ICU nurses, Is 3:1 patient to nurse ratio a common occurence or am I just tripping?

[Scrubs911]

Hi. I'm a relatively new nurse in a general ICU (we get a variety of patients). Considering the shortage of jobs for new nurses, I'm very grateful I found a job in an area of nursing that I find interesting albeit challenging. When I interviewed for the job, I was told that the Patient:Nurse ration was 2:1, and very rarely would a nurse have 3 patients. Well as it turned out, 3:1 is the norm on the unit (we're chronically understaffed) as I've seen more nurses tripled than doubled on any given day. Is that the norm in ICUs? Or is it just because we're a general ICU? I personally think it's dangerous because there is no way a nurse can be in 3 rooms at a time, and inevitably, one or more patients receive less than optimum care, especially if one of the three patients is more critical than the others. I worry about liability should something go wrong on the nurses' watch (more like the absence of it). Should I be concerned about this or is this the way things are in most ICUs?

PS: It's insane that nursing units across the country are so understaffed (putting more stress and workload on the nurses especially the more experienced ones) while thousands of nurses, new and old, remain without work.

[CrufflerJJ, BSN, RN, EMT-P]

Sounds scary to me. 2:1 is the norm in my ICU, 1:1 if the pt is very unstable. 3:1 is rare.

[SummerGarden, BSN, MSN, RN]

yes, you are trippin (i am being sarcastic)! there are even more then that on med surg and in the er. i know, you mean icu in theory... however some of your brothers and sisters are working on crazy units and have 6-8 patients (med surg) or 4-5 patients (er), where 1-2 of them should be in the icu because their condition is serious and unstable! so, an icu nurse with 3 patients does not surprise me. is it dangerous? yep!!! but not a surprise … there is a nursing shortage you know…. at least that is what our managers and the media say!!

[Scrubs911]

Thanks for the responses.

I understand that other units have higher pt:nurse than we do, and in no way do I attempt to minimize the work other nurses do. I just wanted to focus on the ICU setting (since that is where I work) and not compare settings because that could lead to needless arguments that could go on forever. I hope you understand.

[SummerGarden, BSN, MSN, RN]

thanks for the responses.

i understand that other units have higher pt:nurse than we do, and in no way do i attempt to minimize the work other nurses do. i just wanted to focus on the icu setting (since that is where i work) and not compare settings because that could lead to needless arguments that could go on forever. i hope you understand.

i was not trying to start an argument. i was trying to make a point. in theory icu nurses are to have only two patients and having more is not suppose to be normal. however, in practice managers get away with giving nurses who care for patients with serious conditions more then a 2:1 ratio. that is my point.

last week i had an icu admit who was in serious condition. when er nurses have them we are to be treated like we are icu nurses and are to stay at a 1:2 ratio and no more. my night charge and triage thought i could also take a new chest pain patient for r/o and a low acuity patient as well. it turns out the low acuity patient was not low acuity and so i ended up having two serious condition patients and a medium acuity patient.

when i worked med surg i floated icu. the charge in the icu i floated got away with giving me 4-5 patients on days because those patients were considered "ready for the floor". well, some patients in this condition are still serious but they are labeled "guarded". when i worked step-down i got 5 patients (no matter what) who were recent open hearts. again i had unstable patients with unstable rhythms that imo should have remained in the icu at least one more day prior to being admitted to the floors... it all boils down to how the charge nurse and the doctors "lable" the patient. we the staff nurses have little to no say.

[Scrubs911]

i was not trying to start an argument. i was trying to make a point. in theory icu nurses are to have only two patients and having more is not suppose to be normal. however, in practice managers get away with giving nurses who care for patients with serious conditions more then a 2:1 ratio. that is my point.

last week i had an icu admit who was in serious condition. when er nurses have them we are to be treated like we are icu nurses and are to stay at a 1:2 ratio and no more. my night charge and triage thought i could also take a new chest pain patient for r/o and a low acuity patient as well. it turns out the low acuity patient was not low acuity and so i ended up having two serious condition patients and a medium acuity patient.

when i worked med surg i floated icu. the charge in the icu i floated got away with giving me 4-5 patients on days because those patients were considered "ready for the floor". well, some patients in this condition are still serious but they are labeled "guarded". when i worked step-down i got 5 patients (no matter what) who were recent open hearts. again i had unstable patients with unstable rhythms that imo should have remained in the icu at least one more day prior to being admitted to the floors... it all boils down to how the charge nurse and the doctors "lable" the patient. we the staff nurses have little to no say.

thank you for clarifying your post mbarn08. i get what you're saying and you're right, what should be in theory is hardly ever what is in practice. thank you for sharing your experience.

[NickiLaughs, ADN, BSN, RN]

I live in California, so the ratio law is 1:2. There was only one night, one time where a few nurses had a triple assignment, and of those few, they all had a New grad training with them. Union was called and the facility reported. That was the only time it ever occurred. That is the plus side of a Union.

[Bec717]

1:1 or 2:1 @ our facility!

[Woodenpug, BSN]

A clarification question. Does ICU mean patients who require invasive monitoring? I have worked ICU's where no patients were on any type of invasive monitoring. I have worked PCU's where most patients had central line monitoring but no PA lines. It seems that if a unit is called ICU the staffing is 1:2-3 and if it's called PCU the staffing is 1:3-5, without any real reguard to the acuity of the patients.

[stewiegriffin]

Usually 1:1 and sometimes 1:2 at my place.

1:3 just does not sound safe.