assessments which are every 4 hours for step down and every 8 for genereal floor. so....if we have those types of patients we may have a RN to 3 patient ratio.

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Specializes in Author/Business Coach.

On the assignment I'm currently on the norm is 2:1, but it seems as if we're getting "tripled" more often. I was told the Director of the unit doesn't care and has even told the House Supervisor the ICU nurses can be tripled...no big deal to her. I think its completly unsafe and many people will get fed up and leave. I'm sure not staying for another 13 week contract.

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Specializes in Mixed Level-1 ICU.

"I'm sure not staying for another 13 week contract."

Good for you, get out of there before your career is bashed by the age-old management excuse, "Well, no one told us what was really happening."

CYA 'cause when the third pt extubates himself and dies they'll be all over you and your lack of "judgment."

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Specializes in critical care/ Hospice.
"I'm sure not staying for another 13 week contract."

Good for you, get out of there before your career is bashed by the age-old management excuse, "Well, no one told us what was really happening."

CYA 'cause when the third pt extubates himself and dies they'll be all over you and your lack of "judgment."

Good for you....and document in your nurse notes the same. When I have been stretched, i.e. 3 ICU neuro pt's believe me my notes document- no AM care due to high pt load and acuity, or labs not drawn for same. Let the day shift do it as they have a tech and full staff.

I will say my favorite assignment is 2 vented pt's with sedation...no call bell, or obnoxious calls for fluffing of pillows like you get in stepdown!:bowingpur

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Specializes in Med Surg, ER, OR.
at my facility they like to pull icu nurses all over the hospital to cover for call ins and leave us short 90% of the time, the other night i had a fresh open heart been out of the OR less than an hour and 2 other pts. another nurse had a patient on CRRT and Balloon Pump and had to take another patient while they floated 2 of our nurses out becuse another floor didnt staff enough for the weekend. if things dont change im outa their in a few weeks do to not wanting to risk my license anymore.....

Even as a miniscule student, I know well enough that this is definitely NOT SAFE! I am sorry that you had to put up with this because this should not be tolerated at all! Open hearts need to be 1:1 until stable then can be advanced to 1:2

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Specializes in Cardiac & ICU.

I work in small hospital. We have 12 ICU beds, 4 PINS (Post Intensive Nursing Services) beds, 48 M/S (tele available) beds, plus L&D and ED. This past weekend was bad. At one point we had 11 patients and 4 nurses - and no tech. You do the math. Unfortunately, having 3 patients has become too common. I do the best that I can with what God gave me. It's all about prioritizing.

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Specializes in Author/Business Coach.

The sad part about it is that I work on the day shift. It takes long enough to do things the way they chart there (ancient Meditech system). They're constently short and we have a lot of Nursing Home pts with tons of meds. They don't have CNA's on the unit because they say we're not busy enough. No one helps. It sucks!

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Specializes in Critical Care Baby!!!!!.

ok nurses hold on to your hats for this one!!! the hospital that i left is currently staffing nurses 4:1!!! can you believe this! hence, why i left! i just spoke with a nurse that still works in that unit and she told me a horrific story....so here it goes!

the unit had 20 patients in it the other night. there were 5 nurses scheduled. they called the manager and said we are way understaffed you are going to have to come in and take patients, it is unsafe. his response.....i work 12 hours days i am not coming in you are going to have to make it work. now it's my impression that as a manager you have 24 hour accountability correct?

so, since he refused to come in, the nurses were left with 4 icu patients a piece. later that night an obese patient had a bowel movement, a very large bowel movement. it required at least 4 nurses to help turn and clean the patient. however, all 5 nurses went into this room. that left the nurse's aid out on the unit alone to watch monitors and patients. anyhow, one of the patients that was in the unit had a knee replacement and developed pulmonary edema. he had received lasix but had not responded well and was placed on bipap. to make a long story short, the aid heard the alarm going off on the bipap and went into the patient's room. there she found the bipap mask and the patient hanging over the side rail. the patient was dead!!!!!! all the nurses that were scheduled that night were in the room attending to the man who had the huge bowel movement and no one was left to watch monitors or alarms, except an aid who was not qualified to do so.

now why the aid was not in the room and nurse was left on the floor i will never know, but the point to all of this is the safety issue involved with a nurse taking 4 icu patients. three patients is becoming the norm more and more. next is 4 patients. where do we draw the line? we as nurses need to refuse assignments such as these and stick together to ensure patient safety. after all we are our patients greatest advocates! i love nursing but we seriously need some changes to occur and fast. people should not be dying due to staffing issues. i am willing to bet this is not the first story of its kind.

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